Ovarian Cancer: Symptoms, Causes, Risk Factors, Prevention, Diagnosis, Staging, Treatment

A malignant tumor on the ovary is called ovarian cancer. The ovary itself may be the source, but more frequently, it comes from neighboring tissues that communicate with it, including the fallopian tubes or the abdominal wall. 

Three main cell types, including epithelial, germ, and stromal cells, make up the ovary. These cells have the capacity to multiply and develop tumors. Other bodily parts may also be invaded or colonized by these cells.

There may be none or simply hazy signs when this procedure starts. As the cancer spreads, the symptoms become more obvious.

 Bloating, vaginal bleeding, pelvic pain, stomach swelling, constipation, and loss of appetite are a few of these symptoms that may be present. Typical locations where the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.

Read this blog further to get a quick overview of this important topic for OBSTETRICS AND GYNECOLOGY to ace your NEET PG exam preparation.

Symptoms Of Ovarian Cancer

Ovarian cancer may not initially manifest any symptoms. When ovarian cancer symptoms appear, they are frequently misdiagnosed as being caused by other, more prevalent illnesses.

Ovarian cancer symptoms and signs may include:

• Stomach bloating or oedema
• Having a quick feeling of fullness after eating
• Loss of weight
• Pelvic discomfort
• Fatigue
• Back discomfort
• Alterations in bowel habits, such as constipation
• A constant urge to urinate  

Causes of Ovarian Cancer

Although there are factors that can raise the risk of developing the disease, the exact cause of ovarian cancer remains unknown.

Physicians know that cells in or near the ovaries generate DNA changes (mutations), which is how ovarian cancer starts. The instructions directing a cell's actions are encoded in its DNA. The adjustments instruct the cells to fast divide and increase, resulting in a mass (tumor) of cancer cells. When healthy cells expire, malignant cells live on. They have the ability to expand (metastasise) to different body areas by invading surrounding tissues and splintering from an initial tumor.

Your ovarian cancer kind and the best treatments for you will be determined by the type of cell where the disease first appears. Forms of ovarian cancer include:

• Ovarian carcinoma with epithelial cells- The majority of cases involve this type of carcinoma. Serous carcinoma and mucinous carcinoma are two of its numerous subtypes.
• Stromal carcinoma-  Compared to other ovarian cancers, these uncommon tumors are typically discovered earlier in the disease.
• Germ cell tumor- These uncommon ovarian malignancies typically develop when people are younger.

Risk Factors of Ovarian Cancer

Ovarian cancer risk factors include:

• An older age-  As you become older, risk of developing ovarian cancer rises. The majority of diagnoses are made on older persons.

• Gene Modifications Brought on Via Inheritance-  A small portion of ovarian tumors are brought on by genetic abnormalities. BRCA1 and BRCA2 are two of the genes that raise the risk of ovarian cancer. Additionally, these genes raise the chance of developing breast cancer.

• In addition, mutations in the BRIP1, RAD51C, and RAD51D genes, as well as those linked to Lynch syndrome, are known to raise the chance of developing ovarian cancer.

• Hereditary Ovarian Cancer-  You may be at a higher risk for the disease if you have blood relations and have been diagnosed with ovarian cancer.

• Being Obese or Overweight- Ovarian cancer risk is increased by being overweight or obese.

• Hormone Replacement Therapy after Menopause- Ovarian cancer risk may rise if hormone replacement treatment is used to manage menopause symptoms and signs.
• Endometriosis. Endometriosis is a condition where tissue that resembles the tissue that lines the interior of the uterus grows outside of the uterus. It is frequently uncomfortable.

• The age at which menstruation began and finished. Ovarian cancer risk may be increased by early menstruation, a later onset of menopause, or even both.

• Never Having Given Birth. If you've never been pregnant, your chance of developing ovarian cancer may be higher.

Prevention of Ovarian Cancer

There's no way to completely prevent ovarian cancer. There may be ways to reduce your risk, though:

• Consider using birth control tablets. Ask your doctor if you should use oral contraceptives, also referred to as birth control tablets. When birth control pills are utilized, the chance of ovarian cancer is reduced. However, consider if the risks of these treatments outweigh the benefits given your situation.
• Discuss your risk factors with your doctor. If you have a history of breast and ovarian cancer in your family, let your doctor know. Your doctor can decide what this might mean for your own risk of developing cancer. You might be given the name of a genetic counselor who can help you decide whether genetic testing might be beneficial for you.

