Ovarian cancer is a condition in which there is an uncontrolled growth and multiplication of cells in the ovary. Ovaries are the primary reproductive glands in females that produce eggs. They also produce hormones that control the menstrual cycle and pregnancy..
Most of the symptoms are recognizable at Stage III or IV and include abnormal vaginal discharge, pain or pressure in the pelvic area, abdominal pain, bloating, and constipation.
The common risk factors include advancing age, family history, and breast cancer susceptibility gene (BRCA) mutations. The incidence of ovarian cancer has been increasing substantially among younger females, due to increasing prevalence of obesity, metabolic syndrome, and not having children either by wish or infertility.
The treatment and prognosis of ovarian cancer depends on the location, size, stage, and extent of cancer spread, as well as the overall health of the patient. Debulking surgery that comprises removal of ovaries, fallopian tubes or uterus depending upon the stage is the mainstay treatment. Along with surgery, chemotherapy, radiation therapy, hormonal therapy immunotherapy and/or their combinations are given.
The outlook of ovarian cancer is not very positive due to late appearance of symptoms and absence of specific screening factors.
Adults between 55 to 64 years of age
Women
Ovary
Fallopian tube
Uterus
Stomach
Small intestine
Large intestine
Lymph nodes
Lungs
India: 43,886 (2020)
Worldwide: 313,959 (2020)
Metastatic gastrointestinal carcinoma
Ovarian torsion
Peritoneal cyst
Retroperitoneal mass
Rectovaginal pelvic exam
Blood tests: CA125 and human Human epididymis protein 4 (HE4)
Laparoscopy
Biopsy
CT scan of abdomen, pelvis and chest
Debulking surgery
Radiation therapy
Chemotherapy: Paclitaxel, Altretamine, Capecitabine, Cyclophosphamide & Gemcitabine
Hormonal therapy: Goserelin, Leuprolide, Letrozole & Anastrozole
Targeted drug therapy: Bevacizumab, Olaparib & Rucaparib
The symptoms of ovarian cancer are usually missed at an early stage due to their resemblance with other medical conditions. Most of the following symptoms are recognizable at later stages of the condition:
Abnormal vaginal discharge
Pain or pressure in the pelvic area
Abdominal pain and fullness
Early satiety
Urgency to urinate
Increased frequency of urination
Fatigue
Loss of weight
Persistent or recurrent genital pain that occurs just before, during or after sexual intercourse
Menstrual abnormalities
Vaginal bleeding
Before knowing about the exact cause of ovarian cancer, it is important to understand the structure and function of ovaries.
Ovaries are the primary reproductive glands in females that produce eggs. Women have two ovaries located on each side of their uterus. The egg produced by the ovaries travels through the fallopian tube and fuses with the sperm. This fertilized egg travels further and settles in the uterus. The uterus nourishes the developing fetus prior to birth.
The ovaries also produce estrogen and progesterone – the two main reproductive hormones of the women.
Ovaries comprises three kinds of cells which are:
Cancer is a disease in which some of the body's cells grow uncontrollably and spread to other parts of the body. Cells of any part of the body can become cancerous.
The exact cause of ovarian cancer is not known. However, there are certain theories behind the pathogenesis of ovarian cancer:
Ovarian cancer are of four types based upon the cells from which they arises:
They are the most commonly observed ovarian cancer accounting for 85 to 90% of all observed ovarian cancer. This cancer originates from the surface of the ovary and extends first to the lining of the pelvis.
The cancer is then spread to the abdomen and other parts of the body. Nearly 70% of these types of cancers are usually diagnosed in advanced stages.
There are following types of epithelial ovarian cancer:
High-grade serous ovarian carcinomas (HGSOC): These types of cancer spread at a faster rate and usually remain undiagnosed in the initial stages.
Endometrioid carcinoma: This type of cancer spreads to the endometrium (inner lining of the uterus)
Low-grade serous ovarian carcinoma (LGSOC): LGSOC spreads slowly and usually affects people at a younger age (between 45 and 57).
Mucinous carcinoma: In this, tumor (mass of cells) is made up of cells coated in mucus.
Ovarian clear cell carcinoma (OCCC): This cancer is characterized by the presence of a pelvic mass which causes symptoms such as abdominal pain and bloating.
Primary squamous cell carcinoma (SCC) of the ovary: They typically develop from noncancerous) conditions and respond well to treatment.
