ovarian cancer

Facts about ovarian cancer 

Q 1 what is ovarian cancer?

Ovarian cancer starts in the cells of the ovary. They are located in a woman’s pelvis, on both sides of the uterus (womb). They are two in number. They are found only in women. The ovaries have 2 main functions. They produce female sex hormones and mature eggs.

The eggs travel from the ovaries through the fallopian tubes into the uterus where the fertilized egg settles in and develops into a fetus. 

Q 2 What causes ovarian cancer? 

  • Women who have their first full-term pregnancy after age 35 or who never carried a pregnancy to term 
  • Family history of certain cancers such as having a family history of ovarian cancer, breast cancer, or colorectal cancer
  • Personal history of breast cancer
  • Hormone replacement therapy using estrogens alone or with progesterone after menopause have an increased risk of developing ovarian cancer especially if used more than 5 years. 
  • Smoking

Factors that can lower the risk of ovarian cancer

  • Pregnancy and breastfeeding
  • Birth control
    • Women who have used oral contraceptives (also known as birth control pills or the pill) have a lower risk of ovarian cancer. The risk is lower the longer the pills are used. Other forms of birth control such as tubal ligation (having fallopian tubes tied) and short use of IUDs (intrauterine devices) have also been associated with a lower risk of ovarian cancer.

Q 3 What are the types of ovarian cancer?

  • A non-cancerous tumor of the ovary

Non-Cancerous tumors are also called benign tumors. A benign tumor is a growth that does not spread to other parts of the body. Non-cancerous tumors are not usually life-threatening. 

Benign tumors are usually treated by surgery to remove the part of the ovary that contains the tumor or the entire ovary.

  • A cancerous tumor of the ovary 

They can grow into and destroy nearby tissue. It can also spread to other parts of the body. Cancerous tumors are also called malignant tumors.

Types of non- cancerous tumor of the ovary 

  • Cystadenoma
  • Adenofibroma
  • Cystadenofibroma. 
  • Thecoma
  • Fibroma
  • Fibrothecoma 
  • Mature cystic teratomas or dermoid cysts
  • Functional Cysts

Types of cancerous tumors of the ovary 

  • Epithelial tumors

Epithelial tumors start in epithelial cells, which make up the outer layer of the ovary (called the epithelium). It is the type of cancer that is most commonly called “ovarian cancer.” 

  • Serous carcinoma is the most common type of cancerous epithelial tumor. 
  • Mucinous carcinoma 
  • Endometrioid carcinoma 
  • Clear cell carcinoma 
  • Malignant mesodermal mixed tumors (also called carcinosarcoma or MMMT) 
  • Tumors of borderline malignancy

This category is between cancerous and noncancerous types. 

These tumors are also known as tumors of low malignant potential, borderline tumors

  • Serous borderline tumors 
  • Mucinous borderline tumors 
  • Endometrioid borderline tumors 
  • Clear cell borderline tumors 
  • Brenner (transitional cell) borderline tumors 
  • Stromal tumors

Also called sex cord-stromal tumors. They start in the cells of the stromal tissues that support the ovary. 

  • Granulosa cell tumors are the most common type of malignant stromal tumors. 
  • Gynandroblastomas 
  • Steroid cell tumors 
  • Germ cell tumors

Germ cell tumors start in the cells that make the eggs (called germ cells) in the ovary. They usually develop in young women in their teens and 20s.

  • Dysgerminomas are the most common cancerous ovarian germ cell tumor
  •  Yolk sac tumors 
  • Immature teratomas  
  • Embryonal 

Q 4 What are the symptoms of ovarian cancer? 

The most common symptoms include:

  • Pelvic or abdominal pain
  • Trouble eating or feeling full quickly
  • Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)
  • Fatigue (extreme tiredness)
  • Back pain
  • Pain during sex
  • Constipation
  • Changes in a woman’s period, such as heavier bleeding than normal or irregular bleeding
  • The buildup of fluid in the abdomen (called ascites) or in the legs (called lymphedema)

It’s important to remember that these symptoms can be caused by many different conditions and are not usually the result of cancer.

Q 5 How is ovarian cancer diagnosed? 

  • Health history:  family history of colon or breast cancer, infertility
  • Physical examination:

Pelvic and rectal examination to check the uterus, vagina, ovaries, bladder, and rectum for any unusual changes. Feel the abdomen for lumps, bloating, or enlargement of organs such as the liver or spleen.

  • Ultrasound is the first investigation to be done
  • Blood cancer marker tests: CA125, CEA, b-HCG, AFP, and LDH 
  • CT scan/ MRI scan is done to look for local spread of disease 

Q 6 What is ovarian cancer staging?

Staging is a measurement of how far cancer has spread.

The most common staging system for ovarian cancer is the FIGO system.

Ovarian cancer is staged during surgery to remove the ovaries and as much cancer that has spread as possible. All tissues removed will be tested for cancer. The stage is based on the results of the tests.

Stage 1

  • Cancer is limited to one or both the ovary with or without cancer cells in ascites or peritoneal washings

Stage 2

  • Cancer has grown into the surrounding lower part of pelvic organs such as into the uterus, fallopian tubes, rectum or urinary bladder with or without cancer cells in ascites or peritoneal washings

Stage 3

  • Cancer has spread to areas outside the pelvis (in the upper abdomen) with or without cancer cells in ascites or peritoneal washings

Stage 4

  • Cancer has spread to other parts of the body (called distant metastasis) outside the abdomen and pelvis.

Q 7 How is ovarian cancer treated? 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, or chemotherapy
  • Your personal preferences
  • Surgery

Surgery is the main treatment for all stages and types of ovarian cancer.

A total hysterectomy and bilateral salpingo-oophorectomy is the most common surgery. This operation removes the uterus, ovaries, and fallopian tubes. A surgeon may also remove nearby lymph nodes, momentum, and any other issues that look abnormal at the time of surgery.

  • Chemotherapy

Chemotherapy is offered before or after surgery to treat some types and stages of ovarian cancer. The decision depends upon local spread of disease in the body and general condition of the patient 

  • Targeted therapy

Some women with advanced ovarian cancer can be treated with targeted therapy, with or without chemotherapy.

  • Hyperthermic Intraperitoneal Chemotherapy (HIPEC)  

It is used in advanced cases of ovarian cancer especially when cancer has spread to the inner lining surfaces of the peritoneal (abdominal) cavity.

The surgeon will remove all visible cancer that can be removed throughout the peritoneal cavity. This is known as cytoreductive surgery. Following cytoreductive surgery, in the operative setting the surgeon will administer HIPEC treatment. HIPEC means that the solution containing chemotherapy is heated to a temperature greater than normal body temperature and it is delivered into the abdominal cavity.