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Ovarian Cancer

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Overview

Ovarian cancer refers to the abnormal growth of cells in the ovaries, which are an important part of the female reproductive system. Ovaries are two small glands, located on either side of the uterus. They help produce female sex hormones and store or release eggs. An ovarian tumor is it is the eighth most common type of cancer among women. It is the fifth most common cause of cancer deaths in women around the world. Ovarian cancer can be life-threatening if not diagnosed and treated on time, however, the chances of survival are great in the case of early diagnosis.

Ovarian cancer forms when normal ovarian cell growth fails, and there is an uncontrolled growth of cells. Most of the ovarian cancers arise from the lining cells (epithelium) of the ovary. The ovarian tumor can metastasize and spread to other organs of the body.

Ovarian Cancer: Causes

There is no identified and known cause of ovarian cancer. However, there are some risk factors associated with the disease. Family history (genetics) of ovarian cancer, older age, breast cancer, obesity, and endometriosis are some of the known ovarian cancer risk factors. Other than these, menstrual cycles play a major role in ovarian cancer. The high number of total lifetime ovulations, greater the risk of ovarian cancer.  That is, women who have had their periods before the age of 12 are at an increased risk of ovarian cancer.

The risk of ovarian cancer is also high in women suffering from familial melanoma, which is characterized by the presence of certain genes. These genes are inherited from parents and mostly occurs when two or more relatives suffer from the aggressive form of melanoma or skin cancer.

Signs of Ovarian Cancer

Typically, the symptoms of ovarian cancer are subtle during the early stage. However, the patients may experience signs of ovarian cancer once the cancer advances and starts to grow. The following are some of the ovarian cancer symptoms:

  • Pain in the pelvis or belly

  • Bloating

  • Frequent and urgent urination

  • Changes in bowel habits

  • Nausea and fatigue

  • Weight loss

  • Breathlessness

  • Loss of appetite

These signs of ovarian cancer can be confused with those of ovarian cyst. However, patients must know that ovarian cysts are far more common and primarily affects women during their childbearing age.

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Before the Treatment

Before initiating any kind of treatment, it is important to diagnose the type and stage of ovarian tumor that you are suffering from.

Ovarian Cancer Diagnosis

Often after examining vague signs of ovarian cancer and medical history of the patient, the doctor carries out some physical tests for visible abnormalities in the uterus or ovaries. But the final diagnosis is made after conducting certain clinical tests, including the following:

  • CT scan

  • MRI scan

  • Blood test

  • Ultrasound

  • Laparoscopy

  • Colonoscopy

  • Abdominal fluid aspiration

  • Biopsy

    Stages> Sub-stage What does it mean?
    Stage 1 Stage 1A Cancer is restricted to the ovary where it started.
      Stage 1B Cancer is restricted to both the ovaries.
      Stage 1C Cancer is restricted to one or both the ovaries and cancer cells are present in the abdominal fluid retrieved during diagnosis or cells are present on the surface of the ovary or the ovary ruptures during or before the surgery
    Stage 2 Stage 2A Cancer has spread to the Fallopian tubes or the uterus.
      Stage 2B Cancer has grown in tissues of the pelvis.
      Stage 2C Cancer has grown in tissues of the pelvis and cells are present in the abdominal fluid.
    Stage 3 Stage 3A Cancer cells are present in the lining of the abdomen.
      Stage 3B     Cancerous growth 2cm or smaller in size are discovered in the lining of   the abdomen.    
      Stage 3C   Cancerous growth larger than 2cm in size is found in the lining of the abdomen or lymph nodes present in the upper abdomen or groin are affected by cancer.
    Stage 4 Stage 4a Cancer has caused pleural effusion or the build-up of fluid in the lungs.
      Stage 4b   Cancer has spread to the inside of the spleen and liver, to other organs, or lymph nodes present in or outside the abdomen.



Types of Ovarian Cancer

Epithelial ovarian cancer (EOC) is the most common form of ovarian cancer. Epithelial cancers are of three types, which includes ovarian, the Fallopian tubes, and primary peritoneal cancer. All these three types of tumors behave and are treated the same way.  The most common cell types of epithelial ovarian cancer are serous, mucinous, clear cell, and endometrioid. EOC occurs due to DNA changes in the cells. The type of ovarian cancer and the cells affected by it is confirmed in the tests conducted at the time of diagnosis.

Ovarian Cancer Stages

The ovarian cancer stage is confirmed during the biopsy. The stage of ovarian cancer describes the extent and level of invasiveness of cancer. The following table highlights the different types of stomach cancer stages and what do they actually mean.

How it is Performed

Ovarian Cancer Treatment

Depending on the type, stage, grade of ovarian cancer and general health of the patient, the oncologist will devise the best treatment plan for the patient. However, a patient’s expectations and desires play a major role in selecting the treatment plan. For example, some patients may desire childbirth in the future, while others could be okay with having their uterus. the Fallopian tubes and ovaries removed.