This type of cancer originates from reproductive cells of the ovaries. This cancer is rarely observed and usually affects teenagers.
These cancers arise from connective tissue cells of the ovaries. These represent about 1% of all ovarian cancers. This type of cancer is often found in the early stages. Vaginal bleeding is one of the most common symptoms of stromal cancer.
It is an extremely rare ovarian cancer whose exact origin is still not known. It usually presents in younger females with features of hypercalcemia.
Ovarian cancer has four stages:
Stage 1: It is the earliest stage in which cancer is found in both the ovaries.
Stage 2: In this, the cancer has spread to the pelvic region.
Stage 3: It is the advanced stage in which cancer has spread to the areas of the abdomen.
Stage 4: It is the most advanced stage in which cancer has spread beyond the abdomen to other parts of the body, such as the lungs.
Various risk factors are associated with an increased chance of colon cancer:
Mutations (changes) in BRCA1 and BRCA2 genes significantly increase the risk of developing ovarian cancer.
Get tested for BRCA1 and BRCA2 Gene Sequencing test
The risk of ovarian cancer increases with advancing age. Approximately half of the women diagnosed with ovarian cancer are above 63 years. It is seen that the risk increases steeply from around 45 years.
The following races are more prone to ovarian cancer due to the higher prevalence of BRCA1 mutations:
Ovarian cancer runs in families. It is considered as the strongest risk factor. A positive family history of breast, ovarian, and fallopian tube cancer increases the risk of ovarian cancer.
Individuals having a history of breast cancer, uterine cancer, and colorectal cancer have higher chances of contracting ovarian cancer too. The risk is higher in women diagnosed with breast cancer at a younger age.
Screening tests help in the early detection of cancer. This enables timely treatment, reduces additional treatment costs due to advanced disease and substantially improves the chances of survival. Screen yourself for different cancers.
Women whose menstrual cycle starts early (age <12 years) are at a higher risk of developing ovarian cancer. This is due to the more number of ovulatory cycles.
Women whose menopause hits late (age > 50 years) are also more likely to have ovarian cancer.
Here are 7 common signs and symptoms of menopause.
It is a medical condition in which tissue from the lining of the uterus starts to grow outside. This condition slightly increases the risk of ovarian cancer.
Women who have never given birth to a child either by choice or due to some medical issues are more prone to ovarian cancer.
Women who take HRT, especially estrogen for a longer duration (10 or more years) have an increased risk of ovarian cancer. This risk is even more in postmenopausal women.
Note: HRT is helpful for many women with menopausal symptoms. So, it is always advisable talking to your doctor about the risks and benefits of taking HRT.
Diabetes increases the risk of several cancers including ovarian cancer. Glucose allows tumors to grow larger and cancer cells to reproduce faster. Diabetics that are on insulin therapy are even more likely to develop ovarian cancer later in life.
Studies suggest that obesity in early adulthood increases the risk of ovarian cancer.
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There are several genetic conditions that can cause ovarian/fallopian tube cancer, including:
Lynch syndrome
Peutz-Jeghers syndrome (PJS)
Nevoid basal cell carcinoma syndrome (NBCCS)
Li-Fraumeni syndrome and ataxia-telangiectasia
Several studies also suggest the role of smoking in the development of ovarian cancer, especially epithelial cancers. The risk increases with the duration of smoking.
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The tests that help detect ovarian cancer are:
A rectovaginal exam examines and identifies abnormalities in the pelvic area, including the cervix, uterus, ovaries, fallopian tubes, anus, and rectum.
In this, an ultrasound wand is put into the vagina to examine the uterus, fallopian tubes, and ovaries. It helps in the identification of any mass but cannot confirm its cancerous nature.
In this, the ovaries are examined through a thin tube inserted through a small cut in the abdomen.
In biopsy, a small amount of tissue is studied under a microscope. The tissue is collected with the help of a needle from the ovaries or from a sheet of fatty tissue inside the abdomen called the omentum.
Sometimes, a CT or ultrasound scan is used to guide where to put the needle. This is called an image guided biopsy. It helps in identifying the type, grade and stage of cancer.
This imaging test uses X rays to generate a detailed picture of the internal organs. CT scans of the abdomen, pelvis, and chest are done to check the spread of cancer.
