OVARIAN CANCER

OVARIAN CANCER
           

Ovarian cancer begins in the ovaries. Ovaries are reproductive glands found only in females (women). The ovaries produce eggs (ova) for reproduction. The eggs travel through the fallopian tubes into the uterus where the fertilized egg implants and develops into a fetus. The ovaries are also the main source of the female hormones estrogen and progesterone. One ovary is on each side of the uterus in the pelvic.

Signs and Symptoms of Ovarian Cancer

Ovarian cancer may cause several signs and symptoms. Women are more likely to have symptoms if the disease has spread beyond the ovaries, but even early- stage ovarian cancer can cause them. The most common symptoms include:

• Bloating
• Pelvic or abdominal pain
• Trouble eating or feeling full quickly
• Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)

These symptoms are also commonly caused by benign (non-cancerous) diseases and by cancers of other organs. When they are caused by ovarian cancer, they tend to be persistent and represent a change from normal − for example, they occur more often or are more severe. If a woman has these symptoms more than 12 times a month, she should see her doctor, preferably a gynecologist.

Others symptoms of ovarian cancer can include:

• Fatigue
• Upset stomach
• Back pain
• Pain during sex
• Constipation
• Menstrual changes
• Abdominal swelling with weight loss

However, these symptoms are more likely to be caused by other conditions, and most of them occur just about as often in women who don’t have ovarian cancer.

Types of ovarian cancer

The ovaries are made up of three types of cells. Each cell can develop into a different type of tumor:

• Epithelial tumors form in the layer of tissue on the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors
• Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumors.
• Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare .

Ovarian cysts

Most ovarian cysts aren’t cancerous. These are called benign cysts. However, a very small number can be cancerous.

An ovarian cyst is a collection of fluid or air that develops in or around the ovary. Most ovarian cysts form as a normal part of ovulation, which is when the ovary releases an egg. They usually only cause mild symptoms, like bloating, and go away without treatment.

Cysts are more of a concern if you aren’t ovulating. Women stop ovulating after menopause . If an ovarian cyst forms after menopause, your doctor may want to do more tests to find out the cause of the cyst, especially if it’s large or doesn’t go away within a few months.

If the cyst doesn’t go away, your doctor may recommend surgery to remove it just in case. Your doctor can’t determine if it’s cancerous until they remove it surgically.

Risk factors for ovarian cancer

The exact cause of ovarian cancer is unknown. These factors can increase your risk:

• a family history of ovarian cancer
• genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
• a personal history of breast , uterine , or colon cancer
• obesity
• the use of certain fertility drugs or hormone therapies
• no history of pregnancy
• endometriosis

Older age is another risk factor. Most cases of ovarian cancer develop after menopause.

It’s possible to have ovarian cancer without having any of these risk factors. Likewise, having any of these risk factors doesn’t necessarily mean you’ll get ovarian cancer.

How is ovarian cancer diagnosed?

It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect. Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumor. There’s no routine diagnostic screening available for ovarian cancer. That’s why it’s so important for you to report unusual or persistent symptoms to your doctor.

If your doctor is concerned that you have ovarian cancer, they’ll likely recommend a pelvic exam . Performing a pelvic exam can help your doctor discover irregularities, but small ovarian tumors are very difficult to feel. As the tumor grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.

Your doctor may also do the following tests:

• Transvaginal ultrasound (TVUS) : This is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine whether tumors are cancerous.
• Abdominal and pelvic CT scan : If you’re allergic to dye, they may order an MRI .
• Blood test to measure cancer antigen 125 (CA-125) levels: This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids , and uterine cancer can also affect levels of CA-125 in the blood.
• Biopsy : This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.

What are the stages of ovarian cancer?

Your doctor determines the stage based on how far the cancer has spread. There are four stages, and each stage has sub-stages:

Stage 1

Stage 1 ovarian cancer has three sub-stages:

• The cancer is limited, or localized, to one ovary in stage 1A.
• The cancer is in both ovaries in stage 1B.
• In stage 1C, there are also cancer cells on the outside of the ovary.

Stage 2

In stage 2, the tumor has spread to other pelvic structures. In stage 2A, the cancer has spread to the uterus or fallopian tubes. In stage 2B, it has spread to the bladder or rectum.

Stage 3

Stage 3 ovarian cancer has three sub-stages:

• In stage 3A, the cancer has spread beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
• In stage 3B, the cancer cells are outside of the spleen or liver.
• In stage 3C, deposits of cancer at least 3/4 of an inch are seen on the abdomen or outside the spleen or liver. However, the cancer isn’t inside the spleen or liver.

Stage 4

In stage 4, the tumor has metastasized, or spread, beyond the pelvis, abdomen, and lymph nodes to the liver or lungs. In stage 4A, the cancerous cells are in the fluid around the lungs. Stage 4B is the most advanced stage . In stage 4B, the cells have reached the inside of the spleen or liver or even other distant organs like the skin or brain.

How ovarian cancer is treated

The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:

• chemotherapy
• radiation
• surgery to stage the cancer and remove the tumor
• targeted therapy
• hormone therapy

Surgery

Surgery is the main treatment for ovarian cancer. The goal of surgery is to remove the tumor, but a hysterectomy , or complete removal of the uterus, is often necessary. Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue. Identifying all tumor locations is difficult. In one study , researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.

Targeted therapy

Targeted therapies, such as chemotherapy and radiation treatments, attack the cancer cells while doing little damage to normal cells in the body. Newer targeted therapies to treat advanced epithelial ovarian cancer include bevacizumab(Avastin) and olaparib (Lynparza). Doctors only use olaparib in people with mutations in the BRCA genes.

Fertility preservation

Cancer treatments, including chemotherapy, radiation, and surgery, can damage your reproductive organs, making it difficult to become pregnant. If you want to become pregnant in the future, talk to your doctor before starting treatment. He or she can discuss your options for possibly preserving your fertility. Possible fertility preservation options include:

• Embryo freezing: This involves freezing a fertilized egg.
• Oocyte freezing: This procedure involves freezing an unfertilized egg.
• Surgery to preserve fertility: In some cases, surgery that only removes one ovary and keeps the healthy ovary can be done. This is usually only possible in early stage ovarian cancer.
• Ovarian tissue preservation: This involves removing and freezing ovarian tissue for future use.
• Ovarian suppression: This involves taking hormones to suppress ovarian function temporarily.

Prevention

Different factors cause different types of cancer. Researchers continue to study what factors cause these types of cancer. Although there is no proven way to prevent these diseases completely, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Research has shown that certain factors may reduce a woman's risk of developing ovarian and fallopian tube cancer:

• Taking birth control pills. Women who took oral contraceptives for 3 or more years are 30% to 50% less likely to develop ovarian cancer. The decrease in risk may last for 30 years after a woman stops taking the pills.
• Breastfeeding. The longer a woman breastfeeds, the lower her risk of ovarian and fallopian tube cancer.
• Pregnancy. The more full-term pregnancies a woman has had, the lower her risk of ovarian and fallopian tube cancer.
• Surgical procedures. Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian cancer. A hysterectomy is the removal of the uterus and, sometimes, the cervix. Tubal ligation is having the fallopian tubes “tied” or closed surgically to prevent pregnancy. Doctors recommend a bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes, for women with a high risk of ovarian and fallopian tube cancer.