Ovarian Cancer
The ovaries are small, almond-shaped organs located on either side of the uterus. Ovaries are important organ for hormone and eggs (oocytes) production in females.
Ovarian cancer is aggressive form of cancer in female, unfortunately involving young females ; most present in advanced stage.
Types
There are more than 30 different types of ovarian cancer, which are classified by the type of cell from which they start. Cancerous ovarian tumors start from three common cell types :
Surface Epithelium
- Cells covering the outer lining of the ovaries
Germ Cells
- Cells that are destined to form eggs.
Stromal Cells
- Cells that release hormones and connect the different structures of the ovaries.
High Risk Factors
Genetic predisposition
- Sometimes this may be because you’ve inherited a faulty version of a gene called BRCA1 or BRCA2. These increase your risk of developing both ovarian and breast cancer.
Personal or family history of breast, ovarian, or colon cancer.
Increasing age
- The risk of ovarian cancer increases as you get older, with most cases happening after the menopause.
Infertility
Hormone replacement therapy (HRT)
- It has been suggested that taking hormone replacement therapy (HRT) may increase your risk of ovarian cancer.
Endometriosis
- Research has shown that women with endometriosis may be more likely to develop ovarian cancer.
Overweight or obese
- Losing weight through regular exercise and a healthy diet may help to lower ovarian cancer.
Smoking
- Stopping smoking may help to reduce your risk of ovarian cancer and many other serious health problems.
Symptoms
Unfortunately symptoms are very vague in ovarian cancer. High degree of suspicion is very important.
Early stage ovarian cancer may not have any symptoms. That can make it very difficult to detect.
However, some symptoms may include:
- Frequent bloating.
- Quickly feeling full when eating.
- Difficulty eating.
- A frequent, urgent need to urinate.
- Pain or discomfort in the abdomen or pelvis.
These symptoms have a sudden onset. They feel different from normal digestion or menstrual discomfort. They also don’t go away.
Other symptoms of ovarian cancer can include:
- Lower back pain.
- Pain during intercourse.
- Constipation.
- Indigestion.
- Fatigue.
- A change in the menstrual cycle.
- Weight gain.
- Weight loss.
- Vaginal bleeding.
- Acne.
- Back pain that worsens.
If you have these symptoms for longer than two weeks, you should seek medical attention.
Some ovarian tumor secrete hormones which may cause masculisation or sometimes early puberty changes.
Diagnosis / Tests Required
Ultrasound of abdomen pelvis
- Ovarian mass with solid lesion, free fliud with ovarian mass. If free fluid present in abdomen with ovarian mass, tapping of fluid under sonography guidance and checking for cytology is important.
CT scan of abdomen pelvis
- It is performed for assessment of ovarian mass with its involvement with other organs or metastasis.
- Any enhancing/solid cystic mass to be taken as suspicious for cancer unless proved otherwise.
Frozen section
- If ovarian mass with no spread, operation to remove ovarian mass intact and check on table by Histopathological examination is done to confirm cancer.
Tumor Markers
- CA 125, HE4 antigen, AFP, CEA, Beta-hcg, CA 19.9 , CA 15.3 are some tumor markers for cancer ovary, although not confirmatory.
Treatment
CT scan is very important for deciding plan of management of ovarian cancer.
Doctor will decide after assessing scan whether to operate upfront or give chemotherapy first to downstage disease. Below are the treatment options for Ovarian Cancer:
Surgery according to staging of disease.
Laparotomy – a total abdominal hysterectomy (TAH).
Bilateral salpingo-oophorectomy (BSO).
Omentectomy.
Biopsies of suspicious areas.
Peritoneal lavage or ascetic fluid sampling.
Blind peritoneal, paraaortic, pelvic lymph node biopsies should be performed.
Sandwich therapy
- In this chemotherapy is given to downgrade the tumour if advanced followed by cytoreductive surgery and then post-operative chemotherapy.
HIPEC Hyperthermic Intraperitoneal Chemotherapy
- It is a process in which heated chemotherapy is pumped directly into the abdomen after surgery. Sometimes cytoreductive surgery is combined with HIPEC to optimize cure, although it is not necessary in all patients.