Ovarian Cancer

Ovarian cancer usually begins in the ovaries and spreads to pelvis and abdomen. There is one ovary in each side of the uterus which is about the size of an almond. The ovaries produce ova and hormones, estrogen and progesterone. 

Ovarian cancer is often undetected until it spreads to pelvis and abdomen and hence is difficult to treat and fatal when detected. If the cancer is detected when it is confined to ovaries only, the treatment is likely to be successful.

The treatments available for ovarian cancer are surgery and chemotherapy.

Hardly any symptoms are seen during early stage of ovarian cancer. Usually few and non specific symptoms are seen in advanced stage ovarian cancer that is often confused for common condition such as constipation or irritable bowel. 

Some of the signs and symptoms are:

• Decreased body weight
• Alternation in bowel habits
• Abdominal flatulence
• Early satiety
• Distress in the pelvic area
• Frequent urination

When to see a Doctor?

If you experience any unusual signs and symptoms you should immediately visit your doctor. If your family has history of ovarian or breast cancer, discuss your risk of developing ovarian cancer with your doctor. 

You may be referred to genetic counselor to discuss testing for genetic mutation to assess your chances of having ovarian or breast cancer. Only few women have genetic mutation that can progress to ovarian cancer.

The exact cause for ovarian cancer has not been identified yet. Generally, cancer begins to grow when normal cell mutate into abnormal quickly multiplying cancer cell. The tumor mass then can invade nearby tissues or organs and metastasize (spread of tumor from the originated place to elsewhere in the body). 

The type of cell from where cancer originates determines the type of ovarian cancer you have. The types of ovarian cancer are:

• Epithelial Tumors: Nearly 90% of ovarian cancer is epithelial tumor that begins in the cells that covers the ovaries. 
• Stromal Tumors: Approximately 7 percent of the ovarian cancer is stromal tumor that begins in tissue producing hormones. They are diagnosed at earlier stage than other ovarian tumor.
• Germ Cell Tumor: This rare cancer is mostly seen in younger women and begins in egg producing cells.

Making a diagnosis of ovarian cancer is done by performing several tests.

If any signs and symptoms seem to trouble you, immediately see your doctor. If ovarian cancer cell is suspected your primary care doctor may refer to gynecologic oncologist (specialist in women's health with additional skills in diagnosis and treatment of gynecologic cancer).  

The doctor is likely to begin the investigation with pelvic examination. Following tests are done for diagnosing the ovarian cancer:

• Pelvic examination: This begins with examination of the outer part of your genital followed by insertion of two gloved fingers into the vagina and at the same time pressing a hand on your abdomen to feel your uterus and ovaries.  A speculum (device to inspect cervix and vagina) is inserted into the vagina to investigate whether there is any abnormality.
• Imaging Tests: You may be recommended with ultrasound or CT scans of  your abdominal and pelvis to inspect the size, shape and structure of your ovaries. 
• Blood test: Blood test are done to detect a protein, called cancer antigen 125 (CA125), that is found on surface of ovarian cancer cells. 
• Surgery: Minimal invasive technique is used to take out tissue sample and abdominal fluid to confirm the diagnosis of ovarian cancer.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Make a list of the questions to ask your doctor. Some typical question can be:

• What could be probable causes of my symptoms?
• Do I need any test that?
• What are treatment options and their side effects?
• What prognosis can I expect?
• Can I conceive child?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• When did you first start noticing the symptoms?
• How severe are your symptoms?
• Does anything improve or worsen the symptoms?
• Do any relatives of yours have ovarian or breast cancer?
• Are the symptoms continuous or occasional?

Staging ovarian cancer 

The result from your surgery helps to determine the stage of your ovarian cancer. The prognosis and treatment options are guided by your cancer's stage.

• Stage I: Cancer is found in one or both ovaries 
• Stage II: Cancer has spread to other parts of the pelvis
• Stage III: Cancer has spread to the abdomen
• Stage IV: Cancer is found outside the abdomen

Ovarian cancer is usually treated by combination of chemotherapy and surgery. 

Surgery

In this treatment process, both ovaries, the fallopian tubes, the uterus are removed along with the nearby lymph nodes and omentum (a fold of fatty abdominal tissue where cancer often spreads). 

If your ovarian cancer is diagnosed at an early stage the treatment includes removal of the one ovary and its fallopian tube which may preserve the ability to have children.

Chemotherapy

You may be prescribed with chemotherapy after the surgery to kill the remaining cancer cells. Chemotherapy can be given intravenously or injected into abdominal cavity or both. In some cases of advanced ovarian cancer, chemotherapy may be given initially.

The definite way for prevention of ovarian cancer has not been established yet. However, there are certain factors which pose less risk of developing ovarian cancer. These include:

• Use of oral contraceptive for prolonged period ( more than 10 years)
• History of pregnancy and breast feeding
• Daily use of aspirin
• Pervious pregnancy

Lifestyle modifications are necessary in order to cope with ovarian cancer.

Being diagnosed with ovarian cancer can be overwhelming and stressful. Following advices may be helpful to overcome the stress and anxiety:

• Discuss your feeling with someone whom you are comfortable with
• Join a support group 
• Set reasonable goals that are gives you control and makes you focused
• Take time for yourself. Eat well, relax and get enough rest to overcome the stress and fatigue of cancer.

There are several risks and complications associated with ovarian cancer, which include:

• Age: Women in their 50s and 60s are at greater risk of ovarian cancer
• Inherited genetic mutation: Women with mutated genes viz., breast cancer gene 1 (BRCA 1) and breast cancer gene 2 (BRCA 2) have higher chances of developing ovarian cancer. The genetic mutations which causes Lynch syndrome and associated with colon cancer also increases the risk of ovarian cancer.
• Estrogen Hormone Replacement Therapy: Women are at increased risk if they are using at higher doses for longer period of time.
• Age: Women who either started menstruating at the age of 12 or underwent menopause after age of 52 or both are at increased risk of ovarian cancer
• Smoking
• Use of intrauterine device
• Polycystic ovary syndrome
• If a women has never been pregnant or has undergone fertility treatment