The following are some of the ovarian cancer treatment strategies:

Surgery

Surgery is often the first and the best treatment for ovarian cancer. Surgical removal of the cancer is done in a vast majority of ovarian cancer patients. The type of surgery opted for depends upon how widespread the cancer is when it is diagnosed.

There are different surgical procedures to get rid of ovarian cancer, such as unilateral oophorectomy (removal of one ovary) or bilateral oophorectomy (removal of both ovaries), salpingectomy (removal of Fallopian tubes), hysterectomy (removal of the uterus), and omentectomy (removal of momentum).

Typically, the organ in question is fully removed in all these procedures. In some of the advanced cancers, complete removal of the cancer cells is not possible. In such cases, the possible amount of tumor is removed in a procedure called debulking surgery.

Such patients require an extensive operation performed by the surgeon, who is a specialized gynecologic oncology surgeon. Therefore, ovarian cancer surgery requires a prolonged stay in the hospital, which lasts for at least three to seven days, plus a recovery period of at least four to six weeks.

Chemotherapy:

Chemotherapy drugs interfere with cell division process and damages the DNA of the cancer cells to reduce their number and stop them from growing any further. Patients will often benefit greatly from its use in the case of ovarian cancer because ovarian cancer patients are able to tolerate it better because of fewer chemotherapy side effects.

In case of ovarian cancer treatment, chemotherapy drugs can be given into the vein intravenously (IV) or placed directly into the abdomen (IP).

In some cases, chemotherapy may be performed first, followed by a surgery. This is called neoadjuvant chemotherapy. Common chemotherapy drugs used to treat ovarian cancer include paclitaxel, cisplatin, topotecan, doxorubicin, epirubicin, and gemcitabine.

Drugs used in chemotherapy travel throughout the body and can also kill a few normal cells in the body, leading to unpleasant side effects. So, chemotherapy should be followed only if the patient can cope with it. Chemotherapy can cause anemia and leucopenia, besides vomiting, diarrhea, appetite loss, hair loss, and fatigue.

Radiation therapy:

Radiation therapy uses high-energy X-rays or proton beams to destroy the tumors of ovarian cancer. This can be given as palliative therapy, or as adjuvant therapy combined with surgery or chemotherapy. However, radiation therapy alone does not improve survival rate in people with well-differentiated cancers. Common side effects of radiotherapy treatment are diarrhea, constipation, and frequent urination.

Hormone therapy:

Although estrogen alone does not have any effect on cancer, cutting off a supply of estrogen slows the growth of cancer cells. Hormone therapy can prevent estrogen from reaching the cancer cells, thus suppressing the growth of cancer.

Targeted drug therapy:

Newer medications are being developed that can target cancer cells directly, but till now this treatment only helps reduce damage to the normal cells and subsidize the side effects of chemotherapy.

Recovery

Recovery after ovarian cancer treatment can be physically and emotionally painful. This is especially true of the patients had her ovaries and uterus removed completely. There may be certain side effects arising out of sudden menopause and women may face difficulty in adjusting to the life after ovarian cancer treatment.

For women who have had a surgery as a part of the treatment plan, driving after a month of the surgery should not be a problem. However, the best is to seek advice from your doctor at every step and before taking any new step.

Some women may face difficulty concentrating on day-to-day chores after the treatment. Several cycles of chemotherapy and radiotherapy may further slow down recovery. It is important to take plenty of fluids to recover from treatment and minimize the side effects of chemotherapy and radiotherapy. It is equally important to maintain a proper diet during the recovery period.

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FAQ

Q: Is ovarian cancer completely treatable?

It is possible to cure ovarian cancer only when it is diagnosed in its early stages. Unfortunately, a majority of cases are diagnosed at a later stage.

Q: Can you survive ovarian cancer?

A: Women who are diagnosed with ovarian cancer at an age younger than 65 have better survival rates than women aged above 65. The 5-year survival rate associated with Stage 1 ovarian cancer is around 92 percent. However, cancer is rarely detected at this stage.

Q: Is chemotherapy effective for ovarian cancer?

A: Chemotherapy drug carboplatin is considered highly effective against epithelial ovarian cancers. Additionally, it has minimal side effects. Typically, three to six cycles of chemotherapy are considered effective against epithelial ovarian cancer.

Q: Who is at risk of ovarian cancer?

A: Menopausal women aged 63 and above are more likely to develop ovarian cancer. For some women, the risk of ovarian cancer runs in the family. Obesity is another risk factor for ovarian cancer.

Q: Can you prevent ovarian cancer?

A: While there is no definite way to prevent ovarian cancer, research suggests that taking birth control pills for three or more years can reduce the risk of developing ovarian cancer by 30 to 50 percent.

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