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personal history of breast cancer or colon cancer. Ovarian cancer seems to be related to the number of times a woman ovulates during her lifetime, with the risk of the disease lower in women who have ovulated less, such as women who have taken birth-control pills. For this reason, women who have never had children (and, therefore, never had a 9-month break from ovulation) and women who have taken fertility drugs (which stimulate ovulation) may be at increased risk. Conversely, women who have taken birth-control pills (and, therefore, have ovulated fewer times) have a significantly lower risk of developing ovarian cancer than other women.

Symptoms

Ovarian cancer often produces no symptoms until late in its development. Eventually, it may cause lower abdominal pain or discomfort, including gas, indigestion, swelling, bloating, or cramps. The first sign may be the feeling that your clothes are getting tighter around your waistline for no obvious reason. Appetite loss, frequent urination, and nausea accompanied by diarrhea or constipation are common. You may also have a feeling of fullness even after light meals.

Diagnosis

Ovarian cancer is difficult to detect in its early stages because the ovaries lie deep inside the pelvis and initial symptoms are vague. If you have any symptoms of ovarian cancer, or if you have a family history of breast cancer or ovarian cancer, your doctor will order an ultrasound to examine your ovaries. If the ultrasound shows multiple cysts on your ovaries, or solid growths containing abnormal tissue (which could indicate cancer), the doctor will do further tests. A blood test that measures the levels of a substance called CA-125 (CA stands for cancer antigen), which is found in high amounts in women with ovarian cancer, can be useful in detecting the disorder in women who are past menopause. In younger women, mildly elevated levels of CA-125 can be present in many noncancerous conditions such as fibroids (see right), endometriosis (see page 870), or pelvic inflammatory disease (see page 871).

Sometimes doctors use a series of X-rays of the colon and rectum (a lower GI series; see page 767) or a CT scan (see page 112) to detect ovarian cancer.

Treatment

If tests detect ovarian cancer, surgery is usually necessary to remove both ovaries, the fallopian tubes, and the uterus (hysterectomy; see page 870). Any cancerous tissue inside the abdomen that may have spread from the ovary and affected lymph glands will also be removed to make sure that no cancer cells remain. Chemotherapy (see page 23) is usually given to kill cancer cells throughout the body and prevent the cancer from recurring or slow its progression (if it has already begun to spread). In rare cases, radiation therapy (see page 23) is used to destroy localized areas of cancer. Blood tests are performed periodically to monitor the effects of the chemotherapy. Any fluid from the tumor that collects in the abdomen can be drained from time to time. The outlook for survival depends on the stage of the disease at the time of diagnosis—generally, the earlier the stage at diagnosis, the better the survival rate. Receiving treatment from a doctor who specializes in gynecologic cancers (called a gynecologic oncologist) can significantly improve a woman’s chances of survival.

Some women who are at high risk of ovarian cancer choose to have their ovaries removed before cancer develops. This procedure usually—but not always—protects a woman from ovarian cancer.

Fibroids

A fibroid (also called a myoma) is a benign (noncancerous) tumor in the uterus that can grow large but is unlikely to spread. The tumor develops either inside the muscular wall of the uterus or on the uterine wall, sometimes attached to the wall by a stalk of tissue. Some fibroids take many years to grow to the size of a pea, while others may reach the size of a grapefruit within a few years.

Fibroids are common—up to 30 percent of women over age 30 have them. Fibroids seldom occur before age 20 and are most common between ages 35 and 45. If you have one fibroid, you are