Ovarian cancer or cancer of the ovaries is a deadly cancer. Many women who have ovarian cancer often have it diagnosed at a late stage when it is difficult to treat and is frequently fatal. In early-stage ovarian cancer, in which the disease is confined to the ovary, it is likely to be treated successfully. The challenge is therefore to detect this disease in its early stages.
Ovarian cancer
Women have two ovaries, one on each side of the uterus. The ovaries — each about the size of a cherry-nut — produce eggs (ova) as well as the hormones oestrogen and progesterone.
The term “ovarian cancer” includes several different types of cancer that all arise from cells of the ovary. Most commonly, tumours arise from the epithelium, or lining cells, of the ovary. These are all considered to be one disease process. There are also less common forms of ovarian cancer that come from within the ovary itself.
There are also entities called borderline ovarian tumours that have the microscopic appearance of a cancer, but tend not to spread much.
What are some symptoms and signs of ovarian cancer?
Many women who have early-stage ovarian cancer do not have any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel.
Signs and symptoms of ovarian cancer may include:
• Abdominal bloating or swelling
• Quickly feeling full when eating
• Weight loss
• Discomfort in the pelvis area
• Changes in bowel habits, such as constipation
• A frequent need to urinate
When to see your gynaecologist?
As noted, the symptoms and signs of ovarian cancer when they occur are usually not specific. You should, however, see your gynaecologist if you have these non- specific symptoms especially if you have a family history of ovarian cancer or breast cancer.
Risk factors for ovarian cancer
We do not know what causes ovarian cancer, but there are some factors that increase a woman’s risk of getting it. These include the following:
• Age. Ovarian cancer can occur at any age but is most common in women age 50 to 60 years.
• Inherited gene mutation. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer.
• Oestrogen hormone replacement therapy, especially with long-term use and in large doses.
• Age when menstruation started and ended. If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be increased.
• Never being pregnant.
• Fertility treatment.
• Smoking.
• Polycystic ovary syndrome.
It should be pointed out that many women develop ovarian cancers that do not have any of these risk factors.
There is no sure way to prevent ovarian cancer, but certain factors are associated with lower risk and include the following:
• Use of oral contraceptives, especially for more than 10 years
• Previous pregnancy
• History of breast-feeding
Making the diagnosis
Some cases are diagnosed during surgery for some other condition. During a visit to your gynaecologist, following a detailed medical history, a complete physical examination is carried out to include a pelvic examination. Your doctor may also recommend various tests, such as ultrasound or CT scans, of your abdomen and pelvis. These tests can help determine the size, shape and structure of your ovaries. Blood tests which can detect a protein (CA 125) found on the surface of ovarian cancer cells might be requested in some cases. In some cases a minor surgical procedure might be done to remove a tissue sample and abdominal fluid to confirm a diagnosis of ovarian cancer.
Treatment
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. The treatment options will vary from patient to patient and also according to the stage of the ovarian cancer.
Prognosis
Epithelial ovarian cancer is the most deadly of the gynaecologic cancers. Approximately 80% of patients will eventually die of the disease. If diagnosed in the early stages survival in the short term is quite good. With the addition of intra-peritoneal chemotherapy, the survival of ovarian cancer has been significantly extended. According to recent studies, if a patient undergoes optimal debulking, followed by IP chemotherapy, then she has a greater than 50% chance to still be alive in 6 years. Even in the recurrent setting, epithelial ovarian cancer is often very sensitive to chemotherapy. The disease can often go into complete remission (no detectable disease) many times. Germ cell and stromal tumours have a much better prognosis. They are often cured because they are more often detected at early stages.
Conclusion
Ovarian cancer is a deadly gynaecological cancer mainly due to the fact that many cases are diagnosed in the late stages, and very often the signs for this cancer are very non- specific. Experts do not know exactly what causes ovarian cancer, but they do know that DNA changes play a role in many cancers. If you have abnormal symptoms you should see your gynaecologist. Examination and various tests might be done, but the only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