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Diagnosis of Ovarian Cancer

The following examinations and techniques are used to identify ovarian cancer:

• Pelvic examination- A pelvic exam involves a doctor palpating pelvic organs by inserting gloved fingers into the vagina and pressing a hand against the abdomen at the same time. Additionally, the vagina, cervix, and external genitalia are all visibly inspected by the doctor.
• Imaging examinations. The size, shape, and structure of ovaries can be determined by tests like ultrasound or CT scans of the abdomen and pelvis.
• Blood Test- Organ function tests that help determine your general health may be included in blood tests.
• Additionally,  physicians may examine blood for tumor markers indicative of ovarian cancer. A cancer antigen (CA) 125 test, for instance, can find a protein that is frequently present on the surface of ovarian cancer cells. Although these tests can't tell you if you have cancer, they could offer hints as to your prognosis and diagnosis.
• Surgery- Sometimes a surgical ovary removal and further cancer screening are necessary before your doctor can be certain of your diagnosis.
• Genetic analysis. In order to check for gene alterations that raise the risk of ovarian cancer, physicians could advise having a sample of your blood tested. Your doctor can decide on the best course of treatment for you if they are aware that you have an inherited DNA alteration.

Ovarian Cancer Staging

• Stage I: Ovarian Involvement
  • A - One ovary involved
  • B - Both ovaries involved
  • C - A/B ±
    • C₁ - Surgical spill 
    • C₂ - Surface growth
    • C₃ - Malignant Ascites/ washings
• Stage II: Pelvis Involvement
  • IIA - Uterus, fallopian tubes
  • IIB - other pelvic organs
• Stage III: Abdominal Visceral Involvement
  • IIIA₁: Retroperitoneal lymph node involvement
    • A₁ (i) - < 10 mm
    • A₁ (ii) - > 10 mm
  • IIIA₂ Microscopic abdominal visceral involvement
  • IIIB Macroscopic involvement <2cm  {superficial liver & spleen involvement}
  • IIIC Macroscopic involvement >2cm   {superficial liver & spleen involvement}        
• Stage IV
  • IVA: Malignant pleural effusion 
  • IV B: Deep/ parenchymal liver & spleen deposits, Inguinal lymph node involvements
• Highlighted ones are new changes in the staging

Treatment of Ovarian Cancer

Ovarian cancer can be managed by the following methods:

• Surgery to remove the uterus and ovaries. The ovaries, fallopian tubes, uterus, adjacent lymph nodes, and an area of fatty abdominal tissue called the "omentum" will all be removed by the surgeon if the cancer is further advanced.
• Surgery for cancer that has Progressed- The doctor could advise surgery to remove as much of the cancer as possible if it has spread. In this case, chemotherapy may occasionally be administered before or following surgery.
• Chemotherapy
  • Chemotherapy is a pharmacological therapy that uses chemicals to eliminate the body's rapidly proliferating cells, including cancer cells. Chemotherapy medications can be ingested or administered intravenously.
• Targeted Therapy
  • Targeted medication therapies concentrate on certain areas of cancer cells. Targeted medication therapies can kill cancer cells by going after these vulnerabilities.
  • The doctor may perform a cancer cell test if you're thinking about receiving a targeted therapy for ovarian cancer to identify the targeted therapy that has the best chance of working.
• Hormone replacement treatment
  • Drugs are used in hormone therapy to stop the effects of the hormone estrogen on ovarian cancer cells. Eliminating estrogen may help manage the tumor because some ovarian cancer cells rely on it to develop.
  • Some forms of slow-growing ovarian cancer may be treated with hormone therapy. If the cancer returns after the first therapies, it can potentially be a possibility.
• Immunotherapy
  • Immunotherapy fights cancer by activating the immune system. Cancer cells create proteins that assist them hide from immune system cells, so the body's immune system that fights disease may not attack them. Immunotherapy affects that process in order to work.
  • In some circumstances, immunotherapy may be an option for treating ovarian cancer.
• Palliative (supportive) care
  • Palliative care is a type of specialized medical treatment that concentrates on relieving pain and other severe sickness symptoms. Specialists in palliative care collaborate with you, your loved ones, and your other medical professionals to add an extra layer of support to your ongoing treatment. While receiving more invasive therapies like surgery and chemotherapy, palliative care can be used.
  • People with cancer may feel better and live longer when palliative care is utilized in addition to all other necessary therapies.
  • A group of doctors, nurses, and other specially qualified professionals offer palliative care. Teams providing palliative care work to enhance the quality of life for cancer patients and their families. Along with any curative or other therapies you might be receiving, this type of care is available.

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