Ovarian Cancer: Symptoms, Risks and Assessments
Photo by National Cancer Institute on Unsplash
Ovarian cancer is a cancerous tumor of an ovary. Ovarian cancer is developed when abnormal cells in the ovary begin to grow and divide in an uncontrolled way and eventually forms a growth (tumor). If not caught early, cancer cells gradually grow into the surrounding tissues. They may spread to other areas of the body. There are 2 ovaries, one on each side of the body. The cancer may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells. When these cells become abnormal, they have the ability to divide and form tumors. When this process begins, there may be no or only vague symptoms. Symptoms become more noticeable as the cancer progresses. These symptoms may include bloating, vaginal bleeding, pelvic pain, abdominal swelling, constipation, and loss of appetite, among others. Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.[1] [2]
The Ovaries And Fertility
The ovaries produce an egg each month in women of childbearing age. The ovaries hold the eggs which are released each month during child bearing age. They also produce sex hormones which control periods. Women are able to have children between puberty (when the periods start) and the menopause (or change of life, when the periods stop). The age when periods start and stop varies a great deal. In the middle of each menstrual cycle (midway between periods), one of the ovaries releases an egg. It travels down the fallopian tube to the uterus (womb). The lining of the womb gets thicker and thicker, ready to receive a fertilised egg. If the egg is not fertilised by sperm, the thickened lining of the womb is shed as a period. Then the whole cycle begins again. [3]
Ovarian Hormones
The ovaries also produce the female sex hormones. These are:
· Oestrogen
· Progesterone
The ovaries produce these hormones throughout the years when women can become pregnant. The hormones control the menstrual cycle. As one gets older and closer to menopause, the ovaries make less and less of these hormones and periods eventually stop.
Ovarian hormones also help to protect the heart and bones and maintain brain and immune system’s health. [3]
Ovarian Cysts
In young women the ovaries are about 3cm long. After the menopause they tend to shrink. Some women have cysts on their ovaries. Cysts are fluid filled sacks. They are not usually cancerous. In women of childbearing age, small cysts develop in the ovary every month as an egg develops. This is normal and they usually disappear without treatment within a few months. One should have tests if the cysts: [3]
· Are longer than normal.
· Are unusually large.
· Cause symptoms.
· Develop when one attains the menopause.
Ovarian Cancers-Globocan’s Global Statistics, 2022
According to Globocan’s 2022 projections, by 2050, the number of women around the world diagnosed with ovarian cancer will rise over 55% to 503,448. The number of women dying from ovarian cancer each year is projected to increase to 350,956 an increase of almost 70% from 2022. The majority of lives lost will be from low- and middle-income countries where 70% of those diagnosed live. The risk of developing ovarian cancer increases as one gets older. The risk is greatest in those aged between 75 and 79.[4]
Photo by Susan G. Komen 3-Day on Unsplash
Symptoms
The symptoms of ovarian cancer can be very vague, particularly when the disease is in its early stages. Early symptoms may include:[5]
· Pain or pressure in the pelvis.
· Unexpected vaginal bleeding.
· Pain in the back or abdomen..
· Bloating.
· Feeling full rapidly when eating.
· Changes in urination patterns, such as more frequent urination.
· Changes in bowel habits, such as constipation.
If any of these symptoms lasts for 2 weeks or more, a person should see a doctor. There may also be:
· Nausea and indigestion.
· Appetite loss.
· Weight loss.
· Breathlessness.
· Fatigue.
The symptoms can change if cancer spreads to other parts of the body.
Risks And Causes Of Ovarian Cancer
Having one or more risk factors doesn’t mean that one will definitely get ovarian cancer.[6]
· Getting older- As with most cancers, ovarian cancer becomes more common as one gets older. The risk of ovarian cancer increases steeply from around 45 years and is greatest in those aged between 75 and 79 years.
· Inherited faulty genes- Between 5 to 15% out of 100 ovarian cancers are caused by an inherited faulty gene including BRCA1 and BRCA2. Women with a mother or sister diagnosed with ovarian cancer have around 3 times the risk of ovarian cancer.
