Ovarian cancer is a type of cancer that begins in the ovaries, which are the female reproductive organs responsible for producing eggs (ova) and the hormones estrogen and progesterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen, making it more difficult to treat at later stages. Early-stage ovarian cancer, when confined to the ovary, is more treatable, but unfortunately, it is often diagnosed at an advanced stage due to subtle and non-specific symptoms.

Types of Ovarian Cancer:

Ovarian cancer is classified into different types based on the cells from which it originates:

  1. Epithelial Ovarian Cancer:
    • This is the most common type, accounting for about 85-90% of ovarian cancers.
    • It arises from the cells on the outer surface of the ovary.
    • Subtypes include serous, mucinous, endometrioid, and clear cell carcinoma.
  2. Germ Cell Ovarian Cancer:
    • Arises from the cells that produce eggs.
    • Less common, typically affecting younger women.
    • Includes types such as dysgerminomas and teratomas.
  3. Stromal Cell Ovarian Cancer:
    • Develops in the ovarian tissues that produce hormones.
    • These cancers are rare and often produce abnormal amounts of estrogen or testosterone.
    • Examples include granulosa cell tumors and Sertoli-Leydig cell tumors.

Risk Factors:

Several factors can increase a woman’s risk of developing ovarian cancer, though not all women with risk factors will develop the disease:

  • Age: Ovarian cancer most commonly occurs in women over 50, particularly after menopause.
  • Family History: A family history of ovarian, breast, or colorectal cancer increases the risk. Genetic mutations, especially in the BRCA1 and BRCA2 genes, significantly raise the risk of ovarian and breast cancer.
  • Personal History of Cancer: Women who have had breast or colorectal cancer may have a higher risk.
  • Genetic Syndromes: Inherited conditions such as Lynch syndrome (hereditary nonpolyposis colorectal cancer) can increase the risk.
  • Endometriosis: Women with endometriosis, a condition where the tissue that normally lines the uterus grows outside it, have an elevated risk of developing certain types of ovarian cancer.
  • Reproductive History: Women who have never been pregnant, or who had children later in life, are at a higher risk.
  • Hormone Replacement Therapy (HRT): Long-term use of estrogen-only HRT after menopause is associated with an increased risk of ovarian cancer.

Symptoms of Ovarian Cancer:

Symptoms of ovarian cancer are often vague and can be mistaken for other common conditions. Early signs may include:

  • Abdominal bloating or swelling.
  • Pelvic or abdominal pain.
  • Feeling full quickly when eating.
  • Unexplained weight loss.
  • Urinary frequency or urgency.
  • Changes in bowel habits, such as constipation.

As the disease progresses, symptoms may become more severe and persistent.

Diagnosis:

Ovarian cancer can be difficult to diagnose early because of its subtle symptoms. Diagnostic steps include:

  1. Pelvic Exam: A healthcare provider may feel the ovaries and surrounding organs for any abnormalities.
  2. Imaging Tests:
    • Transvaginal Ultrasound (TVUS): Used to visualize the ovaries and detect any masses or irregularities.
    • CT scans or MRI: Can be used to look for masses and assess whether the cancer has spread.
  3. Blood Tests:
    • The CA-125 blood test measures a protein that is often elevated in women with ovarian cancer, though it can also be elevated in other conditions.
    • Newer tests may include HE4 or OVA1.
  4. Biopsy: A definitive diagnosis of ovarian cancer is usually made through a biopsy. This may be done by surgically removing a sample of the tumor or tissue for examination.

Staging of Ovarian Cancer:

The stage of ovarian cancer describes the extent to which the cancer has spread. Staging is critical for determining the treatment plan and prognosis:

  • Stage I: Cancer is confined to one or both ovaries.
  • Stage II: Cancer has spread to the pelvis.
  • Stage III: Cancer has spread beyond the pelvis into the abdominal cavity or to nearby lymph nodes.
  • Stage IV: Cancer has spread to distant organs, such as the liver or lungs.

Treatment Options:

Treatment for ovarian cancer depends on the stage and type of cancer, as well as the patient’s overall health. Treatment typically involves a combination of surgery and chemotherapy.

  1. Surgery:
    • Debulking Surgery: The goal is to remove as much of the tumour as possible, often including the ovaries, fallopian tubes, uterus, nearby lymph nodes, and parts of other affected organs (such as the bowel or bladder).
    • Oophorectomy: Removal of one or both ovaries.
    • Hysterectomy: Removal of the uterus may also be necessary in many cases.
  2. Chemotherapy:
    • Platinum-based Chemotherapy: Medications like carboplatin and cisplatin are commonly used, often in combination with another drug such as paclitaxel.
    • Neoadjuvant Chemotherapy: In some cases, chemotherapy is given before surgery to shrink the tumour and make surgery easier.
  3. Targeted Therapy:
    • PARP Inhibitors: Drugs like olaparib, niraparib, and rucaparib can target specific genetic mutations, such as BRCA1 or BRCA2, in cancer cells.
    • Bevacizumab (Avastin): A drug that inhibits the growth of blood vessels that feed tumours, sometimes used in combination with chemotherapy.
  4. Radiation Therapy:
    • Rarely used in the treatment of ovarian cancer but may be considered in certain cases to target specific areas where cancer has spread.
  5. Hormone Therapy:
    • For certain types of ovarian cancer (like stromal tumours), hormone-blocking therapies may be used.

Prognosis:

The prognosis for ovarian cancer depends largely on the stage at diagnosis. Early-stage ovarian cancer has a better prognosis, with a 5-year survival rate of over 90% when caught early. However, because many cases are diagnosed at a later stage, the overall 5-year survival rate for ovarian cancer is approximately 49-50%.

Factors influencing prognosis include:

  • Stage of the cancer at diagnosis.
  • Type and grade of the cancer.
  • Response to treatment.
  • Overall health and age of the patient.

Prevention and Risk Reduction:

While there is no sure way to prevent ovarian cancer, certain factors can reduce the risk:

  • Birth Control Pills: Long-term use of oral contraceptives has been shown to reduce the risk of ovarian cancer.
  • Pregnancy and Breastfeeding: Women who have had children and breastfed may have a lower risk.
  • Risk-Reducing Surgery: For women with a strong family history or genetic predisposition (such as BRCA1/2 mutations), removal of the ovaries and fallopian tubes (prophylactic oophorectomy) can significantly reduce the risk.
  • Genetic Testing and Counselling: Women with a family history of ovarian or breast cancer may benefit from genetic testing to assess their risk and consider preventive options.

Conclusion:

Ovarian cancer is a serious condition that often presents with non-specific symptoms, making early detection difficult. Treatment typically involves surgery and chemotherapy, with newer targeted therapies showing promise. Regular monitoring and proactive management are key for women at high risk. Raising awareness of the symptoms and risk factors of ovarian cancer can lead to earlier diagnosis and improved outcomes.

At Precious Medical Group (PMG), we are here to assist you further. Please feel free to contact us for any enquiry.