Ovarian cancer can affect hormone levels, but this effect is not universal; it depends entirely on the specific cells that form the tumor. Ovarian cancer is the malignant growth of cells originating in the ovaries, which produce eggs and sex hormones like estrogen and progesterone. While most ovarian cancers do not produce hormones, a small subset of tumors originates from the hormone-producing cells. This distinction influences the symptoms a person experiences and the specialized testing required.
The Endocrine Activity of Ovarian Tumors
The ovaries are complex organs containing several cell types, including the ovarian surface epithelium, germ cells, and sex cord-stromal cells. The normal ovarian stroma is composed of specialized cells that naturally produce steroid hormones, such as estrogen, progesterone, and androgens. When certain types of cancer develop, they can retain or mimic this steroid-producing capability, essentially becoming functional endocrine organs themselves. This hormonal activity occurs because the tumor cells originate from or differentiate into these steroid-producing stromal cells. The tumor then secretes large, unregulated amounts of sex steroids directly into the bloodstream, leading to a hormonal imbalance.
Ovarian Cancer Subtypes Linked to Hormone Production
Ovarian cancers are classified into three main groups: epithelial, germ cell, and sex cord-stromal tumors, with the latter group being the primary source of hormone-related activity. Epithelial tumors, which arise from the cells covering the outer surface of the ovary, account for 80 to 90% of all ovarian malignancies, but they typically do not produce significant levels of hormones. Sex cord-stromal tumors are rare, making up less than 10% of all ovarian malignancies, but they are the ones most frequently associated with endocrine disruption. Granulosa cell tumors, the most common hormonally active type, typically produce excessive amounts of estrogen. Sertoli-Leydig cell tumors produce androgens, leading to symptoms of masculinization.
Physical Signs of Hormone Disruption
When a tumor produces excessive estrogen, the resulting physical signs are related to hyperestrogenism, or the presence of too much estrogen. In premenopausal women, this can manifest as abnormal uterine bleeding, heavy or irregular menstrual periods, or breast tenderness and swelling. For postmenopausal women, the most notable sign is postmenopausal bleeding. Conversely, tumors that secrete high levels of androgens lead to hyperandrogenism, causing female patients to develop male-associated characteristics. Symptoms can include hirsutism, acne, oily skin, a deepening of the voice, male-pattern hair loss (alopecia), and sometimes an increase in muscle mass or a loss of female body contour; the rapid onset and progression of these symptoms are highly suggestive of an androgen-secreting tumor.
Hormone Testing in Diagnosis and Monitoring
When a hormone-producing ovarian tumor is suspected based on the physical signs of hormone excess, blood tests are utilized to measure specific hormone levels. For tumors that secrete estrogen, testing for high levels of estradiol may offer an initial clue, but specialized markers are often more definitive. The hormone inhibin, which is normally produced by ovarian cells, is a particularly useful tumor marker for detecting and monitoring Granulosa cell tumors. In cases of suspected androgen-secreting tumors, a blood test for total and free testosterone is generally performed, with very high levels pointing toward a tumor as the source. After a hormonally active tumor is surgically removed, these baseline hormone levels or tumor markers are then used for monitoring, as a subsequent rise in an elevated marker serves as an early indicator that the cancer may have recurred.