Ovarian cancer is one the deadliest gynecological cancers occurring in females. Incidence-wise it is the eighth most common cancer worldwide and the seventh most common cause of cancer-related death in women.
The ovary is a female genital organ that is involved in the production of eggs for reproduction and hormone production such as estrogen and production. There are two ovaries present one on each side of the uterus in the pelvis.
In this article, we will discuss the various aspects of ovarian cancer including its symptoms in early and late stages, various causes for cancer formation and additional risk factors, diagnostic modalities, treatment methods, and also the survival rates in patients affected with cancer at various stages.
Ovarian cancer causes and Risk factors
Ovarian cancer has multifactorial causes and risk factors, and the exact cause often remains unknown in an individual patient.
various causes and risks factors involved in causing cancer in ovaries are following:
- Age: Ovarian cancer is more common in older women, with the majority of cases diagnosed in women over the age of 50. The risk increases with age.
- Genetic Mutations: Inherited gene mutations such as BRCA1 and BRCA2 increase the risk of developing ovarian cancer. Women with these mutations have a higher chance of developing ovarian and breast cancers.
- Family History: A family history of ovarian, breast, colorectal, or uterine cancer increases the risk of ovarian cancer. The risk is higher if multiple family members on the same side are affected.
- Reproductive History: Certain reproductive factors can influence ovarian cancer risk:
- Early Menstruation/Late Menopause: Starting menstruation at an early age (before 12) or reaching menopause at a later age (after 55) increases the risk.
- Nulliparity: Women who have never been pregnant have a slightly higher risk.
- Late Pregnancy: Women who have their first full-term pregnancy after age 35 may have an increased risk.
- Hormonal Factors: Hormonal therapies, such as estrogen replacement therapy without progesterone, used for menopausal symptoms may slightly increase ovarian cancer risk when used long-term.
- Endometriosis: Women with endometriosis, a condition where uterine tissue grows outside the uterus, may have an increased risk of certain types of ovarian cancer.
- Obesity: Being overweight or obese is associated with a higher risk of developing ovarian cancer.
- Personal History: Women who have had breast, colorectal, or uterine cancer are at a higher risk of developing ovarian cancer.
- Smoking: Smoking has been linked to an increased risk of mucinous ovarian cancer.
Knowing about risk factors can help an individual to stratify her own risk and also can help to modify factors which can reduce the risk of encountering cancer later.
Ovarian cancer symptoms
Like many other cancers, Ovarian cancer is not associated with symptoms in early stages.
Symptoms suggestive of early stage Ovarian cancer include
- Abdominal bloating
- Pelvic or abdominal pain
- Difficulty eating or feeling full quickly
- Changes in bowel habits (constipation or diarrhea)
- Changes in urinary habits (urgency or frequency)
- Fatigue
- Indigestion or heartburn
- Back pain
- Pain during sexual intercourse
- Menstrual changes
Advanced stage is associated with symptoms due to local extension and distant spread of tumor to other organs. These may include
- Persistent abdominal or pelvic pain
- Ascites (build-up of fluid in the abdomen)
- Increased abdominal girth or bloating
- Difficulty eating or feeling full quickly (early satiety)
- Nausea and vomiting
- Changes in bowel habits, such as constipation or diarrhea
- Weight loss
- Fatigue and weakness
- Shortness of breath
- Edema (swelling) in the legs
- Back pain
- Frequent urination or urinary urgency
- Changes in menstrual cycles for premenopausal women
- Pleural effusion (fluid around the lungs), leading to breathing difficulties
- Jaundice (yellowing of the skin and eyes) if the cancer spreads to the liver
these symptoms although present with ovarian cancer, are not specific for this cancer. There are other disease both benign and malignant tumors from other organs which may have similar symptoms. Proper examination and investigations are required for establishing a diagnosis.
Ovarian cancer Diagnosis
Your treating doctor may discuss about the various investigative tests which may be used in diagnosing and staging of the cancer. It is important that you should clearly understand about it and also remove all queries after discussing with your oncologist.
Here are the various diagnostic tests and procedures commonly used for diagnosing ovarian cancer:
- Pelvic Exam: Your doctor will perform a pelvic exam to check for any abnormalities in the ovaries, uterus, or nearby organs. This exam may involve manual palpation of the pelvic area to feel for any masses or unusual growths.
- Imaging Studies:
- Transvaginal Ultrasound (TVUS): This ultrasound technique uses a wand-like device inserted into the vagina to create detailed images of the ovaries and uterus. It helps identify ovarian masses, cysts, or tumors.
- Pelvic MRI or CT Scan: These imaging tests provide more detailed pictures of the pelvic area, helping to determine the size, location, and extent of ovarian tumors or masses.
