The Essential Guide to Ovarian Cancer – What You Need to Know for Empowered Health

Ovarian cancer

Ovarian Cancer is an abnormal and uncontrolled growth of cells in the ovaries or fallopian tubes. They eventually form a growth (tumor). If not caught early, cancer cells gradually grow into the surrounding tissues and may spread to other body areas.

Facts on Ovarian Cancer

1. Ovarian cancer is the fifth most common cause of cancer-related deaths worldwide and is the most lethal gynecological cancer.
2. The symptoms of ovarian cancer can be very vague, mainly when the disease is in its early stages. Be aware of signs of ovarian cancer like bloating, weight loss, fatigue, and unusual vaginal bleeding. Early detection is crucial.
3. Know Your Risk Factors: Understand factors like age, family history, and genetic mutations (BRCA1, BRCA2, Lynch syndrome) that increase your risk of ovarian cancer. Get screened with appropriate tests early if you have any risk factors.
4. There is no national screening program for ovarian cancer, as there isn’t a test that reliably picks up ovarian cancer at an early stage.

Causes and Risk Factors of Ovarian Cancer

The exact cause of ovarian cancer is not clear but includes factors like genetic mutations, hormonal imbalance, and environmental factors. Some of the risk factors of ovarian cancer are as follows:

1. Older age: The risk of ovarian cancer increases as you age. It is most often diagnosed in old, postmenopausal females.
2. Inherited gene mutation: A small percentage of ovarian cancers are caused by gene changes you inherit from your parents. These gene changes include BRCA1, BRCA2, or Lynch syndrome. These genetic mutations elevate the susceptibility not only to ovarian cancer but also to breast cancer and various other cancer types. People of Ashkenazi Jewish descent are more likely to have these gene mutations.
3. Family history: Having a first-degree relative, such as a mother, sister, or daughter, who had ovarian cancer increases your risk of developing the disease.
4. Never being pregnant or delayed childbearing: Pregnancy and childbirth may protect against ovarian cancer by reducing the number of ovulations and hormonal fluctuations. Women who never had children or had them after age 35 have a higher risk of ovarian cancer.
5. Hormone therapy: Taking estrogen or estrogen-progestin hormones after menopause for a long time may increase the risk of ovarian cancer. However, birth control pills may reduce the risk of ovarian cancer by suppressing ovulation and hormonal changes.
6. Obesity: Being overweight or obese may increase the risk of ovarian cancer by affecting the levels of insulin, estrogen, and inflammation in the body.
7. Smoking: Smoking may increase the risk of a type of ovarian cancer called mucinous ovarian cancer, which affects the cells that produce mucus.

Symptoms of Ovarian Cancer

There are often no apparent signs of ovarian cancer. The symptoms of ovarian cancer can be very vague, mainly when the disease is in its early stages. However, you may have one or more of the following symptoms:

1. Abdominal bloating
2. Difficulty eating or feeling full quickly
3. Changes in bowel or bladder habits, such as constipation, diarrhea, or frequent urination
4.  Back, abdominal, or pelvic pain
5. Indigestion
6. Menstrual irregularities
7. Tiredness
8. Pain during intercourse
9. Unexplained weight loss or weight gain.

Diagnosis of Ovarian Cancer

Ovarian cancer is often diagnosed at a late stage when the cancer has spread and is more challenging to treat. This is because the symptoms of ovarian cancer are not specific and can be mistaken for other conditions.

To diagnose ovarian cancer, your healthcare provider may perform a physical examination, blood tests, imaging tests, and a biopsy.

1. Physical examination: Your healthcare provider may insert gloved fingers or sterilized instruments inside your vagina to feel for any abnormalities in your ovaries or pelvis. They may also check your abdomen for any swelling or fluid buildup.

2. Blood tests: Your healthcare provider may order blood tests to check for gene changes, hormonal imbalances, or markers for ovarian cancer. A blood marker is a substance produced by cancer cells or the body in response to cancer. One of the most common markers for ovarian cancer is called Cancer Antigen 125(CA 125), but it is not specific to ovarian cancer. Over 80 percent of women with advanced ovarian cancer and 50 percent of those with earlier-stage ovarian cancer have elevated amounts of CA-125 in their blood. However, having a high level of CA-125 doesn’t necessarily mean you have ovarian cancer. Doctors don’t use tumor marker blood tests to screen people at average risk of ovarian cancer. These biomarkers are mainly helpful to assess ovarian cancer treatment and check the progression of the disease or recurrence.
Other markers include Human chorionic gonadotropin(hCG), Lactate Dehydrogenase (LDH), and Alpha-fetoprotein (AFP).

3. Imaging tests: Your healthcare provider may order different imaging modalities to look for tumors in your ovaries or other organs.

