Ovarian Cancer

Ovarian cancer is a type of cancer that begins in the ovaries, the female reproductive organs responsible for producing eggs (ova) and the hormones estrogen and progesterone. It is often called a “silent killer” because it frequently goes undetected until it has spread to the pelvis and abdomen. Early-stage ovarian cancer may not cause noticeable symptoms, which contributes to its late diagnosis in many cases. When ovarian cancer is detected early, treatment is more likely to be successful.

Types of Ovarian Cancer

  1. Epithelial Ovarian Cancer:
    • This is the most common type (about 90% of cases).
    • It originates in the thin layer of tissue that covers the outside of the ovaries (the epithelium).
    • Subtypes include serous, mucinous, endometrioid, and clear cell carcinoma.
  2. Germ Cell Tumors:
    • These cancers begin in the egg-producing cells of the ovaries.
    • They are rare and more common in younger women.
    • Germ cell tumors generally have a good prognosis and respond well to treatment.
  3. Stromal Tumors:
    • These are rare tumors that develop in the ovarian connective tissue that produces hormones.
    • They are often detected at an early stage and can be associated with abnormal bleeding due to hormone production.

Risk Factors

The exact cause of ovarian cancer is unknown, but several risk factors have been identified:

  1. Age:
    • Most ovarian cancers occur in women aged 50 to 60 years, though they can develop at any age.
  2. Family History:
    • A family history of ovarian cancer or other cancers (like breast or colon cancer) increases the risk. BRCA1 and BRCA2 gene mutations significantly raise the likelihood of both ovarian and breast cancer.
  3. Inherited Genetic Syndromes:
    • Women with Lynch syndrome (hereditary non-polyposis colorectal cancer) or mutations in the BRCA1 and BRCA2 genes are at a higher risk of ovarian cancer.
  4. Personal History of Cancer:
    • Women who have had breast, uterine, or colorectal cancer are at increased risk of developing ovarian cancer.
  5. Reproductive History and Infertility:
    • Women who have never been pregnant or had children have a slightly higher risk.
    • Certain fertility treatments and conditions such as polycystic ovary syndrome (PCOS) may also increase risk.
  6. Hormone Replacement Therapy (HRT):
    • Long-term use of estrogen hormone replacement therapy, especially without progesterone, may increase the risk of ovarian cancer.
  7. Endometriosis:
    • A condition in which tissue similar to the lining of the uterus grows outside the uterus, increasing the risk of certain types of ovarian cancer.

Symptoms of Ovarian Cancer

Ovarian cancer often presents vague symptoms that can be mistaken for less serious conditions, such as digestive or urinary problems. Symptoms include:

  • Abdominal bloating or swelling.
  • Pelvic pain or discomfort.
  • Feeling full quickly or difficulty eating.
  • Unexplained weight loss.
  • Frequent urination or an urgent need to urinate.
  • Fatigue or general malaise.
  • Changes in bowel habits, such as constipation.
  • Menstrual irregularities (in younger women).

If these symptoms are new, persistent, and occur frequently, it is essential to seek medical attention, especially in women over 50.

Diagnosis of Ovarian Cancer

Several diagnostic tests and procedures can help confirm ovarian cancer:

  1. Pelvic Exam:
    • A doctor examines the ovaries and uterus for abnormalities, but ovarian cancer is often difficult to detect during a physical exam.
  2. Imaging Tests:
    • Ultrasound: This imaging test uses sound waves to create pictures of the ovaries. It helps distinguish between solid masses (which may be cancerous) and fluid-filled cysts (usually benign).
    • CT Scan or MRI: These scans provide more detailed images to check for the presence of a tumor and assess whether cancer has spread.
  3. Blood Tests:
    • CA-125 Test: This blood test measures the level of a protein called CA-125, which is often elevated in women with ovarian cancer. However, it is not a definitive test since levels can also be elevated in benign conditions.
  4. Biopsy:
    • While a biopsy is not typically performed before surgery, tissue samples taken during surgery can confirm a diagnosis. In some cases, a laparoscopy (a minimally invasive surgical procedure) is used to view the ovaries and take samples.
  5. Genetic Testing:
    • Women diagnosed with ovarian cancer may undergo genetic testing to identify mutations in the BRCA1 and BRCA2 genes. This information can guide treatment and help assess the risk for family members.

Staging

Once ovarian cancer is diagnosed, it is staged to determine the extent of the disease. The staging is based on how far the cancer has spread:

  • Stage I: Cancer is confined to one or both ovaries.
  • Stage II: Cancer has spread to other pelvic organs (e.g., fallopian tubes, uterus).
  • Stage III: Cancer has spread beyond the pelvis to the abdominal lining or lymph nodes.
  • Stage IV: Cancer has spread to distant organs such as the liver or lungs.

Prognosis and Survival Rates

The prognosis for ovarian cancer varies depending on the stage at diagnosis:

  • Stage I: Early-stage ovarian cancer has a 5-year survival rate of around 90% when treated promptly.
  • Stage II: The 5-year survival rate is around 70%.
  • Stage III: At this stage, the 5-year survival rate drops to around 39%.
  • Stage IV: Advanced ovarian cancer has a 5-year survival rate of about 17%.

Prevention and Risk Reduction

Conclusion

Ovarian cancer is a serious but treatable disease, particularly when detected early. Awareness of risk factors, symptoms, and the importance of early diagnosis can help improve outcomes. Advances in surgery, chemotherapy, targeted therapies, and genetic testing have significantly improved treatment options, offering hope for women diagnosed with this challenging disease.