Ovarian Cancer

Ovarian Cancer

The Ovary

The ovary is an organ of the female reproductive gland that produces ovum. Females have a pair of ovaries, held by membrane beside the uterus on each side of the lower abdomen. This organ plays a very important role in overall reproductive process.

Ovarian Cancer 

It refers to any cancerous growth that begins in the ovary. It goes undetected until it has spread within the pelvis and abdomen.

It can start in the ovary’s germ, stromal, or epithelial cells. Germ cells are the cells that become eggs. Stromal cells make up the substance of the ovary. Epithelial cells are the outer layer of the ovary.

Teal Ribbon

Ovarian Cancer Teal Ribbon

September is the Ovarian Cancer Awareness Month.

Symptoms/Signs

• Abdominal bloating or swelling
• Quick feeling full when eating
• Abdomen, back or pelvic pain
• Unexpected vaginal bleeding
• Changes in bowel habits, such as constipation
• Weight loss
• A frequent, urgent need to urinate

Causes

Major cause, genetic mutation in cell DNA.

Functional cysts

Ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when female ovulate.
If a normal monthly follicle keeps growing, it's known as a functional cyst. There are two types of functional cysts:

• Follicular cyst

Around the midpoint of menstrual cycle, an egg bursts out of its follicle and travels down the fallopian tube. A follicular cyst begins when the follicle doesn't rupture or release its egg, but continues to grow.

• Corpus lutem cyst

When a follicle releases its egg, it begins producing estrogen and progesterone for conception. This follicle is now called the corpus luteum. Sometimes, fluid accumulates inside the follicle, causing the corpus luteum to grow into a cyst.

Other cysts

• Dermoid cysts

Also called teratomas, these can contain tissue, such as hair, skin or teeth, because they form from embryonic cells. They're rarely cancerous.

• Cystadenomas

These develop on the surface of an ovary and might be filled with a watery or a mucous material.

• Endometriomas

These develop as a result of a condition in which uterine endometrial cells grow outside your uterus (endometriosis). Some of the tissue can attach to your ovary and form a growth.

Types

• Epithelial tumors

which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.

• Stromal tumors

which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.

• Germ Cell tumors

which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Risk Factors

Family history

People with two or more close relatives with ovarian or breast cancer have an increased risk of the disease.

Age

Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.

Reproductive history

Having had one or more full term pregnancies is associated with a lower risk of ovarian cancer. The more pregnancies a woman has, the lower the risk seems to be. Breastfeeding may also lower the risk.
However, having children later in life (after age 35) or never having children are associated with a higher risk.

Breast cancer

People with a history of breast cancer seem to have a higher chance of ovarian cancer. This may be due to changes in the BRCA gene.
For this reason, some people with breast cancer who test positive for this gene mutation may opt to have an oophorectomy, or surgery to remove the ovaries, as preventive therapy.

Hormone therapy

Undergoing hormone replacement therapy (HRT) after menopause appears to increase the risk of ovarian cancer.
The longer a person uses HRT, the higher the risk. However, the risk appears to fall after treatment stops.

Obesity and overweight

Ovarian cancer is more common in people with a body mass index (BMI) of over 30.

Gynecologic surgery

Having surgery to remove the uterus, called a hysterectomy, may reduce the risk of ovarian cancer by one-third.

Complications

Ovarian torsion

Cysts that enlarge can cause the ovary to move, increasing the chance of painful twisting of your ovary (ovarian torsion). Symptoms can include an abrupt onset of severe pelvic pain, nausea and vomiting. Ovarian torsion can also decrease or stop blood flow to the ovaries.

Rupture

A cyst that ruptures can cause severe pain and internal bleeding. The larger the cyst, the greater the risk of rupture. Vigorous activity that affects the pelvis, such as vaginal intercourse, also increases the  risk.

Prevention

Consider taking birth control pills

Ask your doctor whether birth control pills may be right for you. Women who use oral contraceptives may have a reduced risk of ovarian cancer. But oral contraceptives do have risks, so discuss whether the benefits outweigh those risks based on your situation.

Discuss your risk factors with your doctor

If you have a family history of breast and ovarian cancers, bring this up with your doctor. Your doctor can determine what this may mean for your own risk of cancer. In some cases, your doctor may refer you to a genetic counselor who can help you decide whether genetic testing may be right for you. If you're found to have a gene mutation that increases your risk of ovarian cancer, you may consider surgery to remove your ovaries to prevent cancer.

Stages

Localized

Cancer cells affect only the ovaries or fallopian tubes and have not spread elsewhere.

Regional

Cancer has spread to nearby organs, such as the uterus.