- Blood Tests:
- CA-125 Blood Test: This blood test measures the levels of CA-125, a protein often elevated in women with ovarian cancer. While elevated CA-125 levels can indicate ovarian cancer, they can also be elevated due to other conditions, so this test is not definitive but can aid in diagnosis.
- Biopsy: A biopsy is the definitive method to confirm ovarian cancer. It involves removing a small tissue sample from the ovary or a suspicious mass for examination under a microscope. Biopsies can be obtained through minimally invasive procedures like laparoscopy or during surgery.
- Genetic Testing: In cases where there is a strong family history of ovarian or breast cancer, genetic testing for mutations in BRCA1 and BRCA2 genes may be recommended. These mutations increase the risk of developing ovarian and breast cancers.
- Exploratory Laparoscopy: In some cases, a minimally invasive surgical procedure called laparoscopy may be performed to directly visualize the ovaries, fallopian tubes, and pelvic organs. This allows the surgeon to assess the extent of disease and obtain tissue samples for biopsy if needed.
- PET-CT Scan: In advanced cases or to assess for metastasis (spread) of ovarian cancer to other organs like the liver or lungs, a PET-CT scan may be recommended. This imaging test combines PET (positron emission tomography) and CT (computed tomography) scans to detect cancerous lesions in the body.
Ovarian cancer treatment
Discussion about the treatment options, side effects and expected outcomes is very crucial for decision making for patients. Also, the treatment for every patient is different based on the stage of disease, health of the patient and individual preferences.
Here’s an explanation of treatment options for ovarian cancer:
1. Surgery: Surgery plays a central role in treating ovarian cancer. The primary goal is to remove as much of the tumor as possible in a procedure called debulking surgery. This involves removing the ovaries, fallopian tubes, uterus, nearby lymph nodes, and any visible tumor masses in the abdominal cavity.
The extent of surgery depends on the stage and spread of cancer. For some patients, a secondary debulking surgery may be necessary if cancer recurs after initial treatment.
HIPEC is a newer addition in surgical armamentarium, in this chemotherapy is given within the abdominal cavity after surgical removal of cancer to further reduce the risks of recurrence of cancer.
2. Chemotherapy: Following surgery, chemotherapy is often recommended to destroy any remaining cancer cells and reduce the risk of recurrence.
Platinum-based chemotherapy drugs, such as cisplatin or carboplatin, combined with taxanes like paclitaxel, are commonly used in ovarian cancer treatment. Chemotherapy may be given intravenously (IV) or directly into the abdominal cavity (intraperitoneal chemotherapy) for more localized treatment.
3. Targeted Therapy: For patients with specific genetic mutations like BRCA1/2, targeted therapies called PARP inhibitors (such as olaparib, niraparib, and rucaparib) may be prescribed. These drugs target weaknesses in cancer cells’ DNA repair mechanisms, leading to cell death. Targeted therapies are often used in advanced or recurrent ovarian cancer cases.
4. Radiation Therapy: While less common in ovarian cancer treatment, radiation therapy may be used in certain situations. External beam radiation delivers high-energy rays to target cancer cells, typically after surgery to specific areas or in palliative care to relieve symptoms in advanced cases.
5. Immunotherapy: Immunotherapy is an evolving area in ovarian cancer treatment. Immune checkpoint inhibitors, such as pembrolizumab or nivolumab, are being studied in clinical trials for ovarian cancer. These drugs help the immune system recognize and attack cancer cells more effectively.
After initial treatment, regular follow-up visits with your oncologist are crucial for monitoring response to treatment, detecting any signs of recurrence early, and addressing any new symptoms or concerns.
Ovarian cancer survival rates
Various factors affecting survival of a patient with ovarian cancer apart from stage of cancer include grade of tumor, response to treatment, genetic factor and overall health of the patient.
Every patient’s journey is unique, and factors beyond statistics, such as personal resilience, support systems, and quality of life, play crucial roles in coping with ovarian cancer.
stage based survival rates of tumor are as follows:
Early Stage (I-II): Ovarian cancer diagnosed at an early stage has a higher chance of successful treatment and long-term survival. The five-year survival rate for localized ovarian cancer (confined to the ovaries) is relatively high, often above 90%.
Advanced Stage (III-IV): Ovarian cancer diagnosed at advanced stages, where cancer has spread beyond the ovaries to nearby organs or distant sites, has lower survival rates. The five-year survival rate for advanced ovarian cancer ranges widely, typically between 30% to 50%.
Survival rates are statistical estimates that provide insight into the likelihood of survival over a specified period. It’s important to note that survival rates are based on data from large groups of people and may not accurately predict an individual’s outcome. They are continually evolving as new treatments and therapies emerge.
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