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Ovarian Cancer
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Ovarian Cancer begins in a woman's ovaries, of which there are two located in the pelvis on either side of the uterus. Ovaries are normally the size of a regular almond in the shell. Its job is to produce estrogen, testosterone and progesterone as well as to make eggs in the reproductive years. Ovarian cancer is difficult to detect because it carries few symptoms until it has spread to other body areas. Ovarian cancer is often fatal as a result of a late diagnosis.
As mentioned, ovarian cancer has few symptoms in its early stages. Some symptoms a woman might notice include abdominal pressure, bloating, fullness or swelling, pelvic pain, indigestion, including nausea or gas pains and flatulence, constipation, change in bladder habits such as urinating frequently or pain on urination, feeling quickly full or having no appetite, low back pain or a lack of energy.
The cause of ovarian cancer is not known but it is believed to be due to a genetic mutation in a cell in the ovary. There are several types of ovarian cancer, including cancer that begins on the surface of the ovaries. This is called epithelial cancer and represents the most common type of ovarian cancer. Egg-producing cells can yield cancer as well. This is called a germ cell tumor. It tends to happen to younger women. Cancers can also occur in the hormone-producing cells of the ovary. These are known as stromal tumors and begin within the cells that produce ovarian hormones. Each type of ovarian tumor has its own prognosis and treatment plan.
There are various risk factors for ovarian cancer. These include inherited mutations in certain genes. Women who have mutations in the BRCA1 and BRCA2 genes have an increased risk of cancer of the ovaries. If you have a family history of ovarian cancer, you are also at an increased risk for the disease. Having a history of breast, colon, uterine or rectal cancer increases your risk of a secondary ovarian cancer. Your risk for cancer of the ovaries increases with age and if you haven't been pregnant before, you are at a greater risk for the disease. Hormone replacement therapy increases the risk of ovarian cancer, as shown in some studies.
The diagnosis of ovarian cancer includes doing a pelvic exam and finding an enlarged ovary. This leads to further diagnostics, including an ultrasound of the pelvis, which can be done using a vaginal approach or an abdominal approach. If this shows an abnormal ovary, a laparoscopic surgery can take a biopsy of the ovary to see if it is cancerous. A protein known as CA 125 is high in some cases of ovarian cancer. It can be used to see if the cancer has been removed but, since it is not high in all cases of ovarian cancer, it is a questionable diagnostic test.
Ovarian cancer needs to be staged in order to define the type of treatment necessary. Staging can be done at the time of surgery or using an MRI exam to look for metastases. In Stage I disease, the cancer lies solely within the ovary. In stage II cancer, the cancer has spread to regional areas within the pelvis, such as the fallopian tubes or on the uterus. Stage III disease defines those cancers that have spread to regional lymph nodes or outside the pelvis. Stage IV disease represents those cancers that have spread to other areas of the body, such as the lungs or the liver.
The treatment of ovarian cancer involves a combination of surgery, chemotherapy and radiation. Unfortunately, most people are not diagnosed until later stage disease so that the patient with ovarian cancer needs to have most, if not all, of these modalities in order to stem the tide of the cancer. Surgery involves removing all the pelvic organs, including the uterus, ovaries and the fallopian tubes. Nearby lymph nodes are removed as well as the nearby omentum, a fatty fold within the abdomen that is commonly a place where ovarian tissue grows. As much cancer as possible is removed at the time of surgery.
Chemotherapy involves using drugs that kill off as much of the tumor as possible. It is used in advanced ovarian cancer so that the cancer can shrink further. Chemotherapy drugs can be given by IV or by injecting the chemotherapy directly into the abdomen.
Radiation is rarely used in ovarian cancer because it is not very sensitive to radiation and there are often multiple small metastases that can't be treated well with beam radiation.