• Ultrasound: When an issue with the ovaries is suspected, an ultrasound is frequently the first test performed. It can be used to identify an ovarian mass and determine whether it is a cyst filled with fluid or a solid mass (tumor). It can also be used to examine the ovary closely to determine its size and internal appearance. It helps your physician determine which cysts or masses are more concerning.
• Computed tomography (CT) scan: Small ovarian tumors are complex for CT scans to detect. Still, larger tumors can be seen, and the scan may also reveal whether the tumor is invading adjacent structures. A CT scan can also show enlarged lymph nodes, indications that cancer has spread to the liver or other organs, or symptoms that your kidneys or bladder are being affected by an ovarian tumor.
• Magnetic resonance imaging (MRI) scans: While MRI scans are not frequently used to screen for ovarian cancer, they are beneficial for examining the brain and spinal cord, which are potential cancer metastases.
• X-ray: To find out if ovarian cancer has spread (metastasized) to the lungs, an X-ray could be performed.
• Positron emission tomography (PET) scan: Your doctor may use this test if you already have a cancer diagnosis to determine whether the disease has spread to your lymph nodes or other body parts. If your doctor believes the cancer may have spread but is unsure of the exact location, a PET scan may be helpful.

4. Laparoscopy and tissue biopsy: A laparoscopy can help doctors confirm the cancer’s stage or how far the tumor has spread and can help plan surgery or other treatments by giving them an image of the organs. To perform biopsies, medical professionals can also insert tiny instruments through the laparoscopic incision(s). Removing a portion of growth and examining it in a lab is the only way to ensure the growth is cancerous. The most common method for performing a biopsy for ovarian cancer is to remove the tumor during surgery.

Staging of Ovarian Cancer

Staging in ovarian cancer is a way for doctors to figure out how far the cancer has spread in the body. It helps determine how severe the cancer is and how best to treat it. The stages range from I to IV, with I being the earliest and IV being the most advanced. The treatment of ovarian cancer depends on the type, stage, and grade of the cancer, as well as your age, overall health, and preferences.

Treatment of Ovarian Cancer

The main ways to treat ovarian cancer are surgery and chemotherapy:

1. Surgery: When treating ovarian cancer, the first step is often surgery. The goal is to take out as much of the cancer as possible and see how far it has spread. During surgery, doctors might remove one or both ovaries, fallopian tubes, the uterus, lymph nodes, and other parts affected by cancer. This operation is called a hysterectomy and bilateral salpingo-oophorectomy. Sometimes, for younger women who want to have kids later, doctors may do a surgery that removes only the tumor, saving fertility. But this is only for early-stage and low-grade ovarian cancer.

2. Chemotherapy: Another way to treat ovarian cancer is through chemotherapy. It uses medicines to either kill or slow down the growth of cancer cells. Chemotherapy can happen before or after surgery, or it can be the primary treatment for advanced ovarian cancer. The medicines are given either through a vein (IV) or directly into the peritoneum of the abdomen. Chemotherapy drugs can cause side effects, such as nausea, vomiting, hair loss, fatigue, infection, bleeding, and nerve damage.

Other Treatment
Besides surgery and chemotherapy, there are other treatments. These include hormone therapy, targeted therapy, immunotherapy, or radiation therapy.

• Hormone therapy uses medicines to block or lower the hormones that make some types of ovarian cancer grow.
• Targeted therapy uses medicines to focus on specific things in cancer cells, like gene changes or proteins, to stop them from growing.
• Immunotherapy uses medicines to help the body’s immune system fight and destroy cancer cells.
• Radiation therapy uses solid solid rays or particles to damage the DNA of cancer cells and stop them from growing. These treatments are not used as much for ovarian cancer, but sometimes they can help in certain situations or as part of experiments called clinical trials.

Screening for Ovarian Cancer

There is no national screening program for ovarian cancer in the United States. This is because there isn’t a test that reliably picks up ovarian cancer at an early stage.

Questions for your doctor

1. What are the risk factors for ovarian cancer, and do they apply to me?
2. What stage of ovarian cancer do I have and what is its prognosis?
3. What are my treatment options and which one is the best for me?
4. How will surgery affect my fertility and sexual function?
5. What are the chances of recurrence of the disease after treatment?
6. Are there specific lifestyle changes or dietary recommendations that can support my treatment?

References

1. About ovarian cancer: Ovarian cancer overview (no date) Ovarian Cancer Overview | American Cancer Society. Available at: https://www.cancer.org/cancer/types/ovarian-cancer/about.html
2. Ovarian cancer | ovarian cancer symptoms (no date) MedlinePlus. Available at:https://medlineplus.gov/ovariancancer.html