Ovarian Cancer

Ovarian Cancer

What is Ovarian Cancer?


Ovarian cancer is a type of cancer that begins in the ovaries. The ovaries - each about the size of an almond - produce eggs (ova) as well as the hormones estrogen and progesterone. Ovarian cancer is a growth of cells that forms in the ovaries. The cells multiply quickly and can invade and destroy healthy body tissue.


What are the main symptoms of Ovarian Cancer?


Symptoms of ovarian cancer include frequent (about 12 or more times a month)


  • Abdominal bloating or a feeling of bloating
  • Pain or feeling of tenderness in the abdomen or in the area between the thighs (pelvis)
  • Loss of appetite or feeling full after eating
  • An urgent need to urinate or a need to urinate more often.


Other symptoms of ovarian cancer may include:


  • Indigestion
  • Constipation or diarrhoea
  • Backache
  • Constant feeling of tiredness
  • Effortless weight loss
  • Vaginal bleeding after menopause


Have you been experiencing pain, discomfort, or bloating in your abdominal or pelvis?

Changing your eating habits, becoming full early, and losing your appetite are all signs that you're losing your appetite. Bloating and belching are common side effects, as is stomach discomfort.
Experiencing unusual bleeding or vaginal discharge (particularly if it occurs outside of your regular menstrual cycle or after menopause), as well as, more often, digestive abnormalities such as diarrhea and constipation.
If you see any strange lumps or a change in the size of your abdomen, consult your doctor.
Urine frequency or urgency is a symptom of urinary incontinence.

What exactly are genes, and how do they relate to ovarian cancer?

Genes are a component of your DNA and serve as the blueprint for your cells to multiply. You are born with a certain genetic profile. Your genes may be altered by both inherited features from your family and changes in your genes throughout time. Mutations are the term for these alterations. BRCA1 and BRCA2, two of the most prevalent gene mutations linked to ovarian cancer, have been identified.

The BRCA1 and BRCA2 genes are inherited, which means that you inherit a portion of each from each parent. Your genes are made up of two halves (you have two parts that make up each gene, so two parts to BRCA1). You don't have to get cancer if you have a mutation in one component of the gene. However, cancer may arise if both components of the gene are mutated. Cancerous cells are normally suppressed by BRCA1 and BRCA2. These genes are mutated, preventing them from completing their function and causing aberrant cell proliferation. Breast cancer is related to BRCA1 and BRCA2.

Gene mutations aren't usually passed down across the generations. Your DNA might alter during your life. Over time, a somatic mutation occurs. A somatic mutation of the TP53 gene is a frequent genetic alteration observed in ovarian cancer. The mutation affects the p53 protein, which is a component of the gene. This protein is generally involved in the fight against cancers and the prevention of their growth. When this mutation occurs, however, it is no longer able to stop the tumor from developing. Many different genes in your body may go through this process, and they can all contribute to cancer formation.


What types of Ovarian Cancer exist?


The type of cells from which the cancer starts determines the type of ovarian cancer you have and helps your doctor determine which treatments are best for you. Types of ovarian cancer include:


  • Epithelial ovarian cancer. This type is the most common. It includes several subtypes, including serous carcinoma and mucinous carcinoma.
  • Stromal tumours. These rare tumours are usually diagnosed at an earlier stage than other types of ovarian cancer.
  • Germ cell tumours. These rare types of ovarian cancer usually occur at a younger age.


What are the causes/risk factors for developing Ovarian Cancer?


Factors that may increase the risk of developing ovarian cancer include:


  • Older age. The risk of developing ovarian cancer increases with age. It is most often diagnosed in older people.
  • Hereditary gene changes. A small percentage of cases of ovarian cancer are caused by gene changes that you have inherited from your parents. Genes that increase your risk of developing ovarian cancer include BRCA1 and BRCA2. These genes also increase your risk of developing breast cancer.
  • Family history of ovarian cancer. If you have blood relatives who have been diagnosed with ovarian cancer, you may have an increased risk of developing the disease.
  • Being overweight or obese. Being overweight or obese increases your risk of developing ovarian cancer.
  • Hormone replacement therapy in the post-menopause. Taking hormone replacement therapy for signs and symptoms of menopause may increase the risk of developing ovarian cancer.
  • Endometriosis is an often painful condition in which tissue similar to the tissue lining the inside of the uterus grows outside the uterus.
  • Age of onset and end of menstruation. Starting menstruation at an early age or starting menopause at a later age, or both, may increase the risk of developing ovarian cancer.
  • Never been pregnant. If you have never been pregnant, you may have an increased risk of developing ovarian cancer.


How to prevent Ovarian Cancer?


There is no foolproof way to prevent ovarian cancer. But there are ways to reduce your risk:


Consider taking the contraceptive pill. Ask your doctor if birth control pills (oral contraceptives) are suitable for you.

If you have a family history of breast and ovarian cancer, discuss this with your doctor. Your doctor will be able to determine how this may affect your own risk of developing cancer. You may be referred to a genetic counsellor who can help you decide if genetic testing is right for you. If you are found to have a gene change that increases your risk of developing ovarian cancer, you may consider having surgery to remove your ovaries to prevent cancer.

