Ovarian cancer refers to the abnormal growth of cells or uncontrolled division of cells in the ovaries. These abnormal cells multiply rapidly and can spread to the adjoining organs. Ovarian cancer is the fifth most common cancer in women worldwide & the third most common gynaecologic cancer.
Associated Anatomy of Ovarian Cancer
Ovaries (egg-producing part of the female reproductive system)
Ovarian Cancer Epidemiology
Among all cancers affecting the female reproductive system, ovarian cancer ranks the fifth leading cause of death for women.
- A woman risk of developing ovarian cancer is about 1 in 78 during her lifetime.
- Her lifetime risk of dying from ovarian cancer is about 1 in 108.
Risk factors of Ovarian Cancer
These factors increase the risk of developing ovarian cancer
- Older Age: Almost 50% of ovarian cancer cases occur after 63 years of age.
- Inherited Gene mutations or family history of ovarian cancer
- By taking post menopausal hormone replacement therapy
- Being obese
- Females suffering from Endometriosis are at an increased risk of developing ovarian cancer in their later life.
- Never having a full-term pregnancy
- Having children at a late age: Women who have their first pregnancy after 35 have a higher chance of developing ovarian cancer.
- Breast cancer: Patients with a past history of breast cancer seem to have a higher chance of developing ovarian cancer.
- Using ovulation induction drugs for fertility treatment.
- Early age at menarche & late menopause increases the risk of ovarian cancer likely due to an increase in ovulation & in estrogen exposure. Having a risk factor does not mean that you will get ovarian cancer. Conversely, some women who develop ovarian cancer may not have any known risk factor.
Factors that can lower the risk of Ovarian Cancer:
- Pregnancy
- Breastfeeding
- Oral contraceptive pills
- The risk of ovarian cancer decreases in women who undergo bilateral tubal ligation
- Women who have inherited mutations in BRCA 1 or BRCA 2 genes should be advised to consider risk reducing salpingo-oophorectomy (prophylactic surgery to remove both ovaries and tubes) once childbearing is complete.
Symptoms of Ovarian Cancer
When ovarian cancer is in an early stage, it may not cause any symptoms. When ovarian cancer becomes symptomatic, unfortunately, the disease has already spread in the abdomen. The symptoms of ovarian cancer are usually mistaken for other more common conditions of the digestive tract.
Symptoms of ovarian cancer may include:
- Abdominal bloating or swelling: abdominal pain
- Quickly feeling full while eating
- Weight loss
- Discomfort in the pelvic area
- Fatigue
- Back pain
- Sudden change in bowel habits, such as constipation
- Frequent need to urinate
Diagnosis and Tests for Ovarian Cancer
There are some tests and procedures which are used to diagnose ovarian cancer. These may include:
This is done by your doctor to sense (palpate) your pelvic organs. They also visually examine your vagina, cervix, and external genitalia.
Tests, like ultrasound or CT scans of your abdomen and pelvis, may help decide the size of ovarian mass and spread to adjacent or distant organs thereby deciding the stage of cancer.
Ovarian cancer can be detected by tumor markers in the blood. A tumor marker is a biological substance synthesized and released by the tumor or by the host in response to tumor tissue.
Stages of Ovarian Cancer
As soon as you've been diagnosed with ovarian cancer, your doctor will use the results of your tests and procedures to determine your cancer stage. Ovarian cancer can be classified into stages 1 through 4, indicated by the Roman numerals I through IV.
I. - Cancer confined to one or both ovaries
II. - Spread of cancer to neighbouring pelvic tissues
III. Spread of cancer to the upper abdomen and/or abdominal lymph nodes I
V. Cancer spread to other body organs such as the liver or lungs
Types of Ovarian Cancer
Depending on the type of cell where cancer starts, ovarian cancer may be of the following types:
-
Epithelial ovarian cancer:
This is the growth of abnormal cells that starts in the surface layer (covering the ovaries). It is the most common form of ovarian cancer accounting for 90% of malignant ovarian tumors.
-
Germ cell ovarian tumors:
The abnormal growth of tumor starts in the egg cells (germ cells) of the ovaries. These are rare tumours and usually affect girls and young women in their early 30's.
These are uncommon tumours that represent approximately 7% of all ovarian tumours and occur as a result of abnormal growth of the cells in the primitive sex cords or stromal cells.
-
Borderline ovarian tumors:
These are abnormal cell growths or tumors in the tissue covering the ovaries. They are commonly diagnosed at an early stage.
Ovarian Cancer Treatment
The optimal treatment of ovarian cancer requires surgery and systemic treatment with chemotherapy.
Surgery
It is the treatment of choice in almost all the stages of ovarian cancer in which the doctor not only removes the uterus, ovarian and tubes but also the abdominal lymph nodes, omentum (curtain of fat in abdomen) and all the visible diseased deposits in the abdomen.
Chemotherapy
It constits of giving medication dissolved in glucose or saline vacs through veins to kill the cancer cells. Surgery for ovarian cancer is usally always followed by chemotherapy except in highly select substages of stage – I.
Hormone therapy
Uses drugs that block or slow down the effect of oesteogen hormones. This systemic therapy is not generally used to treat epithelial ovarian cancer but is used more frequently to treat ovarian stromal tumors. Hormone therapy is given after surgery and chemotherapy in select cases to prevent the cancer from coming back. Some patients who have already been treated for ovarian cancer in past and now develop recurrent disease can also be candidates for hormonal therapy.
Expected Prognosis of Ovarian Cancer
The survival rate for ovarian cancer depends on the stage & the type of cancer. Approximately three out of four women with ovarian cancer live for at least one year after diagnosis for all types of ovarian cancer combined. Women diagnosed before the age of 65 do better than older women when surviving after ovarian cancer. Nearly half (46.2%) of women diagnosed with ovarian cancer are still alive at least five years after their diagnosis.
Natural Progression of Ovarian Cancer
More than 70% of women presenting with ovarian cancer already have stage III or IV cancer, or cancer has spread beyond the ovary. It is disproportionately deadly because the symptoms are vague and non-specific. Hence diagnosis is late. For this reason, ovarian cancer is caled a “ SILENT KILLER”. Due to the lack of a cost-effective screening test, more than half of women with ovarian cancer find out they have the disease in an advanced stage.
Primary Prevention for Ovarian Cancer
Ovarian cancer is a common type of disease in females, but you can reduce your risk of developing it through several different methods.
- By avoiding risk factors, such as maintaining a healthy weight, you may be able to lower the risk of developing ovarian cancer.
- Use of oral contraceptives is associated with a 50% lower risk of ovarian cancer for women who use them for five years or more. When women at average risk and BRCA mutation carriers use oral contraceptives (birth control pills), their chances of developing ovarian cancer are lowered as compared to women who have never used oral contraceptives.
Complications of Ovarian Cancer Treatment
For most women with ovarian cancer, surgery is the primary treatment option followed by chemotherapy.
Complications from surgery can include:
- Wound infection or chest infection may reult in fever, chills, sweats, coughing, shivering, as well as swelling or redness around your wound.
- You may experience some vaginal bleeding following your procedure.
- Swelling in the legs may occur if your surgeon removes your lymph nodes.
- Ovarian cancer debulking surgery may include parts of the colon or bladder.
- You will not get pregnant if you have both your ovaries removed. Your doctor can tell you if you want to preserve your fertility or have other options.
- Menopause occurs early after surgery when your ovaries are removed.
- Hernias
- Blood Clots
- Hair Loss
- Nausea/Vomiting
- Constipation
- Neuropathy
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