Ovarian cancer: cancer that begins in the ovaries

Ovarian cancer is a type of cancer that begins in the ovaries. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen and becomes difficult to treat. It is the third most common gynecologic cancer with a high mortality rate. Tumors of surface epithelium are the most common type of ovarian cancer.

There are four stages of ovarian cancer –

Stage I includes carcinoma confined to one or both ovaries or fallopian tubes. Stage 2 cancer is in one or both ovaries or fallopian tubes and has spread into the pelvis.

Stage 3 carcinoma has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes, and stage 4 carcinoma has extended outside the abdomen and pelvis to more distant organs like lungs and bones.

What Causes Ovarian Cancer?

Though the cause of ovarian cancer is unknown, it was found to be linked to DNA mutations.

Inherited mutation on one of two genes: breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2).

What are the Risk factors?

Family history of ovarian cancer in a first-degree relative (mother, daughter, or sister).
Other hereditary conditions, such as Lynch syndrome..
Inherited changes in the BRCA1 or BRCA2 genes.
Postmenopausal hormone therapy.
Endometriosis.
Obesity, tall height, older age.

Signs and symptoms

Abdominal bloating or swelling
Trouble eating or feeling full.
Discomfort in the pelvis area
Changes in bowel habits, such as constipation
A frequent need to urinate
Weight loss

What are the Complications?

Fatigue, weakness, nausea or vomiting, constipation, oedema of the extremities and anaemia.

Major complications are as follows: ascites, bowel obstruction, pleural effusion, and bladder obstruction.

Diagnosis: How to diagnose Ovarian cancer?

Medical history – Check for symptoms and other risk factors.
Physical examination – Pelvic exam (manual examination of the abdomen and pelvic area to feel for any abnormal nodules).
Diagnostic tests – The tests performed are:
- Biopsy : Removal of a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells ( Punch biopsy, LEEP, Conization, ECC).
- Laparoscopy : Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions to look for ovaries and other pelvic organs.
- Colonoscopy : Examine inside of the large intestine using colonoscope.
- Imaging tests : CT scan : A procedure that makes a series of detailed pictures of areas inside the body Chest x-ray : An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. MRI : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. PET scan :
- A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein.
- The PET scanner rotates around the body and takes a picture of where glucose is used.
- Malignant tumor cells appear brighter in the picture because they are more active and consume more glucose than normal cells.
- Transvaginal ultrasound is a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- Other diagnosis test includes blood test to check for level of cancer antigen 125 (CA125) in the blood.
- Many women with ovarian cancer have high levels of CA-125.
- Tests for other tumor markers, such as CA 19-9, CEA, and HE-4, are used most often for women whose CA-125 levels never went up.
- For germ cell tumors, blood is tested for alpha-fetoprotein (AFP) and/or human chorionic gonadotropin (HCG).
- For stromal cancers, checking levels of hormones like estrogen, testosterone, and inhibin is helpful.

Treatment: How is Ovarian cancer treated?

Surgery is the main treatment for most ovarian cancers.

Surgery :
- Total hysterectomy: Surgery to remove the uterus, including the cervix.
- Radical hysterectomy: Remove the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs.
- Unilateral salpingo-oophorectomy: remove one ovary and one fallopian tube.
- Bilateral salpingo-oophorectomy: A surgical procedure to remove ovaries and fallopian tubes.
- Omentectomy: A surgical procedure to remove the omentum (tissue in the peritoneum that contains blood vessels, nerves, lymph vessels, and lymph nodes).
- Lymph node biopsy removes all or part of a lymph node.

Radiation therapy : 1. External radiation therapy uses a machine outside the body to send radiation toward the cancer. 2. Internal radiation therapy uses a radioactive substance that are placed directly into or near the cancer.
Chemotherapy : Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Following drugs are approved to treat ovarian Cancer – •Platinum compound (usually cisplatin or carboplatin) •Paclitaxel (Taxol®) or docetaxel (Taxotere®)
Targeted therapy – identify and attack specific cancer cells without harming normal cells. Examples -Angiogenesis inhibitors (Bevacizumab), PARP inhibitors (Olaparib, rucaparib, niraparib).
Hormone therapy – Use of hormones and hormone-blocking drugs to treat cancer.
- Rarely used to treat epithelial ovarian cancer Example – LHRH agonists, Tamoxifen, Aromatase inhibitors.

Prevention: Can we prevent it?

Prevention of Ovarian cancer –
- Using oral contraceptives (birth control pills) decreases the risk of developing ovarian cancer for average risk women and BRCA mutation carriers (can increase breast cancer risk).
- Tubal ligation and hysterectomy may reduce the chance of developing certain types of ovarian cancer ( should only be done for valid medical reasons)
- Salpingo-oophorectomy may be recommended for high-risk women after they have finished having children.

Living with Ovarian cancer –
- Rest as much as possible and avoid spending too long on your feet.
- Hormone replacement therapy (HRT) – treatment to relieve symptoms of the menopause. It replaces hormones that are at a lower level as a woman approach to menopause.
- Palliative Care.
- Avoid lifting objects and doing heavy housework.

When to see a doctor? :

It is wise to consult with a gynaecologist immediately if observed any symptoms. The typical consultation fee for a gynaecologist ranges from Rs. 500 to Rs. 1500 in India.