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Ovarian Cancer

Introduction/ Ovarian Cancer Definition: Ovarian cancer refers to cancer i.e., abnormal growth in the ovaries (female reproductive organs that produce eggs in women for the process of reproduction). Ovarian cancer holds third place in the most commonly detected cancers in India and seventh place in the most common cancers in the world. What is Ovarian Cancer? As we have already discussed, cancer is an abnormal growth of the cells. Not just the ovary, but this abnormality of growth can be seen in any part of the body. All of the cells have a defined life cycle which includes the growth phase, the dividing phase and the death phase or the phase when they get replaced by other cells. However, at times, these cells can begin to grow at a very rapid rate or no longer die at times when they should be dying. This abnormal growth leads to the development of tumours. These tumours can be either malignant/ cancerous (that can spread to other parts of the body) or benign/ non-cancerous (confined to one area).

Types of Ovarian Cancer: There are more than 30 types of ovarian cancer classifications. These types are put into different groups depending on the kind of cell where they start/ occur. There are three main types of cells that can be found in the ovaries and a tumour can be developed in any one of them.

These types are:

  1. Epithelial cells- cover the surface of the ovary
  2. Germ cells- These are the cells that make the eggs and hence, the name.
  3. Stromal cells- These cells are responsible for making the hormones estrogen and progesterone and for holding the structure of the ovary together.

Epithelial tumours:

Epithelial tumours are the most common type of tumours seen in women with ovarian cancer. It is more commonly seen in women who have undergone menopause. Most of these tumours are non-cancerous in nature and hence, one should not start stressing over if she gets informed about having an epithelial tumour. The benign epithelial tumours include serous adenoma, Brenner’s tumours and mucinous adenoma. An epithelial tumour is known as carcinoma if it is cancerous. These are further divided into four subtypes depending on the things seen under the microscope by the doctor. These carcinoma subtypes are:

  1. Serous (most common of the 4) – 53%
  2. Mucinous- 6%
  3. Endometrioid - 10%
  4. Clear cell- (6%)

The cancer is referred to as an “undifferentiated” one if it does not look like any of the above subtypes. Such types of tumours have a high tendency to grow at a faster rate and these can also spread faster than any of the above 4 types of cancer. There can be times when the doctor is not able to tell whether an epithelial tumour is cancer or not, under the microscope. Such a tumour is said to be a low malignant potential (LMP) tumour or borderline epithelial tumour. This kind of epithelial cancer is found to be less life-threatening than the other kinds of epithelial cancers.

Germ Cell Tumours:

Germ cell tumours can be found in women of any age. Although, these are most commonly seen in women who are in their 20s. The majority of these tumours are benign in nature. Germ cell carcinomas have a few subtypes and the tumours can sometimes be a mix of more than one germ cell subtype. Four of the main subtypes are:

  • Teratoma: When viewed under a microscope, these germ cell tumours appear like the three layers of an embryo (in the developing stage) i.e., the endoderm (innermost layer), the mesoderm (middle layer) and the ectoderm (outermost layer). The benign form of this germ cell tumour is known as a mature teratoma. The cancerous/ malignant germ cell is known as an immature teratoma. This kind of tumour is rare in nature and is seen in girls younger than 18 years of age.
  • Dysgerminoma: Even though it is a very rare germ cell tumour, yet this is the most common kind of germ cell cancer. This is mostly seen in women in their teens and twenties. This malignant subtype does not grow at a rapid rate as the other ones. In fact, there is a 75% probability of the patient getting cured by surgical removal of such tumours that are limited to the ovary.
  • Endodermal Sinus tumours: Also called yolk sac tumours, these are rare and malignant kinds of tumours that are found lining the yolk sac of the embryo.  
  • Choriocarcinoma: These tumours start growing in the placenta itself (during the time of pregnancy). These grow and spread at a rapid rate and are sensitive to chemotherapy.

Stromal Tumours: These tumours are usually diagnosed earlier than the other kind of tumours. The most common symptom of these tumours is abnormal vaginal bleeding which happens due to the extra production of estrogen hormone from these tumours. Because of the same reason, such tumours can cause the development of breasts and menstrual periods in girls even before they hit puberty. In very rare cases, these tumours can also make male hormones like testosterone and hence, causing the menstrual periods to stop and the growth of facial and body hair. These tumours can cause serious abdominal pain if they start bleeding.

