Definition and Overview
Ovarian cancer is an abnormal growth in the ovaries, which are sex glands in females that produce hormones and egg cells essential for reproduction. According to the American Cancer Society, ovarian cancer is responsible for approximately 3% of cancers in women worldwide and the number one cause of deaths among all the cancers arising from the female reproductive tract. It typically affects postmenopausal women. The average age when ovarian cancer is diagnosed is 63 years.
There are different kinds of ovarian cancers, and they are identified based on the location of the abnormal growth. These include epithelial ovarian cancer, sex cord-stromal ovarian cancer, and germ cell ovarian cancer. Of these, the epithelial ovarian cancer is the most common type. It arises from the cells that line the surface of the ovary or what is known as the ovarian epithelium. The sex cord-stromal ovarian cancer and the germ cell ovarian cancer are less common types and arise from the ovarian gland itself. Another kind is the borderline ovarian tumor, where the tumor cells are microscopically cancerous but clinically, they are not as aggressive as the other types of cancers.
Cause of Condition
Ovarian cancer is caused by an abnormal proliferation of cells in the ovaries. Genetics appears to play a role in the development of this kind of cancer. Studies have shown that it is associated with the mutations or alterations in the BRCA genes. A family history of ovarian cancer or breast cancer, especially in a first-degree relative such as your mother or your sister, also increases the risk for the development of this form of cancer. There are also several other factors including early menstruation or late menopausal, never having been pregnant, and the use of hormonal therapy. On the other hand, taking oral contraceptive pills or birth control pills can decrease the risk of developing ovarian cancer.
The signs and symptoms of ovarian cancer are usually non-specific at the onset. Thus, it is usually diagnosed late in the course of the disease. Patients with ovarian cancer initially notice weakness, fatigue, and weight loss. Some patients also note enlargement of the abdomen or abdominal distension, and may complain of feeling bloated. In more advanced stages of the disease, patients usually experience early satiety or a feeling of fullness when eating small amounts of food. They also develop changes in bladder and bowel habits, such as urinary urgency or constipation. This typically happens when the mass enlarges to a point where it is already compressing the nearby organs. Other noted symptoms include abnormal bleeding from the vagina, pain on the lower abdomen, swelling of the lower extremities, and even difficulty in breathing.
Who to See and Types of Treatments Available
Because the disease typically presents with vague, non-specific symptoms in the beginning, it takes a high index of suspicion for ovarian cancer to be diagnosed early on. If you suffer from any of the aforementioned symptoms, especially if they are persistent for more than two weeks, it is best to consult your health care provider or your gynecologist. A pelvic examination is typically performed to check for any masses. Several laboratory tests may also be performed including an ultrasound and blood tests such as the tumor marker CA 125.
A biopsy, as well as CT scan, may likewise be ordered to detect any spread of the cancer to the nearby organs. This is also helpful when planning the surgery. If ovarian cancer has been confirmed, you will be referred to a gynecologic oncologist for treatment.
Treatment of ovarian cancer involves a combination of surgery and chemotherapy. Surgery involves the removal of both ovaries, the uterus, and the fallopian tubes. It may also include the resection of nearby organs, such as the omentum or the bowels if they are already affected by the cancer. If the disease is too extensive to resect completely, tumor debulking is an option. The fewer tumors left behind, the better the outcomes. Ovarian cancer surgery can thus be quite extensive.
Meanwhile, chemotherapy may either be given before the surgery (neoadjuvant chemotherapy) to decrease the tumor load prior to the operation or after surgery (adjuvant chemotherapy) to take out all remaining tumor cells that may not have been removed by surgery alone. Traditional chemotherapy is typically coursed through the veins (intravenous). However, a new route for chemotherapy delivery that shows a promising result is the intraperitoneal route, where the platinum-based chemotherapeutic drugs, such as cisplatin, are directly placed into the abdominal cavity.
When ovarian cancer is discovered early on, the chances of survival are significantly high, with more than 90% of patients still alive after five years. However, ovarian cancer tends to spread early, such that most cases are discovered at more advanced stages, when there has already been localized spread (stage 3 or higher). In this stage, even with optimal treatment, survival rate is only approximately 50% in 5 years. Recurrence may be treated with surgery and chemotherapy as well, depending on the extent of the disease. Sex cord-stromal tumors and germ cell tumors generally have a better prognosis than epithelial ovarian tumors.
Many patients who are found to have ovarian cancer experience problems with coping and undergo depression. Finding other people who are in the same situation and talking about your experiences can help significantly. Support groups for ovarian cancer are available worldwide.
- Ovarian Cancer Institute. https://www.ovariancancerinstitute.org/
- Ovarian Cancer – National Cancer Institute