There is no sure shot way to prevent ovarian cancer. However, there are certain factors that are known to reduce its risk. Although, these are not recommended for every woman as all have different risks and benefits.
Studies suggest that women who have children are less likely to develop ovarian cancer. The more full-term pregnancies a woman has had, the lower their risk of ovarian/fallopian tube cancer.
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It is seen that women who take oral contraceptives for at least 3 years have 30 to 50% lesser chances of developing ovarian cancer. This effect may last for 30 years after stopping pills. Intrauterine devices (IUDs) have also been linked to a decreased risk of ovarian cancer.
Women who breastfed for a year or more are less prone to ovarian cancer. The risk is reduced further with the increase in duration of breastfeeding.
Here are 7 things you must be aware about breastfeeding.
Women who have had a hysterectomy (removal of uterus) may have a lower risk of developing ovarian/fallopian tube cancer.
Tubal ligation (tying of fallopian tubes) in order to avoid pregnancy also decreases the risk of ovarian cancer.
Cancer requires multispecialty comprehensive care. Doctors who take care of patients with ovarian cancer and help in diagnosing and formulating a treatment plan are:
Gynecologists specialize in diagnosing and treating diseases of the female reproductive system. They help in diagnosing ovarian cancer and refer to the superspeciality doctors.
Gynecologic oncologists are doctors who have been trained to treat cancers of a woman’s reproductive system.
Surgeons help in operative procedures that are essential for almost all ovarian cancers.
Medical oncologists help in managing ovarian cancer through drugs.
In case you are facing any health concerns, consult our team of esteemed doctors.
The treatment of ovarian cancer consists of surgery and medications. The cycles of medications and the type of surgery depend upon the stage of cancer.
The major aim of debulking surgery is to remove the tumor.
The unilateral salpingo-oophorectomy (removal of one ovary along with the fallopian tube) is usually done in the early stage of ovarian cancer.
However, an advanced-stage ovarian cancer may require the removal of both ovaries and fallopian tube along with uterus (hysterectomy/bilateral salpingo-oophorectomy or BSO).
Sometimes, spleen, gallbladder, a part of the stomach, liver, pancreas, a part of the colon is also removed depending upon the spread of cancer.
It uses high-energy X-rays to kill cancer cells. The procedure is painless and each session takes a few minutes.
It involves the use of medications to kill cancer cells. Chemotherapy is mostly useful to kill small-sized tumors that have left even after surgery.
In most cases, a combination of drugs are used as it seems to work better for ovarian cancer.
These drugs are usually given as an IV (put into a vein) every 3 to 4 weeks. The duration of chemotherapy depends upon the stage and type of ovarian cancer.
The drugs used during chemotherapy are:
It involves the use of hormones to treat cancer. It is mainly used to treat ovarian stromal tumors. The class of drugs used in hormonal therapy are:
Luteinizing hormone-releasing hormone (LHRH) agonists: These drugs block the production of hormone estrogen by the ovaries. They are usually injected every 1 to 3 months. The common examples are goserelin and leuprolide.
Tamoxifen: The primary function of tamoxifen is to reduce the level of female sex hormone, estrogen. This restricts the growth of cancer cells.
Aromatase inhibitors: These drugs block an enzyme known as aromatase which converts other hormones into estrogen. The drugs that belong to this category are letrozole, anastrozole, and exemestane.
Targeted therapy targets specific proteins that help in the growth, division, and spread of cancer cells. The examples include:
In this, the immune system is modified to destroy cancer cells. This is done through following medications such as pembrolizumab.
Cancer requires conventional medical care. However, some specific additions to the diet can aid in managing some associated symptoms of ovarian cancer and its treatment.
However, make sure to take consent from your doctor before starting any of these:
1. Shiitake mushrooms: This is also known as medicinal mushroom due to the presence of an active ingredient called lentinan. Lentinan inhibits the growth of certain types of cancer including ovarian cancer.
Its extract can be prepared by boiling mushrooms in water which can later be consumed by straining.
2. Soybean: Isoflavones present in soybean help in inhibiting the growth of ovarian tumor. They also help in curing the body from the harmful impacts of chemotherapy and other conventional cancer treatment.
3. Peppermint (pudina) tea: It helps in relieving abdominal pain which is the most characteristic symptom of ovarian cancer. It can be easily prepared by boiling around four or five torn peppermint leaves into the water.