Ovarian Cancer Causes and Risk Factors:

The exact causes of ovarian cancer are unknown. Although, a few factors have been proven as significant factors that can play some role in the development of ovarian cancer. These include the following:

  1. Age
  2. Family history of cancer
  3. Having hormone replacement therapy
  4. Obesity
  5. Inactive/ unhealthy lifestyle

There are no thumb rules when we talk about cancers. Different cancers have different risk factors associated with them. Some of these factors can be changed, others cannot be changed. Although, it is not certain that one develops ovarian cancer if she has one, or even many of such risk factors. The risk factors include the following:

  1. Age: The risk of one getting ovarian cancer increases with the increasing age. This is the reason why most ovarian cancers develop after menopause and very rare occurrences of ovarian cancer in women younger than the age of 40 (the most common ovarian cancer age is 45-50).
  2. Obesity: Obesity leads to an increased risk of developing cancers in general. In fact, occurrences of ovarian cancer are more in the case of obese women (those who have a Body Mass Index of at least 30). Obesity also decreases the survival rate of a person.
  3. Late or no pregnancy: There is a high risk of ovarian cancer in women who get pregnant after the age of 35 or in women who have never had a pregnancy.
  4. Taking Hormone Therapy: There are increased risks of ovarian cancer development in the case of women who use estrogen/ progesterone hormone after menopause in order to manage the post-menopausal symptoms.
  5. Family History: Just like other cancers, ovarian cancer can also run in families. Hence, if anyone in your family had ovarian cancer (like your mother, sister, etc.), you become more prone to develop ovarian cancer. It is not a rule that ovarian cancer only depends on your mother’s side of the family and hence, you can also get ovarian cancer from your father’s side.
  6. Talcum Powder: It may come as a shock to many people, but studies suggest talcum powder can cause ovarian cancer if the particles of the powder travel up to the ovary through the vagina, uterus and then the fallopian tubes. Many controlled case studies have shown that talcum powder is responsible for an increased risk of ovarian cancer. These studies don’t provide us with a sure shot answer (and hence, cannot be considered as rigid proofs).

Ovarian Cancer Symptoms:

Majority of the ovarian cancers begin in the epithelium i.e., the outer lining of the ovaries. There may be a few or no symptoms at all in the early stages. However, even if the symptoms are there, they may resemble those of the other conditions like PMS (Pre-Menstrual Syndrome), irritable bowel syndrome, etc. Although, in the case of ovarian cancer, such symptoms persist for a longer time and get worse with time.

Ovarian cancer early symptoms/ ovarian cancer first symptoms include the following:

  • Experiencing pain or pressure in the pelvic region
  • Vaginal bleeding at unexpected times
  • Pain in back or abdominal region
  • Bloating
  • Getting full even with little food
  • Abnormal urinary patterns like the urination getting more frequent
  • Constipation

If one experiences any of the above symptoms for 2 weeks or more, she should consult a doctor, other than these symptoms, there can also be other symptoms:

  • Loss of appetite
  • Pain during intercourse
  • Weight loss
  • Short breaths or breathlessness
  • Nausea
  • Indigestion
  • Fatigue

These symptoms can change if cancer gets metastasised to other parts of the body

Ovarian Cancer Diagnosis: All thanks to the modern advancements of science, we are able to detect cancers and even, pre-cancers before the symptoms start appearing. There are many methods to diagnose ovarian cancer, which are as follows:

  1. Pelvic examination: During this test, your pelvis is checked by your doctor. The doctor inserts gloved fingers in the vagina along with pressing with another hand on your stomach (abdomen) to feel the pelvic organs. This is also accompanied by the visual examination of the external genitalia, cervix and vagina done by the doctor.
  2. Imaging Tests: This includes tests like CT scans and ultrasound which produce images of the internal bodies or organs. Such tests help determine the size, shape and structure of the ovaries.
  3. Blood tests: These tests are done to test organ functions in order to determine the overall health of the body. Your doctor may test your blood for tumour markers that can indicate the possibility of ovarian cancer. For instance, CA125 is a cancer antigen test that can help in detecting the protein often found on the surface of these ovarian cancerous cells. These tests can’t clearly tell if one has ovarian cancer or not and you will need a proper diagnosis and prognosis.
  4. Surgery:  At times, a diagnosis does not prove to be significantly efficient in diagnosing ovarian cancer. In such cases, your doctor recommends surgeries like laparoscopy in order to diagnose ovarian cancer and perform surgical removal of ovarian cancer also.
  5. Genetical testing: Your doctor or healthcare provider can also recommend a blood sample test to see for any genetic changes which may increase the risk of ovarian cancer. Knowing if someone has a genetic mutation can help the doctor to structure a proper treatment plan.

