Ovarian cancer is a growth of abnormal cells in the ovary that begin to multiply out of control and form a tumor. In case it is left untreated the tumor can spread to other parts of the body. This is also known as metastatic ovarian cancer.
Stages of ovarian cancer
There are four stages-
Stage 1
- Stage 1A: The cancer is restricted or localized to one of the ovaries.
- Stage 1B: The cancer is present in both the ovaries.
- Stage 1C: The cancerous cells are also present outside of the ovary.
Stage 2
Tumor spreads to other pelvic structures.
- Stage 2A: The cancerous cells are spread to the uterus or fallopian tubes.
- Stage 2B: The cancer cells have spread to the bladder or rectum.
Stage 3
- Stage 3A: It has spread beyond the pelvis to the lining of the abdomen and to the lymph nodes in the abdomen.
- Stage 3B: The cancerous cells have spread beyond the pelvis to the lining of the abdomen which is visible to bare eyes.
- Stage 3C: The deposits of cancer are seen on the abdomen or outside the spleen or liver. But, the cancer isn’t present in the spleen or liver.
Stage 4
The tumor has metastasized beyond the pelvis, abdomen and lymph nodes to the liver or lungs.
- In stage 4A: The cells are in the fluid around the lungs.
- In stage 4B: It is the most advanced stage; the cells have reached inside the spleen, liver or even other distant organs like skin or brain.
Ovarian cyst vs. cancer
Ovarian cysts are typically not cancerous; it can be nerve-wracking when it is first discovered.
- Ovarian cysts are normally filled with fluid, while ovarian tumors are solid masses of cells
- Ovarian cysts may appear bigger or smaller with menstrual cycle but cancerous tumors do not go away by their own.
Early Signs & Symptoms of Ovarian Cancer
Abdominal bloating, pressure, pain
Abnormal fullness in abdomen after eating
Difficulty after eating
Increase in urination
Later signs and symptoms
- Fatigue
- Indigestion
- Back pain
- Menstrual irregularities (bleeding outside of regular cycle)
- Painful intercourse
- Dermatomyositis- a rare inflammatory disease that can cause skin rash, muscle weakness and also inflamed muscles.
- Loss of appetite
- Weight loss
- Constipation
The symptoms will persist usually become more severe as the tumor grows. At this point of time, the cancer is usually spread outside of the ovaries, making it much difficult to treat effectively.
Severe symptoms
- Pleural effusion- fluid spreads around the lungs
- Ascities- fluid buildup in the abdomen
- Bowel obstruction- obstruction or blockage of the digestive tract
Types of ovarian cancer
- Epithelial ovarian carcinoma forms the layer of tissues on the outer layer of the ovaries.
- Stromal tumors spread in the hormone-producing cells.
- Germ cell tumors progress in the egg-producing cells and are rare.
Risk factors
- Older age
- Inherited gene changes: The gene that increases the ovarian cancer risk includes BRCA1 and BRCA2 which are also the risk factors for breast cancer.
- Family history of ovarian cancer
- Being overweight or obese.
- Postmenopausal hormone replacement therapy
- Endometriosis.
- Age when menstruation started and ended.
- Never having been pregnant.
Diagnosis
- Pelvic exam.
- Imaging tests- ultrasound or CT scans of abdomen and pelvis that may help to determine the size, shape and structure of your ovaries.
- Blood tests- Blood test for tumor markers that indicate ovarian cancer, a cancer antigen (CA) 125 test can detect a protein often found on the surface of ovarian cancer cells.
- Surgery
- Genetic testing
Treatment
It includes combination of surgery and chemotherapy.
- Surgery
- Chemotherapy
- Targeted therapy
- Hormone therapy
Surgery
- Surgery to remove one ovary- In early-stage cancer which hasn’t spread more than one ovary, surgery may involve in removing the affected ovary and its fallopian tube. In this procedure the ability to have children is preserved.
- Surgery to remove both ovaries- If cancer spreads in both ovaries, but no other signs of secondary cancer, both ovaries and both fallopian tubes are removed. Uterus is left intact, thus women can become pregnant using own frozen embryos or eggs or with eggs from a donor.
- Surgery to remove both ovaries and the uterus- If cancer is more extensive both the ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue (omentum) are removed.
- Surgery for advanced cancer- As much as possible the cancer is removed. At times chemotherapy is given before or after surgery.
Chemotherapy for ovarian cancer
- Chemotherapy treatment is to kill fast-growing cells in the body, including the cancer cells by administration of drugs containing chemicals.
- Chemotherapy drugs can be injected into a vein or administered by mouth.
- Chemotherapeutic drugs are mostly used after surgery to kill cancererous cells.
- The drugs are heated and infused into the abdomen during surgery (hyperthermic intraperitoneal chemotherapy).
- Targeted therapy
- Targeted therapies attack the cancer cells by doing minute damage to normal cells in the body.
- PARP inhibitors are newer targeted therapies to treat advanced epithelial ovarian cancer.
- PARP inhibitors include-
- olaparib
- niraparib
- rucaparib
- The addition of drug, bevacizumab, has also been used in chemotherapy following surgery.
- Hormone therapy
Hormone therapy makes use of drugs to block the effects of the hormone estrogen on ovarian cancer cells. Certain ovarian cancer cells use estrogen to help them grow, so blocking this estrogen might help in controlling the cancer.
- Immunotherapy
In Immunotherapy the immune system fights against cancer.
Disease-fighting immune system may not attack cancer cells because they make proteins that assist them to hide from the immune system cells. Immunotherapy works by inhibiting the process.
- Supportive (palliative) care
Palliative care is specialized care which focuses on providing relief from pain and other symptoms of a serious illness.
Palliative care can be done while undergoing other aggressive treatments, such as surgery and chemotherapy.
When palliative care is used along with other appropriate treatments, patients with cancer might feel better and live longer.