Distant

Cancer is present elsewhere in the body. It now affects other organs, such as the lungs or liver.

Once these factors are known, cancer of the ovary is staged according to the following criteria:

• Stage 1 cancer is confined to one or both ovaries.
• Stage 2 cancer is confined to the pelvis.
• Stage 3 cancer has spread into the abdomen.
• Stage 4 cancer has spread outside of the abdomen or into other solid organs.

Stage 1

In stage 1, the cancer has not spread beyond the ovaries. Stage 1A means the cancer is only in one ovary. In stage 1B, the cancer is in both ovaries. Stage 1C means that one or both ovaries contain cancer cells and one of the following are also found: the outer capsule broke during surgery, the capsule burst before surgery, there are cancer cells on the outside of an ovary, or cancer cells are found in fluid washings from the abdomen.

Stage 2

In stage 2 ovarian cancer, the cancer is in one or both ovaries and has spread to elsewhere within the pelvis. Stage 2A means it has gone from the ovaries to the fallopian tubes, the uterus, or to both. Stage 2B indicates the cancer has migrated to nearby organs like the bladder, sigmoid colon, or rectum.

Stage 3

In stage 3 ovarian cancer, the cancer is found in one or both ovaries, as well as in the lining of the abdomen, or it has spread to lymph nodes in the abdomen. In Stage 3A, the cancer is found in other pelvic organs and in lymph nodes within the abdominal cavity (retroperitoneal lymph nodes) or in the abdominal lining. Stage 3B is when the cancer has spread to nearby organs within the pelvis. Cancer cells may be found on the outside of the spleen or liver or in the lymph nodes. Stage 3C means that larger deposits of cancer cells are found outside the spleen or liver, or that it has spread to the lymph nodes.

Stage 4

Stage 4 is the most advanced stage of ovarian cancer. It means the cancer has spread to distant areas or organs in your body. In stage 4A, cancer cells are present in the fluid around the lungs. Stage 4B means that it has reached the inside of the spleen or liver, distant lymph nodes, or other distant organs such as the skin, lungs, or brain. 

Getting an early diagnosis usually means that treatment can be more effective. However, other factors can affect this.

Diagnosis

Blood tests

• CBC
• Cancer Antigen 125
• HCG level test, germ cell tumor
• Alpha-fetoprotein test, germ cell tumor
• Lactate dehydrogenase level test, germ cell tumor
• Inhibin, estrogen and testosterone level, stromal cell tumor
• Liver function tests
• Kidney function tests

Imaging tests

There are several types of imaging tests that can look for changes in the ovaries and other organs that are caused by cancer. These include a CT scan, MRI, and PET scan.

Laproscopy

A healthcare professional will insert a thin tube with a camera attached through a small hole in the abdomen, to see the ovaries and perhaps take a tissue sample for a biopsy.

Biopsy

A biopsy is essential for determining if cancer is present. During the procedure, a small tissue sample is taken from the ovaries to look for cancer cells. 

Treatment

Surgery
The choice will depend on the type of cancer and how far it has spread. Surgical options include a hysterectomy, removing one or both ovaries, and removing affected lymph nodes. A doctor will discuss suitable options with the individual.

Chemotherapy
These drugs aim to kill cancer cells. If a person takes chemotherapy drugs by mouth or as an injection or infusion, they will affect the whole body. Another option is intraperitoneal chemotherapy. In this case, a tube delivers the drug directly to the body area affected by cancer. Chemotherapy can have widespread adverse effects, especially if it affects the whole body.

Targeted therapy
Some treatments target specific cells that help promote cancer growth. Examples include monoclonal antibody therapy and angiongenesis inhibitors. Targeted therapy aims to limit the adverse effects by targeting specific functions.

Radiation
This technique uses X-rays to kills cancer cells. One way to do this is by introducing a radioactive liquid into the peritoneum. This may help people with advanced ovarian cancer.

Immunotherapy(biotherapy)
This aims to boost the immune system's ability to defend the body against cancer. Vaccine therapy involves injecting substances that will find and kill a tumor. It may help people with advanced ovarian cancer.

Success Rate

95%

1. Dr. Tripti Sharan, Sr. Consultant - Gynaecology & Obstetrics, BLK Super Speciality Hospital, Near Rajendra Place Metro Station, Pusa Road, New Delhi - 110005, India.

She is an expert and having a rich experience of 21 years in this field.

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2. Dr. Satinder Kaur, Sr. Consultant - Gynae Oncology, Dharramshila Narayana Superspeciality Hospital, Dharmashila Marg, Vasundhara Enclave, Near New Ashok Nagar Metro Station, New Delhi - 110096, India.

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