Ovarian cancer is a type of cancer that originates in the ovaries. Ovaries are female productive glands responsible for producing eggs and female hormones estrogen and progesterone.
Ovarian cancer is the fifth leading cause of cancer deaths for females.
The American Cancer Society estimates for ovarian cancer incidence in the United States for 2020 are:
- About 21,750 new cases will be diagnosed with ovarian cancer.
- About 13,940 deaths from ovarian cancer.
Types of ovarian cancer:
There are there main types of cell that make up the ovary. The type of ovarian cancer is determined by the type of cell it originated from.
- Epithelial tumors: originates from the cells in the outer surface of the ovaries (epithelial cell). Cancerous (malignant) epithelial tumors are identified as carcinomas and they are the most common type of ovarian cancer. Here are the subtypes of ovarian carcinomas:
- Serous carcinomas
- Clear cell carcinoma
- Mucinous carcinoma
- Endometroid carcinoma
- Stromal tumors: originates from the cells in the ovarian connective tissues that produces estrogen and progesterone (stromal cell). The subtypes of malignant stromal tumors include the following:
- granulosa cell tumors
- granulosa-theca tumors
- Sertoli-Leydig cell tumors
- Germ cell tumors: originates from the cells that produce eggs (germ cell). The subtypes of malignant germ cell tumors include the following:
- Endodermal sinus tumors
What are the risk factors of ovarian cancer?
- Age: the risk of developing ovarian cancer increases with age. Most commonly develops after menopause.
- Inherited genetic mutations: genetic mutations of the BRCA1 and BRCA2 genes increase the risk of developing breast cancer
- Family history: Women with family history of ovarian cancer, breast cancer or colon cancer have higher risk of developing ovarian cancer
- Reproductive history: early menstruation and late menopause increases the risk of developing ovarian cancer. Women who have children after the age of 35 or women who never carried a full-term pregnancy have higher risk of developing ovarian cancer.
- Taking Hormones: women who use estrogen hormone replacement therapy after menopause have higher risk of developing ovarian cancer compared to women who have never used hormones.
Signs and symptoms of ovarian cancer:
Ovarian cancer may have nonspecific symptoms that can be mistaken for other conditions. Frequently, ovarian cancer is not detected until it has progressed.
The common signs and symptoms of ovarian cancer include:
- Abdominal bloating
- Pelvic or abdominal pain or discomfort
- Feeling of fullness
- Urinary frequency or urgency
The other less common signs and symptoms of ovarian cancer may:
- Weight loss
- Changes in menstruation
- Back pain
- Pain during sexual intercourse
- Abdominal swelling from fluid in the abdomen (ascites)
How to diagnose ovarian cancer?
- Medical history and physical examination, including pelvic examination, followed by further tests and investigations, such as:
- Imaging tests: ultrasound, CT scan and MRI scan. PET/CT scan can also be used to find out if the cancer has metastasized (spread) to other areas of the body.
- Blood tests: tumor marker, CA-125, test along with other blood tests.
Treatment of ovarian cancer:
After diagnosis, your doctor will establish the stage of your disease. According to your current health status, history, and staging results, your doctor will discuss with you your treatment options. Regular follow-ups with your doctor and periodical monitoring with tests and investigations are highly recommended.
Treatment for ovarian cancer is more likely to be successful when the cancer is still in early stage and hasn’t metastasized to other areas.
Treatment options include:
- Surgery: Surgery is often performed to treat most ovarian cancers. The type of surgery depends on the patient’s health condition and the staging of the ovarian cancer. The types of surgery for treating ovarian cancer include:
- Total hysterectomy (TAH): surgery to remove the uterus and cervix
- Bilateral salpingo-oophorectomy (BSO): surgery to remove both ovaries and fallopian tubes
- Unilateral salpingo-oophorectomy: surgery to remove only one ovary and fallopian tube
In addition, surgical procedures below may also be done:
- Debulking: surgery to remove as much of the tumor as possible
- Omentectomy: surgery to remove the omentum, a fold of fatty tissue in the abdomen
- Lymphadenectomy or lymph node dissection: surgery to remove affected lymph nodes
- Colectomy: surgery to remove the bowel
- Removal of other organs that ovarian cancer has metastasized to
- Chemotherapy: using chemo drugs to kill cancer cells systemically, which can be taken either intravenously or orally. Chemotherapy for treating ovarian cancer usually involves using two different types of chemo drugs and can be given before surgery to shrink the tumor size or after surgery to kill possible remaining cancer cells. In some cases, intraperitoneal (IP) chemotherapy can also be done by injecting chemotherapy into the abdominal cavity.
- Hormonal Therapy: using hormones or drugs to block estrogen (i.e. Luteinizing-hormone-releasing hormone (LHRH) agonists, Tamoxifen and Aromatase inhibitors).
- Targeted therapy: using certain drugs to target specific abnormalities present within cancer cells.
- Radiotherapy: using high-powered energy beams to kill cancer cells. The most common type of radiotherapy for treating ovarian cancer is external beam radiation therapy (EBRT). Another method is radiotherapy is brachytherapy.
- Alternative treatments: using other scientific based alternatives to attack cancer cells.
How to reduce the risk of developing ovarian cancer?
- Oral contraceptives (birth control pills): Using oral contraceptives may reduce the risk of developing ovarian cancer for women who are at risk and women with inherited BRCA mutation.