Ovarian Cancer

Ovarian cancer, a formidable adversary among women’s health concerns, demands a deeper understanding to combat its challenges effectively.

Ovarian cancer originates in the ovaries, fallopian tubes, or the abdominal lining known as the peritoneum. Women have two ovaries on either side of the uterus in the lower abdomen. These ovaries produce eggs during the reproductive years, which travel through the fallopian tubes to the uterus. If fertilization occurs, the egg may implant in the uterine lining, leading to pregnancy.

Ovarian cancer predominantly affects women aged 63 and older, with a higher incidence among white women compared to Black women. Statistically, a woman’s lifetime risk of developing ovarian cancer is 1 in 78.

Detecting ovarian cancer early poses a challenge as it often advances significantly before symptoms manifest, complicating treatment options.

Causes

Ovarian cancer arises due to abnormal cell growth in the ovaries, which are part of the female reproductive system. The exact cause remains elusive, but several factors contribute to its development, including genetic mutations, family history, and hormonal imbalances.

Prevalence

Ovarian cancer ranks as the eighth most common cancer among women worldwide, with approximately 300,000 new cases reported annually. Its prevalence varies geographically, with higher rates observed in developed countries.

Symptoms

Ovarian cancer can be silent in its early stages due to the small size and deep abdominal location of the ovaries, which are about the size and shape of almonds. However, as the disease progresses, symptoms may arise, including:

1. Abnormal vaginal discharge, such as blood or other substances.
2. Bloating sensation.
3. Loss of appetite.
4. Feeling full quickly during meals.
5. Pain or pressure in the abdomen or back.
6. Increased frequency or urgency of urination.
7. Constipation.

If any of these symptoms persist for more than two weeks, it is advisable to consult a doctor. While these symptoms can indicate various illnesses, some less severe than ovarian cancer, it is essential to seek medical advice for proper evaluation.

Risk Factors

The exact cause of ovarian cancer remains unknown, but certain factors increase the likelihood of developing the disease, including:

1. Eastern European or Ashkenazi Jewish descent.
2. Family history of ovarian cancer, such as a mother, sister, aunt, or grandmother.
3. Genetic mutations like BRCA1, BRCA2, or Lynch syndrome.
4. Previous history of colon, uterine, or breast cancer.
5. Being middle-aged or older.
6. History of endometriosis, a condition where uterine tissue grows outside the uterus.
7. Nulliparity (never giving birth).
8. Difficulty conceiving.
9. Prolonged use of estrogen without progesterone for ten years or more.

However, having these risk factors does not guarantee the development of ovarian cancer. It is essential to discuss individual risk factors with a healthcare provider for personalized assessment and guidance.

Diagnosis

When you consult your doctor, they’ll inquire about your medical history, including any family members with a history of cancer, to assess potential risk factors. Additionally, they’ll discuss any symptoms you may be experiencing and may conduct a pelvic examination to check for signs like fluid accumulation (ascites) or enlarged ovaries. During this exam, they’ll gently insert a finger into your vagina and rectum to feel for any abnormalities.

If ovarian cancer is suspected, your medical team may recommend further diagnostic tests, such as:

1. Imaging tests: These include ultrasound, X-ray, CT scan, MRI, or other methods to capture images of the inside of your body.
2. Laparoscopy: In this procedure, a thin, lighted tube with a camera is inserted through a small incision in your abdomen to visually inspect the ovaries and surrounding tissues and organs.
3. Biopsy: Your doctor may remove a sample of suspected cancerous tissue, either during surgery to remove the tumor or through laparoscopy or needle biopsy guided by imaging like a CT scan, to examine it under a microscope.
4. CA-125 blood test: This test measures the level of the protein CA-125, which is produced by ovarian cancer cells. While it can be a helpful indicator, it’s possible for CA-125 levels to be normal even in the presence of ovarian cancer, and elevated levels can also be caused by other conditions.

Types and Stages of Ovarian Cancer

Ovarian cancer can be classified into three main types:

1. Epithelial cell tumors: These originate in the outer lining of the ovaries and account for approximately 95% of ovarian cancers.
2. Germ cell tumors: These begin inside the ovaries in cells responsible for egg production.
3. Stromal tumors: These develop in other ovarian tissues.

