Brenda Spriggs, MD, MPH, MBA
Each year about 20,000 women in the United States are newly diagnosed with ovarian cancer, reports the Centers for Disease Control and Prevention. According to the American Cancer Society, ovarian cancer is the most common cause of death among all cancers affecting a woman's reproductive system. Most ovarian cancers are due to cancer of epithelial cells, which are located on the surface of the ovary. Ovarian cancers range in severity from early, Stage I cancer and to Stage IV, or end-stage, cancer. In this last stage, ovarian cancer spreads beyond the ovaries to enter the liver, spleen or distant parts of the body. These metastases may produce various symptoms, including a swollen abdomen and symptoms due to blockage of the intestines.
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A buildup of fluid in the abdomen -- known as ascites -- occurs when ovarian cancer cells spread to the peritoneum. The peritoneum is a thin layer of tissue that lines the inside of the abdominal cavity. As fluid collects, the abdomen becomes swollen. Gallons of fluid may accumulate in end-stage ovarian cancer, causing severe abdominal swelling. Other symptoms may also occur as the fluid presses on abdominal organs and the diaphragm -- the large muscle separating the chest from the abdomen. These include abdominal pain, loss of appetite, nausea, vomiting or shortness of breath.
Ovarian cancer cells may spread to the surface of the intestines, where they can produce scar tissue called adhesions. These adhesions can cause loops of intestines to bind together. This impedes the movement of food and fluid through the intestines, causing partial or even complete blockage. Cancer cells may also grow directly into the intestines, producing blockage. Intestinal blockage leads to abdominal swelling and pain, loss of appetite, nausea, vomiting, weight loss, fatigue and constipation. According to an article published in the July-August 2004 edition of the "Journal of Supportive Oncology," intestinal blockage is the leading cause of death in women with ovarian cancer.
Other Metastases Symptoms
End-stage ovarian cancer may spread to a number of other areas. When it enters the liver, the resultant liver metastases can press on the diaphragm, producing pain and shortness of breath. Spread to the lungs or pleural space surrounding the lungs can cause chest pain and shortness of breath. Ovarian cancer in the bone causes severe bone pain and brain metastases may lead to various symptoms, such as headaches, seizures, confusion or muscle weakness. Lymph nodes run throughout the body. When ovarian cancer cells spread to lymph nodes, the resultant growths press against organs in the area, interfering with their normal function.
Like the final stages of other cancers, end-stage ovarian cancer produces generalized symptoms. These typically include worsening fatigue, generalized weakness, loss of appetite and weight loss.
Reviewed by: Mary D. Daley, MD
REFERENCES & RESOURCES
- Obstetrics and Gynecology: Symptoms of Ovarian Cancer
- Cancer: Ovarian Carcinoma Diagnosis
- JAMA: Frequency of Symptoms of Ovarian Cancer in Women Presenting to Primary Care Clinics
- Cancer: Development of an Ovarian Cancer Symptom Index: Possibilities for Earlier Detection
- Journal of the National Cancer Institute: Predictive Value of Symptoms for Early Detection of Ovarian Cancer
- Cancer: The Search for Meaning -- Symptoms and Transvaginal Sonography Screening for Ovarian Cancer: Predicting Malignancy
- Journal of the National Cancer Institute: Re: Predictive Value of Symptoms for Early Detection of Ovarian Cancer
- Clinical Obstetrics and Gynecology: Symptoms Associated With Ovarian Cancer
- American Cancer Society: What Are the Key Statistics About Ovarian Cancer?
- Journal of Supportive Oncology: Pathophysiology and Palliation of Inoperable Bowel Obstruction in Patients With Ovarian Cancer
- Centers for Disease Control and Prevention: Ovarian Cancer Facts
- Cass I, Karlan BY. Ovarian cancer symptoms speak out--but what are they really saying? Journal of the National Cancer Institute. Feb 24 2010;102(4):211-212.