Ovarian Cancer Treatment:

If we talk about the treatments for ovarian cancer, they usually involve surgery along with chemotherapy. However, the treatment course may change depending on the situations of the particular cases.

  • Surgery:

There are various kinds of surgeries that are used to remove ovarian cancer from an individual. Your doctor might suggest one of the following depending upon your case.

Surgical removal of one ovary: This surgery can be used for cancers in the early stage. The cancer is only confined to a single ovary and hence, has not spread to the other ovary. Such surgery may involve the removal of the ovary that is affected along with the fallopian tube. This procedure doesn’t create a hindrance to your reproductive capability and hence, you can still be a mother after this surgery.

Surgical removal of both ovaries: Such surgery is done in cases where cancer has spread or is present in both ovaries. However, no additional signs of cancer can be seen in such individuals. Your surgeon/ doctor may remove both of your ovaries and fallopian tubes. This surgery also doesn’t cause any serious damage to your reproductive organs and hence, one can get pregnant after this procedure if they use frozen embryos/ eggs or donor eggs.

Surgical removal of the uterus along with both ovaries: If the cancer is extensive or in cases of people who do not wish to preserve their reproductive capability then, in such cases, the surgeon may remove the ovaries, fallopian tubes, uterus, surrounding lymph nodes and a fold of fatty abdominal tissue through surgery.

Surgery for advanced cancer: If the cancer is of the advanced stage, the doctor might recommend you to undergo surgery that involves the removal of as much cancer as can be removed. Chemotherapy is often preceded or succeeded before or after this surgery.

  • Chemotherapy: This is a drug treatment that involves using chemicals in order to fast kill the abnormally growing cancer cells in the body. These drugs can be given to a person by either the oral route (ingestion) or an injection in the veins. Chemotherapy is often used after surgery in order to kill any remaining cancer cells. However, it can be used before surgery also. These chemotherapy drugs can also be infused into the abdomen after heating in certain cases which are known as hyperthermic intraperitoneal chemotherapy. These drugs are kept/ left there till the time they get drained and then the operation is said to be complete and successful.
  • Targeted Therapy:  This is also known as the targeted drug treatment therapy and, as the name suggests, this includes focusing or targeting on a particular weakness existing/ present in the cancer cells and hence, ultimately causing these cancer cells to die. Your doctor may perform some tests to determine which targeted therapy is going to have the best effect on your ovarian cancer.
  • Hormone Therapy: This involves the use of drugs that block the effects of the additional estrogen hormone which is produced by the cancer cells. Blocking estrogen hormone is an effective way to fight against cancer as some ovarian cancers use this estrogen hormone to grow. Hormone therapy can be an option for ovarian cancers that are slow-growing in nature. It can also be a treatment option if cancer reappears after the initial treatment protocol.
  • Immunotherapy: This therapy uses the immune system of the body to fight against cancer. Normally, the immune system of the body which fights against the diseases is unable to detect the cancer cells as these cells produce certain proteins which help them hide. Immunotherapy works by causing interference between this process of hiding and hence, immunotherapy can also be a good option for treating ovarian cancer.
  • Palliative or Supportive Care: This refers to specialized medical care that mainly focuses on providing relief from the pain and other serious symptoms associated with cancer and other serious illnesses. A palliative care specialist works with you, your family and other doctors to give extra support for the ongoing care. It can be used with other aggressive treatments like surgery and chemotherapy.

Conclusion:

Even though, ovarian cancer sounds like a devastating condition (that it is, at times) yet if you ask an ovarian cancer survivor, you’ll get to know all you need is a timely detection, some hope and a competent doctor by your side. You need to have a doctor who is straight forward and direct with the approach and timeline of your case that she/he has planned in their head. Hence, you should be careful when consulting a doctor as you will not feel very wise of yourself if you go to any doctor recommended by your family and/ or friends. One must look through all the options and then decide if she/he wants to go ahead with something in their life.

 

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