4. Ginger tea: It helps in relieving symptoms such as pain and cramping that is associated with ovarian cancer. Studies also suggest that ginger stopped the growth of ovarian cancer cells.
It can be prepared by boiling a few slices of ginger with water. Lemon juice and honey can also be added to enhance flavor.
Untreated ovarian cancer can lead to:
Ascites (accumulation of fluid between the layer of abdomen and pelvis)
Obstruction in the small or large intestine
Pleural effusion (build-up of fluid between the tissues that line the lungs and the chest)
Bladder obstruction (blockage in the urinary system)
Nutritional disorders
Ovarian cancer cannot be treated and managed without surgery and chemotherapy. However, certain therapies help in managing symptoms and help cope with the side effects of chemotherapy. They also aid in relieving stress and improve overall quality of life.
It is a form of physical activity that helps in increasing mental concentration through breathing control. It helps in reducing stress. It also alleviates pain through improving flexibility, strength, and balance.
It is a very ancient technique that is used in China and Japan. In this, fine metal needles are inserted into the skin at specific points. This helps in alleviating symptoms of ovarian cancer such as pain. It also helps in coping with the side effects of chemotherapy.
Sometimes, needles are stimulated by electricity which is known as electro-acupuncture.
This technique is used to reduce stress. It involves methods such as quiet sitting, progressive muscle relaxation, repetition of a particular word during inhale and exhale. Practicing for 10-20 minutes daily helps in providing emotional stability.
The technique records the responses of the individuals such as heart rate, muscle tension, brain activity etc after stimulation. It helps in alleviating physical and emotional symptoms through analyzing the triggers.
In this, the practitioner hallucinates the person to create some pictures in the mind. These mental images calms down the person and helps in relieving stress.
Whether you are a patient who has been diagnosed with ovarian cancer or care for someone who has the disease, it will have a large impact on their lives. Things that the caregiver and the patient should take into consideration include:
Hydration is very important to curb the most important symptoms of ovarian cancer such as diarrhea and constipation. This also helps in smooth digestion and helps in reducing gastrointestinal symptoms.
Massage gives relaxation and helps in coping with the stress and pain associated with ovarian cancer.
Every cancer therapy has numerous physical changes. It is important to discuss every little change happening in your body to your doctor. This helps doctors in modulating your treatment regimen to alleviate the symptoms. Continuous follow up even after the end of therapy is recommended to track long term effects and relapse of cancer.
Every cancer therapy has side effects which may vary depending on various factors. It is completely common to have a fear of side effects. However, there are various options available to manage the side effects effectively. These include:
Take an active role in your treatment plan. This helps you in knowing about possible side effects well in advance.
Talk about the side effects to your doctor that may help you in alleviating and preventing the side effects.
Maintain a journal in which you can write about your experiences.
Talk about your fear to your loved ones. This will reduce your anxiety.
Diagnosis of cancer can have emotional and social effects on the patient. This includes stress, anxiety, depression, sadness, and a feeling of helplessness. Some of the easy steps that can be taken to manage your emotional health is to:
Engage yourself in activities you like such as crafting, painting, and singing.
Do regular exercise as it helps in reducing stress.
Join any support group either online or offline.
Ask help from a professional counselor.
Meet someone who is undergoing the same type of treatment.
Listen to a podcast related to survival stories of the patients with colon cancer
Cancer treatment can be very expensive and this can give anxiety and stress to the patient and his/her family. This can be managed through:
Understanding the cost of therapy well in advance.
Communicating any financial issues with the cancer team. This will help doctors to look for affordable alternatives.
Finding financial support resources though oncology social workers, oncology nurses, doctors, or online.
Taking help through your health insurance partners.
Follow-up care even after the completion of treatment is required to check relapse, managing long-term side effects and overall health. The first 5 years after treatment are very crucial for ovarian cancer. Follow-up care includes regular physical examinations, tests, and counseling. Cancer rehabilitation is also required to give:
Physical therapy
Emotional counseling
Managing the long-term pain
Nutritional guidance
Cancer can drain a person physically and mentally. Gaining knowledge and awareness about cancer and the myths that surround it is necessary to enable timely diagnosis and treatment.
The surgical removal of both the ovaries and uterus help prevent ovarian cancer in high-risk women. This is usually adopted by women after giving birth to all of the children they intend to have.