The stages of ovarian cancer are determined based on the extent of the disease:

1. Stage 1: Cancer is confined to the ovaries (subdivided into stages 1A and 1B) or has spread to fluid surrounding the ovaries (stage 1C).
2. Stage 2: Cancer has spread to nearby pelvic organs, such as the uterus or fallopian tubes.
3. Stage 3: Cancer has spread to the abdomen but not to distant parts of the body.
4. Stage 4: Cancer has metastasized to distant parts of the body beyond the abdomen.

Treatments

Ovarian cancer treatment typically involves a combination of surgery and chemotherapy or radiation therapy, depending on the extent of cancer spread.

1. Surgery: Your medical team may recommend surgery to remove ovarian tumors.
2. Chemotherapy: Special drugs are administered either through injection into the veins or orally as pills to target and shrink cancerous growths.
3. Radiation therapy: High-energy X-rays are used to kill cancer cells and reduce tumor size, especially if cancer has spread to other parts of the body. However, radiation therapy is rarely used if ovarian cancer has not metastasized.
4. Palliative care: This specialized medical care focuses not only on managing the illness but also on enhancing your quality of life, pain relief, and emotional well-being. It addresses physical, emotional, mental, and spiritual aspects of your health. Palliative care is beneficial for anyone dealing with a serious illness like cancer, irrespective of the disease stage.

Your medical team may consist of various specialists, including:

• Gynecologic oncologists: These experts specialize in treating cancers of the female reproductive system and may perform surgeries and administer chemotherapy.
• Surgeons: They are skilled in conducting procedures such as tumor removal and biopsies.
• Medical oncologists: These doctors specialize in treating cancer using medications like chemotherapy, targeted therapy, or immunotherapy.
• Palliative care specialists: They focus on providing comprehensive care to improve your quality of life during treatment, addressing physical, emotional, and psychological needs.
• Counseling or support groups: These resources can provide valuable emotional support and guidance as you navigate through your diagnosis and treatment journey.

Home Care Tips

While undergoing treatment, individuals with ovarian cancer can benefit from certain home care practices. These include maintaining a balanced diet rich in fruits, vegetables, and whole grains, staying physically active within one’s limits, managing stress through relaxation techniques, and seeking support from loved ones or support groups.

Prevention

Although preventing ovarian cancer entirely may not be feasible, certain lifestyle choices can reduce the risk. These include maintaining a healthy weight, quitting smoking, using oral contraceptives, breastfeeding, and discussing preventive strategies with a healthcare provider for high-risk individuals.

When to See a Doctor

Prompt medical attention is crucial if experiencing persistent symptoms suggestive of ovarian cancer, especially if they worsen over time or interfere with daily activities. Consultation with a healthcare professional can facilitate timely diagnosis and appropriate management.

Outlook/Prognosis

It’s important to understand that statistical data is based on large groups of people and does not predict individual outcomes.

For cancers originating in the ovaries and remaining localized, the five-year survival rates exceed 90%. This means that more than 90% of individuals diagnosed with ovarian cancer are still alive five years after diagnosis.

For cancers that spread to nearby areas such as the lymph nodes, five-year survival rates vary from 57% to 94%, depending on the specific type of ovarian cancer. However, once the cancer has metastasized to distant parts of the body, the survival rate decreases to 30% to 74%, again depending on the type of cancer.

It’s crucial to remember that each case is unique. Therefore, it’s essential to have a detailed discussion with your doctor about your specific diagnosis and what it means for your individual health and prognosis.

Sources:

1. American Cancer Society. (2021). Key statistics for ovarian cancer.
2. National Cancer Institute. (2021). Ovarian cancer treatment (PDQ®)–patient version.
3. Mayo Clinic. (2021). Ovarian cancer.
4. American Society of Clinical Oncology. Types of Oncologists.
5. CDC.
6. National Ovarian Cancer Coalition.
7. UpToDate. Patient education. Ovarian cancer diagnosis and staging (Beyond the Basics).