When ovarian cells begin to multiply in an uncontrolled fashion and form a tumor, this is known as ovarian cancer. Like other cancers, this is rarely painful in the early stages and is often diagnosed incidentally. Ovarian cancer has a fast rate of metastasis and if left untreated can spread to other parts of the body within weeks or months. Along with this, a high recurrence rate and a low 5-year survival rate make it the most lethal gynecological cancer.
Symptoms of ovarian cancer
In the early stages, the symptoms resemble other issues like PMS, IBS, constipation, etc. Some of the symptoms in the early stages are:
- The feeling of pressure and pelvic pain
- Vaginal bleeding
- Pain in the lower back
- Urinary problems like incontinence and frequent urination
- Bowel disorders like diarrhea and constipation
- Early satiety
- Fatigue
- Menstrual irregularities
- Dyspareunia
As the disease progresses the symptoms become grave and are mostly related to the area of metastasis.
Causes of ovarian cancer
Ovarian cancer is caused due to genetic mutation of genes BRCA-1 and BRCA-2. There can be an influence of a number of heredity or environmental factors which is responsible for the gene mutation and thus an abnormal pattern of cell division.
Types of ovarian cancer
Ovarian cancer can be of several different types, depending upon the type of cells involved. However, the most common type of is epithelial cancer. These cells are derived from the surface of the ovary, tubes, and peritoneum. Other less common types of are:
- Germ cell tumors
- Stromal tumors
Stages of ovarian cancer
Prognosis and treatment of depends upon the stage of cancer, which is determined based on the extent of metastasis. There are four stages which are further divided into sub-stages.
Stage 1:
This is further divided into three substages:
- 1A- the tumor is localized to one ovary
- 1B- the tumor cells are present inside both ovaries
- 1C- the tumor cells are also present on the outside of the ovary
Stage 2:
By the second stage, ovarian cancer has metastasized to other pelvic organs and it is further divided into two sub-stages:
- 2A- the cancer cells are found in the uterus or fallopian tubes
- 2B- the cancer cells have metastasized to the rectum or bladder
Stage 3:
The third stage has three substages:
- 3A- the microscopic spread of cancer cells beyond the pelvic cavity to the lining of the peritoneum and abdominal lymph nodes
- 3B- cancer cells on the lining of the peritoneum are visible to the naked eye, measuring less than 2cm
- 3C- cancer cells are seen on the abdomen and outside the liver and spleen. But are not found inside the liver or spleen
Stage 4:
This is the last stage and is rarely treatable. Cancer has spread beyond the pelvic cavity and abdomen. This is divided into two sub-stages:
- 4A- cancerous cells are present in the pleural fluid outside the lungs
- 4B- this is the most advanced stage of cancer, the tumor has metastasized to distant organs like the brain, heart, or even skin
Risk factors
There are a number of factors that can increase the risk of cancer. Some of these are:
- A family history of ovarian cancer
- History of Lynch syndrome (uterine or colon cancer) or Li-Fraumeni syndrome
- Use of hormonal therapy
- Endometriosis
- Obesity
- Nulliparity (no conception)
- Menopause
- High androgen levels
- Talcum powder is often suspected as a risk factor among others.
Ovarian cancer recurrence
70% of the patients who undergo treatment for ovarian cancer suffer from its recurrence. Recurrent cancer is lethal and is rarely cured. The most common site of recurrence is the peritoneum and as the cancer advances in its stages, the chances of recurrence increase.
Prevention of ovarian cancer
Some factors can be used to prevent or at least decrease the risk. There are as under:
- Exercise and diet control in obese women
- Pregnancy and practice of breastfeeding
- Avoiding any sort of carcinogens
- Regular screening in patients with a family history of ovarian cancer or history of breast, colon, or uterine cancer
- The use of contraceptives decrease the risk
- Gene therapy in patients with a genetic predisposition
- Tubal ligation
- Salpingectomy
Management of ovarian cancer
Ovarian tumor is managed after proper staging. There is a high rate of recurrence but if diagnosed early, can be treated.
Diagnosis:
For diagnosis of cancer, the doctor would take a detailed past medical history along with a family history. A pelvic examination can also show a mass or tumor in advanced stages.
Some other diagnostic measures are:
- Ultrasound of pelvis and abdomen
- An MRI or CT scan
- Laparoscopy is also conducted in cases of high suspicion and to take a biopsy sample
- Blood tests are also conducted to determine the levels of tumor Marker CA-125
Treatment:
The treatment depends upon the stage, type, and grade of cancer along with the age of the patient and his health status. If the tumor has metastasized, the treatment would also include the area of metastasis and a follow-up treatment routine to avoid recurrence.
Medical treatment
Medical treatment includes monoclonal antibody therapy that targets the tumor cells solely as opposed to chemotherapy that affects the whole body.
Immunotherapy is employed to boost the immune system and strengthen the body’s defense mechanism against cancer cells.
Surgical treatment
Surgical options include hysterectomy, oophorectomy, lymph node removal, and others depending upon the involvement of organs. Gynecological oncologists carry out optimal debulking to avoid any risk of recurrence.
Other treatment options
Treatment options that can be employed to primarily treat the tumor or as a follow-up procedure, are:
- Radiation therapy, which is part of neoadjuvant therapy along with chemotherapy.
- Vaccine therapy includes the injection of substances that target and kill the tumor cells in patients with advanced cancer where surgical options may not be possible.
- Fertility preservation options for patients who want to conceive in the future are also employed. Some of these are; embryo freezing, ovarian tissue preservation, Ovarian suppression, removal of just one ovary, and oocyte preservation.
Coping with ovarian cancer
Diagnosis of cancer has drastic effects on patient’s emotional as well as physical health and both aspects should be given equal attention. Oftentimes, the patient faces anxiety, depression, and fear. Proper care and support measures should be taken to handle the emotional aspect of the patient. There are several support groups to allow such people to connect with other patients with the same condition as them. This allows them to get hold of themselves and carry on with the treatment as they have people they can relate to.
After complete treatment of cancer, screening should be timely done to help treat the recurrent tumor in its early stages.
FAQ
What are the chances of recurrence of ovarian cancer?
The risk of recurrence in stage 1 is 10%, in stage 2 it’s 30%, stage 3 it’s 70% to 90%, while the chances of recurrence in stage 4 are 95%.
What are the earliest signs of ovarian cancer?
Females present with bloating and indigestion problems in the early stages which are shortly followed by urinary problems.
What are the symptoms in the late stages of ovarian cancer?
Patients face urinary problems along with excessive weight loss and ascites in advanced stages of cancer.
What is the rate of metastasis of ovarian cancer?
Ovarian cancer spreads fastly. According to several studies, epithelial types of cancer can grow and spread out within a matter of weeks or months.
How deadly is ovarian cancer?
Ovarian cancer is the most lethal of all gynecological tumors with just a 45% 5-year survival rate.
