What is ovarian cancer?

ovarian cancer refers to illnesses that start in the ovaries or nearby organs such as the fallopian tubes and the peritoneum. Ovarian cancer develops when abnormal cells in your fallopian tubes or ovaries grow and replicate uncontrollably. Women have ovaries on either side of the uterus in their pelvis, which produce female hormones and eggs for reproduction. The female reproductive system also includes a pair of slender and elongated tubes, called fallopian tubes, that extend from either side of the uterus. The eggs produced by the ovaries are carried by the fallopian tubes to the uterus. The peritoneum is the tissue lining that covers the abdominal organs.

What are the types of ovarian cancer?

Ovarian cancer typically has three types depending upon the type of cell where the cancer begins.

  • Epithelial ovarian cancer: This type is the most common. Epithelial ovarian cancer can be further categorized into subtypes such as serous and mucinous carcinoma
  • Stromal tumours: These are rare and are usually diagnosed at an earlier stage than other ovarian cancers.
  • Germ cell tumours: These rare ovarian cancers tend to occur in younger women.

Who is more likely to develop ovarian cancer?

Some women have a slightly higher risk of developing ovarian cancer. Risk factors include

  • Being over the age of 60. The risk increases as you grow older
  • Endometriosis
  • Obesity
  • Having a family history of ovarian cancer in a mother, daughter, or sister
  • Never being pregnant or having children
  • Inherited gene changes:  A small number of ovarian cancers are caused by inherited gene mutations from parents. Some of the genes associated with an increased risk of ovarian cancer are BRCA1 and BRCA2. These genes are also known to raise the risk of breast cancer
  • Postmenopausal hormone replacement therapy
  • Early menstruation and late menopause

What are the symptoms of ovarian cancer?

  • Pelvic or abdominal pain, swelling, discomfort, or a feeling of pressure in the abdomen or pelvis
  • An increase in the size of the abdomen
  • Sudden or frequent urge to urinate
  • Changes in your eating habits, getting full early, and losing appetite
  • A lump in the pelvic area
  • Gastrointestinal problems, such as gas, bloating, diarrhea, or constipation
  • Vaginal discharge or abnormal bleeding, mainly if the bleeding occurs outside of the typical menstrual cycle or after menopause.

How is ovarian cancer diagnosed?

In order to diagnose ovarian cancer, typically, a blood test and a scan are conducted as the first step, although additional tests are often necessary. Blood tests are conducted to measure the levels of a substance called CA-125. Elevated levels of CA-125 in the blood can indicate the presence of ovarian cancer. However, it is essential to note that CA-125 levels can be normal even when cancer is present, and they can also be elevated in various non-cancerous conditions. Due to this, healthcare providers utilize blood tests in conjunction with other diagnostic methods to accurately diagnose ovarian cancer.

An ultrasound will help to scan and see if there are changes in the ovaries. An imaging device, which is inserted into the vagina (transvaginal scan) or an external scan over the abdomen (abdominal scan), may be used for this purpose.

Other tests you may have include:

  • CT scan of abdomen and pelvis: The preferred imaging method for staging, treatment selection, and evaluating disease response in ovarian cancer
  • Needle Biopsy: removing a small sample of cells or fluid from your ovaries
  • Laparoscopy: Looking at your ovaries using a camera on the end of a tube through a small cut in your tummy
  • Laparotomy: Surgery to remove tissue or possibly your ovaries

What are the stages of ovarian cancer?

Ovarian cancer is categorized into four stages. In this staging system, lower numbers indicate less severe stages, while higher numbers indicate more advanced stages of the disease.

Stage I: Cancer is confined to one or both ovaries. Cancer cells are also found on the surface of the ovaries or in fluid collected from the abdomen.

Stage II: Cancer has spread from one or both ovaries to other tissues in the pelvic region like fallopian tubes or uterus.

Stage III: The cancer has spread beyond the pelvic region to the abdominal cavity or nearby lymph nodes.

Stage IV: Cancer has spread to distant organs outside the abdomen and pelvis, such as the liver, lungs, or spleen.

How is ovarian cancer treated?

The primary objective of treating cancer is to eliminate as much cancer from the body as possible if not all of it. The standard methods used to treat ovarian cancer include:

  • Surgery: This typically involves the removal of affected reproductive organs.  It can be performed using different techniques depending on the specific situation. Two common approaches are minimally invasive laparoscopic surgery and an open laparotomy that requires an abdominal incision.
  • Chemotherapy: Chemotherapy uses drugs that target and eliminate cancerous cells and can be administered intravenously or orally in the form of pills. It is recommended before or after surgery.
  • Targeted therapy: This cancer treatment utilizes drugs that recognize and attack cancer cells, altering their growth and division.
  • Hormone therapy: Some types of ovarian cancer rely on hormones to grow. Hormone therapy blocks the hormones, which hinders the growth or prevents the cancer from progressing.
  • Radiation therapy: Radiation therapy is rarely used for treating ovarian cancer.

Can I prevent ovarian cancer?

There is no way to prevent ovarian cancer completely. Awareness of your biological family history can be beneficial in preparing for any increased risk of ovarian cancer. There may be ways to lower your risk of ovarian cancer:

  • Oral contraceptives: Long-term use of oral contraceptives, such as birth control pills, has been shown to lower the risk of ovarian cancer. Consult with your healthcare provider to discuss oral contraceptives’ potential benefits and risks.
  • Pregnancy and breastfeeding: Having one or more full-term pregnancies and breastfeeding may reduce the risk of ovarian cancer.
  • Genetic testing and counselling: If you have a family history of ovarian or breast cancer, especially with known genetic mutations like BRCA1 or BRCA2, consider genetic testing and counselling. This can help you understand your risk and make informed decisions about preventive measures.
  • Undergo risk-reducing surgeries: For individuals with a high risk of ovarian cancer due to inherited genetic mutations (e.g., BRCA1 or BRCA2), risk-reducing surgeries such as bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) or prophylactic hysterectomy (removal of the uterus) may be considered. These surgical procedures significantly reduce the risk of ovarian cancer but have implications for fertility and other aspects of health, so careful consideration and discussion with healthcare providers are essential.
  • Healthy lifestyle choices: Adopting a healthy lifestyle can contribute to overall well-being and reduce the risk of various cancers. This includes maintaining a healthy weight, engaging in regular physical activity, and eating a well-balanced diet inclusive of fruits, vegetables, and whole grains.

What can I expect if I have ovarian cancer?

After the initial treatment of ovarian cancer, regular follow-up appointments will be necessary to monitor your progress, manage any side effects, and check for any signs of recurrence. These follow-up appointments may include physical exams, blood tests, imaging scans, and other tests. It is important to pay attention to new symptoms and inform your healthcare provider of any unusual occurrences. It is emphasized that observation is crucial after ovarian cancer treatment. 

The prognosis and individual experience with ovarian cancer can vary widely. Regular health check-ups, awareness of potential symptoms, and open communication with your healthcare provider are crucial for early detection and timely medical intervention.

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