By keeping a healthy weight and implementing excellent lifestyle practices, you may be able to reduce your chance of developing cancer later in life (exercising, having a balanced diet, limiting alcohol). There are currently no screening tests that can accurately detect ovarian cancer. Many women are unaware that they have it until symptoms appear.


What tests and procedures are performed to diagnose Ovarian Cancer?


  • An examination of the pelvic organs. During the pelvic exam, the doctor inserts gloved fingers into your vagina and simultaneously presses his hand on your abdomen to feel (palpate) your pelvic organs. The doctor also visually examines the external genitalia, vagina and cervix.
  • Imaging tests. Tests such as an ultrasound or a CT scan of the abdomen and pelvis can help determine the size, shape and structure of the ovaries.
  • Blood tests. Blood tests may include tests for organ function, which can help to determine your general state of health.
  • Your doctor may also check your blood for the presence of tumour markers that indicate ovarian cancer. For example, a test for Cancer Antigen (CA) 125 can detect a protein that is often found on the surface of ovarian cancer cells. These tests cannot tell your doctor whether you have cancer, but they can give clues about the diagnosis and prognosis.
  • Sometimes the doctor cannot be sure of the diagnosis until you have an operation to remove your ovary and check it for signs of cancer.
  • Genetic testing. Your doctor may recommend that you have a blood test to check for gene changes that increase your risk of developing ovarian cancer. Knowing if you have hereditary changes in your DNA will help your doctor decide on a treatment plan. You may want to share this information with your blood relatives, such as brothers, sisters and children, as they too may be at risk of these gene changes.
  • Once it is confirmed that you have ovarian cancer, your doctor will determine the stage of cancer based on the results of tests and procedures. The stages of ovarian cancer range from 1 to 4, which are often denoted by Roman numerals from I to IV. The lowest stage means that the cancer is limited to the ovaries. At stage 4, the cancer spreads to distant parts of the body.


How is Ovarian Cancer Surgery carried out?


Surgery to remove one ovary. For early stage cancer that has not spread beyond one ovary, the operation may involve removing the affected ovary and its fallopian tube. This operation may preserve your ability to have children.

Surgery to remove both ovaries. If cancer is present in both ovaries but there is no sign of additional cancer, the surgeon may remove both ovaries and both Fallopian tubes. With this operation, the uterus remains intact, so you can still become pregnant using your own frozen embryos or eggs or eggs from a donor.

Surgery to remove both ovaries and uterus. If the cancer is more extensive, or if you do not want to retain the ability to have children, the surgeon will remove the ovaries, fallopian tubes, uterus, nearby lymph nodes and a fold of fatty tissue in the abdomen (omentum).

Surgery for advanced cancer. If the cancer is at an advanced stage, the doctor may recommend surgery to remove as much of the cancer as possible. Sometimes in this situation, chemotherapy is given before or after surgery.


How long does Ovary Removal Surgery take?


Abdominal ovary removal is performed under general anesthesia and generally lasts about 1-2 hours. It may last longer if the surgeon needs to do some further exploration. Abdominal ovary removal requires making a larger incision to remove the ovaries and fallopian tubes.


What type of anaesthesia is used for surgery to remove Ovarian Cancer?


You are having surgery for ovarian cancer under general anaesthesia. So you're asleep all the time.


How long does it take to recover from Ovarian Cancer surgery?


Depending on the type of surgery, you are usually in hospital for 2 to 4 days. After that, you recover at home for a month or so.


What treatments are available for Ovarian Cancer?


  • Chemotherapy


Chemotherapy is a drug treatment that uses chemicals to kill fast-growing cells in the body, including cancer cells. Chemotherapy drugs can be injected into a vein or taken by mouth.

Chemotherapy is often used after surgery to kill any remaining cancer cells. It can also be used before surgery.

In some situations, chemotherapy drugs can be heated and injected into the abdominal cavity during surgery (hyperthermic intraperitoneal chemotherapy). The drugs are left in place for a certain amount of time, after which they are drained. The operation is then terminated.


  • Targeted therapy

Targeted drug therapy targets specific weaknesses of cancer cells. By acting on these weak points, targeted therapy can lead to the death of the cancer cells.


If you are considering a targeted therapy for ovarian cancer, your doctor may carry out an analysis of your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer.


  • Hormone therapy

Hormone therapy uses drugs that block the effects of the hormone oestrogen on ovarian cancer cells. Some ovarian cancer cells use oestrogen for their growth, so blocking oestrogen can help to fight the cancer.

Hormone therapy may be an option for treating some types of slow-growing ovarian cancer. It may also be used if the cancer returns after initial treatment.


  • Immunotherapy

Immunotherapy uses the immune system to fight cancer. The body's immune system fighting the disease may not attack cancer cells because they produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with this process.

In certain situations, immunotherapy can be a treatment option for ovarian cancer.


Is it possible to have children in the future after ovarian cancer surgery?


In some low stage 1a cancers, only the affected ovary and fallopian tube can be removed. This leaves the unaffected ovary and uterus. This means that you will be able to get pregnant and have a baby later on.

Your doctor may advise you to have both ovaries and uterus removed if you are going through menopause. Or if you do not want to have any more children.