This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 21 Jun 2020

All about Ovarian Cancer

Ovarian cancers start in the cells of the ovaries in women.

All women have a pair of ovaries that stem from the uterus and present on its sides. The location is below the waist. These will be roughly 3cm long, 2cm wide, and 1.5 cm thick. In short, almost the size of a big almond. It produces and stores ova or eggs needed for reproduction. It also releases female sex hormones like estrogen and progesterone.

Ovarian cancers begin when some cells in the ovaries divide more than others. These cells also go on to live for a longer time than is needed.

Your risk of the disease is more as you age. Most of those who have it are above sixty. Also, the risk is more in those who have never got pregnant.

Ovarian cancers show very few signs in its early stages. As it grows, you will have a few problems. You will have abnormal bleeding or discharge from the vagina, stomach pain or cramps, indigestion, etc.

Early-stage ovarian cancers respond well to treatments. But as the stage advances, one will need aggressive treatments.

What causes ovarian cancer?

The exact cause of ovarian cancers is not very clear. Some changes in the genes of some of the cells may be the reason. The changes in the genes that tell the cells about how they should divide may cause these cells to divide faster. Also, changes in the genes that tell the cells about how long they should live will make them live longer.

But how exactly these gene changes happen is not clear. But there are a few things that can increase your risk of ovarian cancer. 

What are the risk factors of ovarian cancer?

A risk factor can be anything that will increase your chance of getting a disease. You can avoid some of these, but there are some others that you cannot avoid.

Some factors can increase your risk of ovarian cancers. These include

  • Getting old- Your risk increases as you age. Most of those who have it are above 60
  • Having a close relative with the disease
  • Getting your periods too early, say before 12 years
  • Having your menopause after the age of 55
  • Being overweight or obese
  • Having a history of ovarian cancer before
  • Having defects in some genes 
  • Having no children 

 

Some factors that can reduce the risk include

  • Having many children
  • Having your first child before 30
  • Using oral birth-control pills 

 

You may have cancer without any of these risk factors, and you may not have it even if you have a few risk factors.

What are the symptoms of ovarian cancer?

In its early stages, ovarian cancers have very few signs. As the disease progresses, you will have more severe symptoms. Some of the first signs are

  • Unusual bleeding or discharge from the vagina
  • Pain in and around the pelvis 
  • Feeling of nausea
  • Feeling of gas in the abdomen

 

But as cancer grows and spreads, you will have other symptoms as well. These include

  • Feeling tired all the time
  • Swelling around the abdomen
  • Feeling less hungry
  • Feeling full even with very little food
  • Problems with passing urine
  • A change in your bowel habits
  • Shortness of breath

Diagnosis of ovarian cancer

If your doctor wants to rule out or confirm ovarian cancer, you will have a few tests.

  • Pelvic examination- Your doctor will insert a gloved finger through your vagina to feel for any lumps or growths in the area.
  • Ultrasound, CT, MRI, PET scans- All these tests will help to create a picture of the ovaries and other organs around it. It will help the doctor to know about the size of the tumor and also its spread.
  • Blood tests- You will have a cancer antigen CA 125 blood test. It helps to detect the presence of some proteins in the blood with a link to ovarian cancer.

Types of ovarian cancer

There are three main types of ovarian cancers.

  1. Epithelial tumors – These are the most common ovarian tumors and affect the cells on its surface. Some of these tumors will be benign, as well.
  2. Germ cell tumors- These are tumors of the cells that produce ova or eggs. It is more common in young women. Some of these tumors are benign.
  3. Stromal cell tumors- These are tumors that occur in the cells that hold the ovaries together and produce female hormones. It occurs very rarely than others.

Stages of ovarian cancer

There are four stages of ovarian cancers.

  • Stage I -The cancer is confined to one or both of the ovaries. There is no spread to the abdomen, pelvis, or lymph nodes.
    • Stage IA – Cancer is in one ovary
    • Stage IB – Cancer is in both ovaries.
  • Stage II - Cancer has spread to the fallopian tubes or uterus apart from the ovaries
    • Stage IIA – The cancer is in the fallopian tubes or uterus
    • Stage IIB – Cancer has spread to other pelvic organs
  • Stage III - The cancer is in one or both the ovaries. Cancer has spread beyond the pelvis and involves the lining of the abdomen. The lymph nodes in the back of the abdomen are also involved.
    • Stage IIIA – Microscopic cancer cells found in the upper abdomen or lymph nodes
    • Stage IIIB – Tumours less than 2 cm in size present in the upper abdomen or lymph nodes
    • Stage IIIC – Tumours more than 2 cm in size found in the upper abdomen or lymph nodes
  • Stage IV -Cancer has spread to distant organs like spleen, liver, lungs, etc.
    • Stage IVA – There are cancer cells is in the fluid around the lungs
    • Stage IVB – Cancer has spread to the other organs

 

Your doctor needs to know the stage of the disease to plan the treatment. 

Treatments will vary according to the stage as well as the spread of the disease.

Treatment for ovarian cancer

SurgeryThe type of surgery you will have will depend on the size of the tumor. If it is small, the surgeon will remove only the tumor. In large cancers, the surgeon may remove the whole of the ovary along with the fallopian tube. In those in whom both the ovaries have cancers, the surgeon will remove both. If cancer has spread to the uterus, the surgeon will remove it as well. For advanced-stage cancers, the surgeon will aim to remove as much of the tumor as possible.

It is possible to remove a few eggs from the ovaries before surgery for women of childbearing age who wish to get pregnant. The surgeon will also help to freeze and store these eggs for later use. It is possible to use these eggs for IVF techniques. But this is of use only for those in whom the uterus remains unaffected by cancer.

Chemotherapy: It uses drugs to treat cancers. You will have it as pills or as injections to your veins. You will have the treatment for a few days together called a 'cycle' with a period of rest in between the cycles. The number of cycles you will have depends on the stage of the disease.

Targeted therapyIt also uses drugs to treat cancers. The main advantage is that there will be fewer side effects as its target and kill only the cancer cells. The drugs target them with the help of a few markers in the cells. But it is not suitable for all types of cancers.

Radiation therapy: It uses high energy x-rays or other particles to destroy cancers. The x-rays will be from an external source. The x-rays or particle beams will target the tumor with precision to destroy it. You may have this before surgery to shrink the tumor or to kill any cancer cells that remain after treatment. In advanced cancers, it helps to provide relief from the symptoms

Ovarian cancer treatment In India
Ovarian cancer treatment In India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 21 Jun 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
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