ovarian cancer

Ovarian Cancer

Ovarian cancer happens when abnormal cells in the ovary start to multiply out of control and form a tumor. The female reproductive system has two ovaries, one on each side of the uterus. The ovaries, each about the size of an almond, produce eggs (ova) along with the hormones progesterone and estrogen.

Ovarian cancer mostly goes undetected until it has spread within the abdomen and pelvis. At this stage, ovarian cancer is more difficult to treat. On the other hand, early stage ovarian cancer, in which the disease is limited to the ovary, is more likely to be treated successfully.

According to latest report of National Council on Radiation Protection and Measurements (NCRP), after cervix and breast cancer, it is ovarian cancer which constitutes the third most common cancer among Indian women. It is estimated that by the end of 2020, there will be around 36200 new cases of ovarian cancer in India. Chemotherapy and surgery are generally used to treat ovarian cancer.

Types of ovarian cancer

The type of cell where the cancer forms determines the type of ovarian cancer you have. The types include:

  1. Epithelial tumor – It begins in the thin layer of tissue that covers the outside of the ovaries. About 90 per cent of ovarian cancers are epithelial tumors
  1. Stromal tumor – It begins in the ovarian tissue that contains hormone-producing cells. These tumors are mostly diagnosed at an earlier stage than other ovarian tumors. Around 7 per cent of ovarian tumors are stromal
  1. Germ cell tumor – It begins in the egg-producing cells. These rare ovarian cancers are most likely to occur in younger women

Early symptoms

Early-stage ovarian cancer rarely causes any signs or symptoms. Advanced-stage ovarian cancer may cause few non-specific symptoms that are sometimes mistaken for more common benign conditions. The symptoms may include:

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

Causes and diagnosis

It is not exactly clear what causes ovarian cancer, though doctors have identified factors that can increase its risk.

In general, cancer begins when a cell develops errors in its DNA. The mutations inform the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when the healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread somewhere else in the body.

The ovaries are situated deep within the abdominal cavity, so you are unlikely to feel a tumor. There is no routine diagnostic screening available for ovarian cancer. That makes it all the more important for you to report unusual or persistent symptoms the doctor.

Performing a pelvic exam can help the doctor discover irregularities, but small ovarian tumors are quite difficult to feel. As the tumor grows, it presses against the rectum and bladder. The doctor may be able to detect irregularities during a rectovaginal pelvic exam. He may also do the following tests:

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

Stages and treatment options

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

  1. Stage 1 – This stage has three sub-stages:
  • Stage 1A – The cancer is localized, or limited, to one ovary.
  • Stage 1B – The cancer is present in both the ovaries.
  • Stage 1C – Cancer cells are also present on the outside of the ovary.
  1. Stage 2 – In this stage, the tumor has spread to the other pelvic structures. It has two sub-stages:
  • Stage 2A – The cancer has spread to the fallopian tubes or uterus.
  • Stage 2B – The cancer spread to the rectum or bladder.
  1. Stage 3 – This stage has three sub-stages:
  • Stage 3A – The cancer has spread beyond the pelvis to the lymph nodes in the abdomen and lining of the abdomen.
  • Stage 3B – The cancer cells are outside of the liver or spleen.
  • Stage 3C – Deposits of cancer at least 3/4 of an inch are seen on the outside the spleen or liver or abdomen. However, the cancer is not inside the spleen or liver.
  1. Stage 4 – In this stage, the tumor has spread beyond the pelvis, abdomen and lymph nodes to the lungs or liver. It has two sub-stages:
  • Stage 4A – The cancerous cells are in the fluid around the lungs.
  • Stage 4B – The most advanced stage, the cells have reached the inside of the liver or spleen or even other distant organs like the brain or skin.

The treatment options include:

  1. Surgery – Surgical options include removing one or both ovaries, hysterectomy, and removing affected lymph nodes. A doctor will discuss suitable options you.
  1. Chemotherapy: These drugs aim to kill the cancer cells. If you take chemotherapy drugs by mouth or as an injection, they will affect the entire body. Another option is intraperitoneal chemotherapy. Here, a tube delivers the drug directly to the body area affected by ovarian cancer. Chemotherapy can have adverse effects, more in case it affects the entire body.
  1. Targeted therapy – Few treatments target specific cells that help promote cancer growth. This treatment works to limit the adverse effects by targeting specific functions.
  1. Radiation therapy – This technique uses x-rays to kills cancer cells. One way is by introducing a radioactive liquid into the peritoneum. This is useful for people having advanced ovarian cancer.
  1. Immunotherapy (biotherapy) – This aims to boost the immune system’s ability to defend the body against cancer. Vaccine therapy usually involves injecting substances that will search and kill a tumor. This may help people with advanced ovarian cancer.

Fertility preservation

Cancer treatments, including radiation, chemotherapy and surgery, can damage the reproductive organs, making it difficult to become pregnant.

If you want to become pregnant in the future, talk to the doctor before starting treatment. They can discuss the options for possibly preserving your fertility. The options include:

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

Side effects of treatment

Ovarian cancer treatment can cause physical, psychological, and/or emotional side effects. Some of these include:

  1. Fatigue
  1. Infertility
  1. Menopause
  1. Impact on sexuality and intimacy
  1. Bowel changes
  1. Internal scar tissue (pelvic adhesions)
  1. Feeling depressed or low

Survivorship and prevention for ovarian cancer

Often, women will present with sexual dysfunction and menopausal symptoms following initial surgery or chemotherapy. Lymphedema may occur after a lymph node removal. Patients should also be routinely screened for psychosocial distress, such as anxiety, depression, financial toxicity, change in body image, or fear of recurrence. Palliative care and symptom management are important in patients with advanced or recurrent diseases. Given the physical and psychosocial side effects associated with diagnosis and treatment of ovarian cancer, oncology nurses must perform side effect assessment measures and offer resources as needed.

There is no definite way to prevent ovarian cancer. However, there may be ways to reduce the risk:

  1. Take birth control pills – Women who use oral contraceptives may have a reduced risk of ovarian cancer. But remember having these pills do contain risks, so discuss whether the benefits outweigh those risks based on the situation.
  1. Pregnancy and child birth
  1. Breastfeed – Studies suggest that women who breastfeed for a year or so may have a reduced risk of ovarian cancer.
  1. Having had a tubal ligation (getting the tubes tied), both ovaries removed, or a hysterectomy (an operation in which the uterus, and sometimes the cervix, is removed).

Discuss the risk factors with the doctor – If you have a family history of ovarian and breast and ovarian cancers, bring this up with the doctor. He can determine what this may mean for your own risk of cancer.

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