The ovary sits at the rim of the pelvis underneath the fallopian tube and attached to the uterus by a short ligament.The ovary has two major functions. The first being to provide the egg for ovulation, and the second to produce the steroid hormones necessary for growth of breasts and the uterus so that a pregnancy can be achieved.There are three types of cancers of the ovary, each arising from a different cell.The most common type is epithelial cancer; less commonly occurring are germ cell tumours that are more common in younger womenRarest of all are tumours of the hormone-producing tissue within the ovary - 'sex cord-stromal tumours'. Epithelial ovarian cancer arises from the single layer of cells that cover the surface of the ovary. Medical scientists believe that when this single layer of cells is broken at the time of ovulation, a defect in the repair mechanism that heals the break occurs and eventually a cancer develops. This explains why cancers of the ovary are significantly less common in women who use the oral contraceptive — which stops ovulation - and in women who have had pregnancies since the total number of ovulations is reduced with the more number of pregnancies women has. In about 5% of cases, a strong family history is found and a gene mutation responsible, but in the remaining 95% of cases there is usually no reason as to why the cancer has occurred.Because the ovaries sit in the pelvis surrounded by bone and reasonably well away from other important body parts, cancer of the ovary can grow to quite a size before symptoms appear. Thus, in over three-quarters of cases the tumour has already spread outside the pelvis to other areas of the abdomen and the diagnosis is therefore delayed. It is often associated with vague symptoms which may mimic other benign and much more common diseases. It has been estimated that up to 24 months can go by before the cancer becomes detectable in its advanced stage.If cancer of the ovary is not treated early enough, it spreads to other areas and other organs within the abdominal cavity, particularly the bowel and lymph nodes. Bowel obstruction is common and pain due to lymph node enlargement can also be a feature in advanced cases. Fluid accumulation ('ascites') in advanced cancer of the ovary is very common indeed. This can lead to major abdominal swelling and often requires drainage, with a resultant loss of protein that in turn can lead to leg swelling.Just as fluid can accumulate within the abdominal cavity, if the disease spreads along the lymphatic and up through the lymph channels in the diaphragm to the pleura (the lining of the lungs), then fluid can accumulate in the space between the lining of the lungs and the lung tissue itself ('a pleural effusion'). This may require surgical drainage in many cases. If fluid accumulates in the chest, breathlessness can be a major problem.Germ cell tumours arise in cells in the ovary, which were destined to be part of the egg. Germ cell tumours are more likely to occur in younger women and they can be benign ('a dermoid') or malignant ('a teratoma'). The most common sort of germ cell tumour is the 'dysgerminoma which often spreads to the lymph glands and which is the only germ cell tumour which commonly affects both ovaries at the one time - in about 10-15% of cases.The average age of detection of such malignant germ cell tumours is 19 years. In most cases the diagnosis is made following pelvic pain and discomfort, when examination reveals a lump that can be easily felt in the lower part of the abdomen.If this cancer is not treated it can spread to the other organs within the pelvis and abdominal cavity, just as in epithelial tumours. Fortunately, these tumours are very sensitive to chemotherapy and every attempt is made by the doctor to preserve fertility by leaving at least one ovary intact during surgery.Sex Cord-Stromal Tumours are rarely malignant, except the granulosa cell tumour. The granulosa cells in the ovary are responsible for oestrogen production, so that such a tumour can present with the effects of excess oestrogen. For instance, in girls who have not reached puberty, breast development and vaginal bleeding can occur, whereas in the older women, bleeding following menopause may be the symptom.Since most of these tumours are benign, then simple removal of the tumour prevents any recurrence. For the malignant tumours, however, spread to the liver can occur, and left untreated it can result in liver enlargement with resultant pain under the right diaphragm. Sometimes bleeding into these tumours can happen with a sharp and sudden increase in pain.*5/144/5/*
