Brenda Spriggs, MD, MPH, MBA
According to the American Cancer Society, epithelial ovarian carcinomas comprise 85 to 90 percent of all ovarian cancers. Epithelial cancers involve the cells on the outside or surface of the ovary. Staging of these ovarian cancers begins with Stage I and progresses in severity to Stage IV, end-stage, when spread outside the abdomen occurs. In Stage IV, ovarian cancer spreads to distant parts of the body, or metastasizes, leading to a variety of symptoms.
Ascites, or a buildup of fluid in the abdomen, results from ovarian cancer spreading to the cells lining the inside of the abdominal cavity. These metastatic ovarian cancer cells attach to multiple sites on the abdominal lining and produce fluid that stays in the abdominal cavity.
Patients with ascites accumulate gallons of fluid in the abdomen, which causes severe abdominal swelling. As the abdominal fluid puts pressure on abdominal organs and the diaphragm--the muscle that separates the chest cavity from the abdominal cavity--resultant symptoms include pain, anorexia, vomiting and shortness of breath.
Ovarian cancer cells also spread to multiple places on the surface of the intestine, leading to the formation of adhesions. These surface adhesions, made up of fibrous scar tissue, bind together loops of the intestine. This impedes the normal muscle contractions of the intestines, which propel contents along, and movement slows. Adhesions also produce complete intestinal obstruction, meaning that food and fluid cannot pass. The growth and spread of cancer cells in both the small and large intestine can also lead to blockage of the intestines.
Intestinal obstruction and decreased movement of the bowel content lead to distention and consequent severe abdominal pain. Further symptoms include anorexia, nausea, vomiting, weight loss, fatigue and constipation. In a 2004 publication of the Journal of Supportive Oncology, physicians from the Mayo Clinic report that this type of intestinal obstruction causes death in the majority of women who die of ovarian cancer.
Other Metastatic Symptoms
End-stage ovarian cancer spreads to many organs causing significant and often debilitating symptoms. Ovarian cancer that goes to the liver results in growths on the liver, or liver metastases. These liver metastases put pressure on the diaphragm, leading to symptoms of pain and shortness of breath. End-stage ovarian cancer also spreads to the lungs and to the pleural fluid around the lungs, producing symptoms of pain as well as shortness of breath.
Bone metastases, or ovarian cancer that has spread to the bones and produce growths there, cause severe bone pain. Brain metastases lead to various symptoms, including headache, seizures and muscle weakness.
Lymph nodes run throughout the body. When ovarian cancer cells spread to the lymph nodes, the resultant growths press against body organs and can impeded normal organ function.
Similar to the end stages of other cancers, end-stage ovarian cancer patients suffer generalized symptoms. These include worsening fatigue, anorexia and weight loss.