Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries – each about the size of an almond – produce eggs (ova) as well as the hormones estrogen and progesterone.
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. Some tumors are benign (non-cancerous). Others are malignant (cancerous.) Ovarian tumors may be either solid or cystic (fluid-filled sacs). They can look very similar in appearance to benign ovarian cysts, which are very common, and this can make early diagnosis difficult.
If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer. Ovarian cancer often has warning signs, but the earliest symptoms are vague and easy to dismiss. Hence only 20% of ovarian cancers are detected at an early stage and majority are diagnosed in advanced stage of the disease.
Ovarian cancer is considered to be the deadliest among all gynaecological cancers. There are no specific symptoms that can help in diagnosing ovarian cancer early. Symptoms often develop late, when the cancer is already advanced, and hence ovarian cancer has been called the “silent killer” or “the cancer that whispers.” Survival rates for ovarian cancer vary depending on many different factors, including the age of the woman, the stage of ovarian cancer at the time of diagnosis and the type of treatment received.
Staging is the process of finding out how much cancer is in a person’s body and where it’s located or how much it has spread.
Ovarian cancer grows quickly and can progress from early to advanced stages within a year. It has been scientifically studied that ovarian cancer canprogress from stage to stage in a matter of months, making it far more aggressive than malignancies such as breast cancer.
Paying attention to symptoms can help improve a woman’s chances of being diagnosed and treated promptly. Detecting cancer while it is still in its earliest stages may help improve prognosis.
Staging is the process of finding out how much cancer is in a person’s body and where it’s located or how much it has spread.
Age – Older women have a higher risk for ovarian cancer than younger women. Ovarian cancer usually occurs after menopause, although it can develop in women of all ages. Most women diagnosed with ovarian cancer are older than age 55.
Family History – Women are at high risk for ovarian cancer and for harboring a genetic mutation such as BRCA if they have a family history of breast and ovarian cancer in close relatives.
Genetic Mutations – Inherited mutations in the genes called BRCA1 and BRCA2 greatly increase the risk for ovarian and breast cancers.Women with a BRCA1 mutation have about a 44% lifetime risk for ovarian cancer. Women with a BRCA2 mutation have about a 17% lifetime risk for ovarian cancer. (By contrast, the lifetime ovarian cancer risk for women in the general public is about 1 in 55 or 1.3%.)These gene mutations are also associated with increased risks for breast cancer, fallopian tube cancer, pancreatic cancer, and prostate cancer in the male.In addition to an increased lifetime risk, women with these gene mutations tend to develop these cancers at an earlier age than that seen in the usual population of women with ovarian cancer.Other genetic factors are also associated with increased risk. Women who have genetic mutations associated with hereditary non-polyposis colorectal cancer (HNPCC or Lynch syndrome) have about a 10% to 15% lifetime risk of developing ovarian cancer.
Personal Medical History – Women who have been diagnosed with breast cancer are at increased risk for ovarian cancer, even if they do not have BRCA mutations. Endometriosis, a condition in which the cells that line the cavity of the uterus grow in other areas of the body such as on the ovaries or on the other pelvic structures, increases the risk for ovarian cancer.
Reproductive History – Women are at increased risk for ovarian cancer if they began menstruating at an early age (before age 12), have not had any children, had their first child after age 35, or experienced early menopause (before age 50). There are also preventive factors associated with reproductive history. The more times a woman gives birth, the less likely she is to develop ovarian cancer. Breast-feeding for a year or more after giving birth may also decrease ovarian cancer risk. Tubal ligation, a method of sterilization that ties off the fallopian tubes, is associated with a decreased risk for ovarian cancer. Similarly, hysterectomy, the surgical removal of the uterus, may decrease risk.
Hormone Use – Women who use hormone therapy (HT) after menopause for longer than 5 years may have an increased risk for ovarian cancer. The risk seems to be particularly significant for women who take estrogen-only HT. The risk is less clear for combination estrogen-progestin HT. Oral contraceptives (birth control pills) significantly reduce the risk of ovarian cancer, in some series by as much as 50%. The longer a woman takes oral contraceptives the greater the protection and the longer protection lasts after stopping oral contraceptives.
Obesity – Women who are obese have an increased risk for ovarian cancer.
Ovarian cancer does have symptoms, but they are often very subtle and easily mistaken for other, more common problems. In some rare cases, early stage ovarian cancers may produce symptoms, but in the majority of women these don’t show up until the cancer has advanced (when the growth of the tumor triggers symptoms). Several studies show that ovarian cancer can produce these symptoms:
If you have these symptoms for more than two weeks, and the symptoms are new or unusual for you, see a Gynec Oncologist and ask about Ovarian Cancer.
If a woman has the signs and symptoms of ovarian cancer, she needs a complete pelvic exam by a Gynec Oncosurgeon, a CT scan or MRI scan, and a CA-125 blood test.
The most important factors to be considered are the patient’s age, menopausal status, family history of any malignancy, clinical examination, and the results of blood levels of tumor markers i.e. CA-125 and imaging studies like CT or MRI scan.
Because of the lethality of ovarian cancer, it is considered advisable to “err on the side of caution.”
American College of Obstetrics and Gynecology (ACOG) and SGO consensus guidelines recommend referral to a gynecologic oncologist for women with elevated blood level of CA-125, presence of fluid in abdomen, an ovarian mass and evidence of abdominal/distant metastasis.
If a woman has the signs and symptoms which suggest possibility of ovarian cancer, she needs a complete pelvic exam by a Gynec Oncosurgeon, a CT scan or MRI scan, and a CA-125 blood test.
The most important factors to be considered to know a woman’s risk of ovarian cancer are, the patient’s age, menopausal status, family history of any malignancy, clinical examination, and the results of blood levels of tumor markers i.e. CA-125 and imaging studies like CT or MRI scan.
Because of the lethality of ovarian cancer, it is considered advisable to “err on the side of caution.”
If there is a suspicion from these tests that ovarian cancer might be present, the patient should seek a referral to a gynaecologic oncologist for Cytoreductive surgery and further treatment. Research shows that women treated by gynaecologic oncologists live longer than those treated by other physicians like general gynaecologists and general surgeons.
American College of Obstetrics and Gynecology (ACOG) and SGO consensus guidelines recommend referral to a gynecologic oncologist for women with elevated blood level of CA-125, presence of fluid in abdomen, an ovarian mass and evidence of abdominal/distant metastasis
Most women have one or more risk factors for ovarian cancer. There are several ways to reduce one’s risk of developing ovarian cancer.
Some risk factors for ovarian cancer, like getting older or having a family history, cannot be changed. But women might be able to lower their risk slightly by avoiding other risk factors, for example, by staying at a healthy weight, or not taking hormone replacement therapy after menopause.
Oral contraceptives are one way that high risk women (women with BRCA1 and BRCA2 mutations) can reduce their risk of developing ovarian cancer.
Risk-reducing or prophylactic salpingo-oophorectomy (removal of both ovaries and fallopian tubes) is the standard recommendation for high-risk women after they have finished having children.