Overview

 

Ovarian cancer is a cancer that starts in the ovaries and spreads throughout the body. Two ovaries, one on each side of the uterus, make up the female reproductive system. Each ovary, about the size of an almond, produces eggs (ova) as well as oestrogen and progesterone hormones.

Ovarian cancer is frequently misdiagnosed until it has spread throughout the pelvis and abdomen. Ovarian cancer is more difficult to treat at this stage. Early-stage ovarian cancer, which is limited to the ovary, is more likely to be successfully treated.

Ovarian cancer is typically treated with surgery and chemotherapy.

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Symptoms :

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Ovarian cancer in its early stages rarely causes any symptoms. Advanced-stage ovarian cancer can present with a variety of symptoms that are easily confused with more common benign conditions. The following are some of the signs and symptoms of ovarian cancer:

 

• Bloating or swelling in the abdomen

• Feeling full quickly after eating

• Loss of weight

• Discomfort in the area of the pelvis

• Constipation or other changes in bowel habits

• Urination problems on a regular basis

 

Talk to your doctor about your risk of ovarian cancer if you have a family history of ovarian cancer or breast cancer. Your doctor may refer you to a genetic counsellor to discuss gene mutation testing for breast and ovarian cancer risk. 

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Causes:

Although doctors have identified factors that can increase the risk of ovarian cancer, it is unclear what causes it.

In general, cancer begins when a cell's DNA becomes faulty (mutated). The mutations cause the cell to grow and multiply rapidly, resulting in a mass of abnormal cells (tumor). When healthy cells die, abnormal cells continue to live. They can infiltrate nearby tissues and break away from a primary tumor, spreading to other parts of the body (metastasize).

 

Ovarian cancer comes in a variety of forms. The type of ovarian cancer you have is determined by the type of cell where the cancer starts. Types of ovarian cancer include:

 

• Epithelial tumors start in the thin layer of tissue that covers the outside of the ovaries and grow from there. Epithelial tumors make up about 90% of ovarian cancers.

• Stromal tumors are cancerous tumors that start in the ovarian tissue, which contains hormone-producing cells. These tumors are typically detected earlier than other ovarian tumors. Stromal tumors make up about 7% of all ovarian tumors.

• Germ cell tumors are cancers that start in the cells that produce eggs. Younger women are more likely to develop these rare ovarian cancers.

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Risk Factors:

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Ovarian cancer can be caused by a number of factors, including:

 

1) Age - Ovarian cancer can strike at any age, but it is most common in women between the ages of 50 and 60.

 

2) Gene mutations that are passed down through the generations. Ovarian cancer is caused by a small percentage of gene mutations that you inherit from your parents. Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are two genes linked to an increased risk of ovarian cancer (BRCA2). Breast cancer is also increased by these genes.

Other gene mutations, such as those linked to Lynch syndrome, have been linked to an increased risk of ovarian cancer.

 

3) Ovarian cancer runs in the family. Ovarian cancer is more likely in people who have two or more close relatives who have the disease.

 

4) Estrogen hormone replacement therapy, particularly when used for a long time and in high doses.

 

5) Menstruation  Ovarian cancer risk may be increased by starting menstruation at a young age or starting menopause later in life, or both.

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Prevention:

Ovarian cancer cannot be completely avoided. However, there may be ways to lower your risk. Take birth control pills if you're thinking about it. Consult your doctor to see if birth control pills are appropriate for you. Oral contraceptives may lower the risk of ovarian cancer in women. Oral contraceptives do have risks, so talk to your doctor about whether the benefits outweigh the risks in your situation.

 

Consult your doctor about your risk factors. Inform your doctor if you have a family history of breast and ovarian cancers. Your doctor can tell you what this means for your own cancer risk. In some cases, your doctor may refer you to a genetic counsellor who can advise you on whether or not genetic testing is appropriate for you. If you have a gene mutation that increases your risk of ovarian cancer, you may want to consider having your ovaries removed to avoid cancer.

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Diagnosis:

The following tests and procedures are used to diagnose ovarian cancer:

 

• Pelvic examination - During a pelvic exam, your doctor presses a hand on your abdomen while inserting gloved fingers into your vagina to feel (palpate) your pelvic organs. Your external genitalia, vagina, and cervix are also visually examined by the doctor.

• Imaging examinations. The size, shape, and structure of your ovaries can be determined using tests such as ultrasound or CT scans or MRI of your abdomen and pelvis.

• Tests on the blood. Organ function tests may be included in blood tests to help determine your overall health. A blood test for tumor markers that indicate ovarian cancer may be ordered by your doctor. A cancer antigen (CA) 125 test, for example, can detect a protein commonly found on the surface of ovarian cancer cells. These tests will not tell your doctor if you have cancer, but they may provide information about your diagnosis and prognosis.

• Surgery. Your doctor may not be able to be certain of your diagnosis until you have surgery to remove an ovary and have it tested for cancer signs.

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Staging:

Doctors use the term "staging" to describe a tumor's size and location. This includes when and where it began, whether it has spread, and where it is now. Doctors determine your stage of ovarian cancer by testing tissue samples from various parts of your pelvis and belly.

