Ovarian Cancer

Ovaries are made of three types of cells, which can develop into three different types of tumors:

1. Epithelial ovarian tumor: The most common type of ovarian cancer (about 90 percent of cases) that forms in the outer layer of tissue on the ovaries. It has the following subtypes:
   • Serous
   • Endometrioid
   • Clear cell
   • Mucinous
2. Stromal cell tumor: A rare type (eight percent or less) that grows in the hormone-producing (estrogen and progesterone) cells.
3. Germ cell tumor: A rare type of ovarian cancer (approximately four percent of cases) that develops in egg-producing cells.

The exact cause of ovarian cancer is still unknown, but researchers have identified factors that can increase the risk of the disease, such as:

• Familial history of ovarian cancer
• Genetic mutations (in BRCA1 or BRCA2 genes)
• Personal history of breast, uterine, or colon cancer
• Advanced age (common in women in the age group of 50 to 60 years)
• Obesity
• Smoking
• Endometriosis (a condition wherein the lining of the uterus grows outside the uterus)
• Use of certain fertility drugs or hormone therapies (long-term use of estrogen hormone replacement therapy)
• Nulliparous women (who have no history of pregnancy) or those who have never carried a pregnancy to term
• Conception after the age of 35 years
• Lynch syndrome (a disorder that runs through families associated with a genetic predisposition to different cancers)

The symptoms of ovarian cancer are persistent and may worsen with time.

Some of the earliest symptoms may include:

• Abdominal bloating, pressure, discomfort, or pain
• Pelvic discomfort
• Early satiety (feeling full quickly after eating)
• Poor appetite
• Increase frequency and urgency of urination

Some of the late symptoms may include:

• Fatigue
• Back pain
• Menstrual irregularities (heavier or irregular bleeding)
• Pain during intercourse
• Loss of appetite
• Upset stomach or indigestion
• Unintended weight loss
• Change in bowel habits

According to the International Federation of Gynecologists and Obstetricians system, ovarian cancer is staged into four groups:

1. Stage I
   • Stage IA: Cancer localized to one of the ovaries.
   • Stage IB: Cancer in both ovaries.
   • Stage IC: Cancer cells have migrated outside of the ovary.
2. Stage II
   • Stage IIA: Cancer has spread to the nearby organs, such as the uterus or fallopian tubes.
   • Stage IIB: Cancer has spread to other organs, such as the bladder or rectum.
3. Stage III
   • Stage IIIA: Cancer has spread beyond the pelvis to the lining of the abdomen or abdominal lymph nodes.
   • Stage IIIB: Cancer has spread beyond the pelvis to the lining of the abdomen, but the tumor measures less than 2 cm in diameter.
   • Stage IIIC: Cancer has spread outside the spleen or liver and the tumor measures more than 2 cm in diameter.
4. Stage IV
   • Stage IVA: Cancer cells are found in the fluid around the lungs, causing malignant pleural effusion.
   • Stage IVB: Cancer cells have spread to other distant organs, such as the skin or brain.

Because there is no simple and reliable way to screen ovarian cancer, it is important to recognize warning signs.

To detect ovarian cancer early, the doctor may recommend certain tests, such as:

• Pelvic examination: A pelvic examination is performed by the doctor to palpate the tumor. 
• Biopsy: A tissue sample from the tumor is obtained and checked under a microscope to confirm the diagnosis.
• Screening tests:
  • Transvaginal ultrasound: The uterus, fallopian tubes, and ovaries are analyzed using sound waves.
  • CA-125 blood test: The amount of a protein called CA-125 in the blood (found on the surface of ovarian cancer cells) is measured.
• Imaging scans:
  • CT scan: X-rays are used to create a detailed picture of the inside of the body.
  • Positron emission tomography scan: A specialized imaging test that uses a radioactive substance (tracer) to evaluate the spread of cancer in the body.
  • MRI scan: Detailed pictures of the inside of the body are created by using a powerful magnet and radio waves.

The treatment of ovarian cancer usually includes:

• Surgery:
  • Unilateral or bilateral salpingo-oophorectomy: Removal of one or both ovaries surgically.
  • Total hysterectomy and bilateral salpingo-oophorectomy: Surgical removal of ovaries along with the uterus.
• Chemotherapy: A drug treatment that uses chemicals to kill fast-growing cancerous cells in the body.
• Targeted therapy: Specific cancer cells are identified and attacked.
• Hormonal therapy: This therapy uses drugs to block the effects of the hormone estrogen on ovarian cancer cells.
• Immunotherapy: The immune system is activated using substances made by the body or in a laboratory to fight cancer.
• Radiation therapy: It is used to treat ovarian cancer that has spread to the pelvis or other parts of the body.
• Palliative care: It includes specialized medical care that provides relief from pain and other symptoms of a serious condition.

 Ovarian cancer may complicate into:

• Pleural effusion (fluid accumulation around the lungs characterized by cough, chest pain, and shortness of breath)
• Ascites (fluid accumulation in the abdomen)
• Bowel obstruction