Ovarian Cancer

   

WHAT IS OVARIAN CANCER

Ovarian cancer is the type of cancer that begins in the ovaries.The ovary is the female reproductive organ that produces eggs.Women have two ovaries, one on each side of uterus. The exact cause of ovarian cancer is unknown. Most ovarian cancers in women under age 30 are benign fluid filled cyst. There are no routine screening test for ovarian cancer. The prognosis, treatment and survival rate of the disease depends on the stage and the overall health of the woman. The cancer may go undetected until it has spread to the pelvis and abdomen and this makes the disease difficult to treat. It is the fifth most common cancer among women and causes death than any other female reproductive cancer.

THE HUMAN OVARY

 

RISK FACTORS

Certain factors increase your risk of getting ovarian cancer. Some of the factors include

Family history  . If women in your family have been diagnosed with ovarian cancer,then you have a high risk of getting it too.Women with family history of breast, rectum, uterus and colon cancer have high risk too.  You may want to talk to a geneticist as certain test can be done to show the presence of specific gene changes that may increase your risk.

Age over 55  Your risk of having cancer increases as you age. Ovarian cancer is common in women after age 55 or mostly developed after menopause.

Inherited gene mutation.  Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are known to increase the risk of having ovarian cancer.These genes are mostly found in families with multiple cases of breast cancer. An inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC) increases  a woman’s chance of getting cancer of the ovaries, uterine lining , colon and stomach.

Never pregnant Older women who have never been pregnant have increased risk of this type of cancer.

Personal history of cancer If you’ve had cancer of the breast, colon , rectum or uterus, you have a higher chance of getting ovarian cancer.

Hormone replacement therapy for menopause  Studies suggest that women who take estrogen replacement only, that is without progesterone have increased chances of getting ovarian cancer.

Other risk factor include obesity,taking certain fertility drug. Having a risk factor does not however mean that you will get the disease, it increases your chances of getting the disease.

The exact cause of ovarian cancer is not known. The cancer begins in healthy tissues that have acquired genetic mutations. The cancer cells then grow and multiply and invade nearby tissues.

TYPES OF OVARIAN CANCER

Epithelial ovarian tumors This is the most common form of ovarian cancer and occurs mostly in adults. This cancer begins in a thin layer of tissue that covers the outside of the ovary.

Gem cell ovarian tumors They begin in egg producing cells and is much more common in younger people.It is rare in comparison to epithelial ovarian tumors.

Sex cord stromal ovarian tumor . They begin in ovary tissues that produce hormones estrogen, progesterone and testosterone.

SYMPTOMS

Ovarian cancer symptoms are mostly vague and  tend to mimic other conditions.When symptoms are present, they tend to be persistent and gets worse. Symptoms include

  • blotting or swollen belly area
  • pelvic or lower abdominal pain
  • changes in bowel habit such as constipation
  • trouble eating or feeling full quickly
  • urinary problems like urinating frequently or urinating more than usual.
  • feeling tired all the time
  • nausea, indigestion or diarrhea
  • abdominal pressure, fullness,swelling or bloating
  • back pain
  • change in menstrual cycle such as heavy bleeding, bleeding in between periods  or bleeding after menopause
  • pain with sexual intercourse
  • shortness of breath
  • weight gain or loss
  • excessive hair growth that is coarse or dark

STAGES OF OVARIAN CANCER

Staging of ovarian cancer depends on if the cancer has invaded other tissues, if the cancer has spread and if so to which organ. Doctors usually use surgery to determine the stage of the cancer.Your doctor will use information from imaging tests, such as computerized tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), to determine whether  the cancer has spread within the abdomen. Staging helps determine your prognosis and best treatment options.

Stage I Cancer is found in one or both sides of the ovaries

Stage II Cancer has spread to other location like the pelvis, uterus  or fallopian tube.Cancer cells may be found in fluid  collected from the abdomen.

Stage III Cancer has spread to tissues outside the pelvis or to the lymph nodes within the abdomen.Cancer cells may be found on the outside of the liver.

Stage IV   Cancer has spread to organs beyond the  abdomen like the lungs and liver.

TEST AND DIAGNOSIS

Pelvic examination A pelvic exam is done to check the woman’s pelvic organs.During a pelvic exam, your doctor feels the ovaries and nearby organs for lumps  or other changes in their shape or size.Your doctor inserts a device called a speculum into your vagina to open up your vagina. This is to enable him visually check for any abnormalities of ovaries and cervix. He may also feel your pelvic  organs to check their size and texture by inserting one or two gloved fingers  into the vagina and pressing on the lower abdomen with the other hand.

Ultrasound It aims sound waves at organs inside the pelvis. It helps doctors check the size, shape and configuration of the ovaries. Your doctor can also use an ultrasound probe inserted into your vagina to create pictures of your ovaries and structures near the ovary. This is called transvaginal ultrasound.

Blood Test. CA 125  is a protein on the surface of most ovarian cancer cells and some healthy tissue. The protein is high in people with ovarian cancer and other diseases.Women with early stages of ovarian cancer may have normal CA 125 protein. It is therefore not used for diagnosing ovarian cancer but to check the progress of the disease.

Surgery  When your doctor suspects you have ovarian cancer, surgery (laparotomy) is done to confirm it.The surgeon may collect fluid samples from the abdomen and an ovary to be examined by a pathologist. If cancer is confirmed, the surgeon will immediately do surgery to remove the all the cancer cells. The surgery may also be used to check for whether cancer has spread.

A pelvic or abdominal CT scan or MRI may be done to check if the cancer has spread.

TREATMENT

Ovarian cancer treatment involve a combination of surgery and chemotherapy.

Surgery  There are different types of surgery options

  • A total hysterectomy is done to remove the uterus and cervix
  • An omentectomy is done to see if cancer has spread by removing fatty tissues attached to some organs in the belly.
  • A unilateral salpingo-oophorectomy is done to remove one ovary and fallopian tube
  • A bilateral salpingo-oophorectomy is surgery done to remove both ovaries and fallopian tubes
  • A lymph node biopsy Lymph nodes nearby are removed and checked for cancer cells.

Your surgeon also removes as much cancer as possible from your abdomen (surgical debulking).  Women with early stages of ovarian cancer may have just one ovary and fallopian tubes removed. It is therefore possible for such patients to have babies in future.

Chemotherapy  Chemotherapy is administered as an initial treatment for patients with advanced ovarian cancer or as the next treatment after surgery to kill the remaining cancer cells. It may be given intravenously or by mouth (systemic chemotherapy). In this case the drug enters the blood stream and kill or control the cancer cells throughout the body. It may also be given directly into the abdominal cavity or pelvis (Intraperitoneal chemotherapy ) to destroy  cancer in these areas or both ways. Chemotherapy drugs are given alone or in combination.

Some of the chemotherapy medicines used for ovarian cancer include:

    • Carboplatin
    • Cisplatin
    • Paclitaxel
    • Docetaxel

 

Radiation therapy uses high energy rays to kill the cancer cells. It is rarely used as an initial treatment for ovarian cancer but can be used to relieve pain and other issues caused by the disease.Side effects of this include  nausea, vomiting, diarrhea, or bloody stools.

PREVENTION

Women who take birth control pills have reduced risk of ovarian cancer. Talk to your doctor about taking birth control pills. If you have a family history of ovarian and breast cancer, discuss with your doctor to find your risk. BRCA testing may be done in women at high risk for ovarian cancer.

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