 

This information aids your doctor in determining the best treatment option for your cancer. The staging must be extremely precise. If you don't, a cancer that has spread beyond your ovaries may go undetected. Some medical groups may use a slightly different staging system. The International Federation of Gynecological Oncologists' FIGO system is a widely used staging system:

 

1) Stage one

This is the stage of ovarian cancer that is the least advanced. It means you only have cancer in your ovaries. This group includes the following individuals:

 

Stage IA: Cancer has only spread to one ovary.

 

Stage IB: Cancer has spread throughout both ovaries.

 

Cancer has spread to both ovaries at stage IC. In addition, one of the following has occurred:

 

Stage IC1: Cancer cells have leaked into your belly or pelvic area during surgery to remove your tumour.

 

Stage IC2: Before surgery, cancer on the outer surface of one of your ovaries or a fluid-filled tumour has burst, spilling cancer cells into your belly.

 

Stage IC3: Cancer cells have been discovered in fluid from your abdomen or pelvis as a result of lab tests.

 

2) Stage Two

Cancer hasn't spread to your lymph nodes or distant organs, but it has spread to organs near your ovaries.

 

Cancer has spread to your uterus, fallopian tubes, or both.

 

Stage IIA: Cancer has spread to your uterus, fallopian tubes, or both.

 

Stage IIB: Cancer has spread to pelvic organs such as the bladder, colon, or rectum.

 

3) Stage Three :

Cancer has spread to your stomach lining, lymph nodes behind your belly, or both, in addition to nearby organs like your uterus and bladder.

 

Stage IIIA1: Cancer has spread to nearby lymph nodes and is likely to spread to nearby organs.

 

Stage IIIA1(i): Your lymph nodes have cancer that is less than 10 millimetres (mm) in diameter.

 

Stage IIIA1(ii): Your lymph nodes have cancer that is larger than 10 mm.

 

Stage IIIA2: Tiny cancer deposits that  can be seen only with a microscope in your stomach lining. It's possible that cancer has spread to nearby lymph nodes.

 

Stage IIIB: During surgery, your doctor discovered cancerous growths in your stomach that are less than 2 centimetres (cm) in diameter. They could also be in your lymph nodes and outside of your liver and spleen.

 

Stage IIIC is similar to Stage IIIB, except your doctor will see cancer growths that are larger than 2 cm.

 

4) Stage Four:

This is the most advanced stage, and it indicates that your cancer has spread to other organs.

 

Stage IVA: Cancer cells are present in the fluid surrounding your lung, but the cancer has not spread to any other parts of your body other than your abdomen and pelvis.

 

 stage IVB: Your skin, lungs, or brain could all be affected.

 

Consult your doctor to learn more about your stage and how it affects your treatment and prognosis. If you're feeling perplexed, anxious, or depressed, don't be afraid to express your concerns and seek help. You should speak with a counsellor who specialises in cancer patients and consider joining a support group.

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Treatment:

Ovarian cancer is usually treated with a combination of surgery and chemotherapy.

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1) Surgery:

The following procedures are used to remove ovarian cancer:

 

• One ovary is removed during surgery. The affected ovary and its fallopian tube may be removed during surgery for very early stage cancer that hasn't spread beyond one ovary. This procedure may help you keep your childbearing ability.

• Both ovaries are removed during surgery. If both of your ovaries have cancer and there are no other signs of cancer, your surgeon may remove both of your ovaries and fallopian tubes. Because your uterus is left intact, you may still be able to conceive using your own frozen embryos or eggs, or eggs from a donor.

• Both the ovaries and the uterus are removed during surgery. Your surgeon will remove the ovaries, fallopian tubes, uterus, nearby lymph nodes, and a fold of fatty abdominal tissue if your cancer is more advanced or if you don't want to preserve your ability to have children (omentum).

 

Surgical treatment for cancer that has progressed. If your cancer has progressed, your doctor may suggest chemotherapy followed by surgery to remove as much of it as possible.

 

2) Chemotherapy:

Chemotherapy is a drug treatment that employs chemicals to kill rapidly multiplying cells in the body, such as cancer cells. Chemotherapy drugs can be given intravenously or orally. The drugs are sometimes injected directly into the abdomen (hyperthermic intraperitoneal chemotherapy- HIPEC).Chemotherapy is frequently used after surgery to eliminate any remaining cancer cells. It's also a good idea to use it before surgery.

 

3) Therapy that is specific to the patient:

Targeted therapy is a type of treatment that uses medications to target specific vulnerabilities in cancer cells. Targeted therapy drugs are typically used to treat ovarian cancer that has returned after treatment or has become resistant to other treatments. Your doctor may conduct tests on your cancer cells to determine which targeted therapy is most likely to work.

 

 

4) Palliative (supportive) care:

Palliative care is a type of medical treatment that focuses on relieving pain and other symptoms associated with a serious illness. Palliative care specialists collaborate with you, your family, and your other doctors to add an extra layer of support to your ongoing treatment. Palliative care can be used alongside more aggressive treatments like surgery or chemotherapy.

 

People with cancer may feel better and live longer when palliative care is used in conjunction with all other appropriate treatments.

 

A team of doctors, nurses, and other specially trained professionals provide palliative care. Palliative care teams are dedicated to enhancing the quality of life for cancer patients and their families. This type of treatment is provided in addition to any curative or other treatments you may be receiving.

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