Ovarian cancer refers to any cancerous growth that begins in the ovary. It is the fifth most common cause of cancer deaths in women and the tenth most common cancer among women in the United States. Early symptoms of ovarian cancer may include: pain in the pelvis, the lower abdomen, or the lower part of the body, back pain, indigestion, feeling full rapidly when eating, more frequent and urgent urination, pain during sexual intercourse, and changes in bowel habits, such as constipation.
As the cancer progresses, there may also be nausea, weight loss, breathlessness, tiredness and loss of appetite.
Causes
Ovarian cancer happens when cells divide and multiply in an unregulated way. However, exactly why this happens is not clear.
The following risk factors are linked to a higher chance of developing the disease:
Family history
Women with close relatives who have had ovarian or breast cancer have a higher risk of developing ovarian cancer, compared with other women.
Genetic screening can determine whether somebody carries certain genes that are associated with an increased risk.
Age
Most cases of ovarian cancer occur after menopause, and especially in women aged over 63 years. It is rare before the age of 40 years.
Reproductive history
Women who have had one or more full-term pregnancies, especially before the age of 26 years, have a lower risk. The more pregnancies they have, the lower the risk.
Breastfeeding may also decrease the risk.
Birth control
Using the contraceptive pill for at least 3 to 6 months appears to reduce the risk. The longer the pill is used, the lower the risk appears to be.
Infertility or fertility treatment
Fertility drugs have been linked to a higher risk of ovarian cancer, especially in women who used them for more than one year without becoming pregnant. Those who are infertile may also have a higher risk than those who are not, possible due to not carrying a pregnancy.
Breast Cancer
Women who have received a diagnosis of breast cancer have a higher chance of being diagnosed with ovarian cancer.
Hormone Therapy
HRT slightly increases a women's risk of developing ovarian cancer. The risk appears to increase the longer the HRT continues, and returns to normal as soon as treatment stops.
Obesity and Overweight
Obesity and overweight appear to increase the risk of developing many cancers. Ovarian cancer is more common in women with a body mass index (BMI) of over 30.
Gynecologic Surgery
Having surgery on the reproductive organs appear to reduce the risk of ovarian cancer.
Endometriosis
Women who develop endometriosis have an around 30 percent higher risk of developing ovarian cancer, compared with other women.
Symptoms
Symptoms may resemble those of other conditions, such as premenstrual syndrome (PMS), irritable bowel syndrome (IBS), or a temporary bladder problem.
The main difference between ovarian cancer and other possible disorders is the persistence and gradual worsening of symptoms.
Stages
If ovarian cancer is diagnosed, the next step is to identify its stage and grade. The stage of a cancer refers to the cancer's spread. There are different ways of staging cancer. The American Cancer Society uses a four-stage system.
Stage 1: Cancer cells affect only the ovary or ovaries and have not spread to another area.
Stage 2: The cancer has affected one or both ovaries and also other organs within the pelvis, such as the uterus, fallopian tubes, bladder, or rectum.
Stage 3: The cancer affects one or both ovaries and either the lining of the abdomen or lymph nodes in the back of the abdomen.
Stage 4: The cancer has spread to other parts of the body, outside the peritoneal cavity. This cavity includes the abdomen and the pelvis. Areas that may now be affected include the liver, spleen, and the fluid around the lungs.
Identifying the stage and grade will help the doctor to decide on the best treatment.
However, the stage and grade of ovarian cancer alone cannot predict how it is going to develop.
Diagnosis
A doctor will carry out a pelvic examination and check for any abnormalities in the uterus or ovaries. They will also check the patient's medical history and family history.
The following tests are used to help diagnose ovarian cancer:
Blood tests: Checking for elevated levels of a marker called CA-125.
Imaging tests: Transvaginal ultrasound, MRI, or a CT scan might be used.
Laparoscopy: A laparoscope, a thin viewing tube with a camera at the end, is inserted through a small incision in the lower abdomen. This will allow the doctor to see the ovaries and, if necessary, to take a tissue sample.
Colonoscopy: If there is constipation or bleeding from the rectum, a colonoscopy may be needed, to examine the large intestine, or colon.
Abdominal fluid aspiration: If the patient's abdomen is swollen, there may be a buildup of fluid, which can be examined by using a fine needle to remove some fluid through the abdomen.
Biopsy: The usual way to diagnose ovarian cancer is to remove the tumor or part of the tumor to examine for the presence of cancer cells.
Treatment
Treatment for ovarian cancer may consist of surgery, chemotherapy, radiation therapy, hormone therapy, or targeted therapy. Often more than one treatment is used.
The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient.
Surgery
In most cases, surgery is done to remove the cancer. It is often the first option. The extent of the surgery depends on the stage of the cancer.
Salpingo-oophorectomy: Surgery is done to remove the ovaries and fallopian tubes.
Hysterectomy: The surgeon removes the uterus and any surrounding tissue that is affected.
Lymph node dissection: The surgeon removes lymph nodes in the pelvis.
Cytoreductive or debulking surgery: If the cancer has spread beyond the pelvic area, the surgeon will reduce as much cancerous tissue as possible. This may include tissue from the gallbladder and other organs. This procedure can help relieve symptoms and make chemotherapy more effective.
Chemotherapy
Chemotherapy is the use of certain medications to destroy cancer cells. Cytotoxic medication delivers drugs that are poisonous to cells. These drugs prevent the cancer cells from dividing and growing. Chemotherapy is used to target cancer cells that surgery cannot or did not remove. Treatment usually involves 3 to 6 chemotherapy sessions, or cycles. These will be given 3 to 4 weeks apart, to allow the body time to recover. If the cancer returns or begins to grow back again, chemotherapy may be given again to shrink it.
