Ovarian Cancer

Overview:

Ovarian cancer is a rare type of cancer that affects less than 1 million people in India every year, but it accounts for more casualties than any other female reproductive organ cancer.  This type of cancer is hard to detect in its early stages.  It is usually detected when it has spread within the abdomen and pelvis, but it is very difficult to treat the cancer at this late stage. Therefore, the best time to treat it is during its early stages.

To understand ovarian cancer better, it is important to understand the role of the ovaries in the female reproductive system. The ovaries are almond shaped & sized organs that produce eggs for the process of reproduction. They also produce estrogen & progesterone hormones. They are connected to the womb (uterus) via the fallopian tubes. Following are the different stages of ovarian cancer.

• Stage I. In this stage, cancer is restricted to one or both the ovaries.
• Stage II. When cancer spreads beyond the ovaries to other parts of the pelvic area, it is categorized as stage II ovarian cancer.
• Stage III: Cancerous cells spread into the abdomen region.
• Stage IV: Cancer spreads beyond the abdomen and pelvis, affecting other parts of the body.

Causes:

It is not known what causes ovarian cancer. In general, cancer is caused when a normal cell turns into an abnormal cancer cell due to genetic mutation. These abnormal cancer cells multiply quickly forming a tumor. They can also spread to nearby organs.

The type of cell which causes cancer determines the type of ovarian cancer. Below are the different types of ovarian cancers.

Epithelial tumors:  This is the most common type of ovarian cancer and counts for about 90 % of ovarian cancers. They begin in the thin layer of tissue which covers the outside of the ovaries.

Stromal tumors:  This type of ovarian cancers is rare. It begins in the hormone producing ovarian tissue.

Germ cell tumors: Such ovarian cancers start from the egg producing cells. They account for about 3% of ovarian cancer cases.

Age: Men over 40 are less fertile than younger men. Similarly, getting pregnant after the age of 45 years is rare for women.

Smoking: Smoking cigarettes or marijuana by either partner can decrease the likelihood of conceiving a child. In men, smoking causes low sperm count and erectile dysfunction. While in the case of women, smoking can cause miscarriage and birth defects.

Alcohol: Any consumption of alcohol should be avoided the female partner while trying to conceive or during the pregnancy. Heavy drinking by men can lead to infertility.

Risk Factors:

The risk factors of ovarian cancer are as follows:

Age: Most of the cases of ovarian cancer are known to occur after reaching menopause. It is rare for a woman below the age of 40 to have ovarian cancer.

Obesity: Various studies suggest that women having a BMI index of greater than 30 have a greater risk of developing ovarian cancer.

Pregnancy history: Women who have never been pregnant or been so only after the age of 35 are more prone to ovarian cancer.

Estrogen therapy: Women using only estrogen inducing hormones after reaching menopause are at a higher risk of ovarian cancer. The risk is comparatively lower in women who take combined estrogen & progesterone inducing medication.

Family history:  If your sister, mother or grandmother has ever had ovarian cancer then it increases the chances of you suffering from it as well.

Other risk factors include:

• Smoking
• PCOS (polycystic ovary syndrome)
• Smoking
• Fertility treatment
• IUDs (intrauterine devices)

Symptoms:

Ovarian cancer is hard to detect in its early stages, therefore during the early stages the patient may not feel any symptoms. Most of the symptoms are felt when the cancer spreads to abdomen & pelvic area. The symptoms include problems related to excretion, abdomen area and menstrual cycle.

Excretion:

• Feeling full without eating much.

• Low urine retention – constant urge to urinate.

• Frequent stomach upsets.

• Constipation

Abdominal area related problems:

• Bloating of abdomen and weight loss.

• Pain in the pelvis or abdomen.

Menstrual cycle & sex related:

• Menstrual changes

• Pain during sex

Diagnosis:

The earlier such type of cancer is detected the better it is for treatment.

Biopsy: A biopsy is the only way to ascertain ovarian cancer without any doubt.

Pelvic examination: The doctor may recommend a pelvic exam along with a Pap test to diagnose cancer.

Blood tests: Blood tests to detect a cancer antigen known as CA 125 may help the diagnosis.

Roma Index: Risk of Ovarian Malignancy Algorithm (ROMA), takes into consideration the Elecsys HE4 and Elecsys CA 125, and also factors in whether the woman has reached menopause. It provides a predictive probability of finding ovarian cancer while performing surgery.

Ultrasound: A transvaginal or pelvic ultrasound may be carried out in order to locate an ovarian lump

Treatment:

The treatment for ovarian cancer depends on how far the cancer has spread and patient’s general health.  Treatment usually involves a combination of surgery and chemotherapy.

Surgery

If the cancer has been detected early it may be possible to preserve the uterus. In such cases the surgeon may remove only one ovary and its fallopian tube. In other cases the surgeon may require to perform a total hysterectomy. In this procedure the surgeon will remove the uterus. The surgeon may also remove the ovaries, fallopian tube & the nearby lymph nodes as well.  The surgeon will also try to remove as much of cancer as possible from the abdomen region.

Chemotherapy

Post surgery, a patient may be treated with chemotherapy to kill any remaining cancerous cells. Chemotherapy is a form of cancer treatment, wherein, the patient is administered medicine and drugs through injections, abdominal opening or both.