· Previous cancer- Women have an increased risk of ovarian cancer if they've had breast cancer at a younger age. The increase in risk of ovarian cancer after previous cancer is likely to be partly due to inherited faulty genes such as:
BRCA 1
BRCA 2
Lynch syndrome
· Using hormone replacement therapy (HRT)- HRT is helpful for many women with menopausal symptoms but it also increases the risk of ovarian cancer. Globally about 4% ovarian cancers are linked to hormone replacement therapy (HRT) use.
· Smoking- Smoking can increase the risk of certain types of ovarian cancer such as mucinous ovarian cancer. The longer one has smoked, the greater the risk.
· Asbestos- The International Agency for Research on Cancer (IARC) classify asbestos as a cause of ovarian cancer. Asbestos is made up of tiny fibres. One can breathe these fibres in when comes into contact with asbestos. Asbestos is an insulating material that’s heat and fire resistant. It is widely used in:
· Building industry
· Shipbuilding
· Manufacturing of household appliances
· Motor industry
· Power stations
· Telephone exchanges
· Medical conditions- Studies have shown that women with endometriosis (Endometriosis is a disease in which tissue similar to the lining of the uterus grows outside the uterus. It can cause severe pain in the pelvis and make it harder to get pregnant. Endometriosis can start at a person's first menstrual period and last until menopause) or diabetes have an increased risk of ovarian cancer. In diabetics, the increase in risk might be higher in those that use insulin.
· Having children and breastfeeding- Having children seems to reduce the risk of ovarian cancer. The more children one has, the lower the risk. Breastfeeding also reduces the risk of ovarian cancer. This reduction in risk may be because while one is pregnant or breastfeeding, she is not ovulating (releasing eggs). The fewer times one ovulates in lifetime, the lower the risk of ovarian cancer. However, having children later in life (after age 35) or never having children have links with a higher risk. People who use some types of fertility treatment may have a higher chance of developing borderline cells, but not all studies confirm this.
· Having a hysterectomy or having fallopian tubes tied- Having one’s tubes tied because one doesn't want any more pregnancies is called sterilization. Studies have found that having tubes tied reduces the risk of ovarian cancer. Until recently, most researches have shown that having one’s womb removed (hysterectomy) may also reduce the risk of ovarian cancer. But this has become less clear in recent years.
· HPV: Scientists have found links between the human papillomavirus (HPV) and various cancers, including tonsil and cervical cancer.
· Obesity and overweight: Ovarian cancer is more common in people with a body mass index (BMI) of over 30. Additionally, a person is 1.1 times more likely to develop ovarian cancer with each 5-unit increase in BMI.
· Possible protective factors- The following factors may reduce the risk of ovarian cancer:
· Taking the combined contraceptive pill- Taking the combined contraceptive pill at some point in one’s life reduces the risk of ovarian cancer and longer one takes the pill, the more risk is thought to be reduced. The reduction in risk lasts for tens of years after one stop taking the pill.
Types of ovarian cancer
Epithelial ovarian cancer is the most common type of ovarian cancer. Rare types of ovarian cancer include germ cell tumours (teratomas and dysgerminomas), stromal tumours (granulosa tumours) and sarcomas. Germ cell ovarian tumours usually affect girls and young women up to their early 30's. Ovarian teratoma is the most common type.[7]
Stages And Grades Of Ovarian Cancer
The stage tells how big the cancer is and whether it has spread or not. The grade means how abnormal the cells look under the microscope:
· Stage 1 : cancer is only in the ovaries. Surgery is the main treatment. Some may need chemotherapy.
· Stage 2 : cancer has grown outside the ovaries and is growing within the pelvis. Treatment is surgery and chemotherapy.
· Stage 3: cancer has spread outside the pelvis into the abdominal cavity or to lymph nodes. Treatment is surgery and chemotherapy.
· Stage 4 : cancer has spread to other body organs some distance away from the ovaries, such as the liver or lungs. The main treatments are surgery and chemotherapy.
Photo by National Cancer Institute on Unsplash
Diagnosis
If a routine screening or symptoms suggest that a person may have ovarian cancer, a doctor may recommend:[8]
· Blood tests: These tests will check for high levels of a marker called CA-125.
· Imaging tests: Examples include transvaginal ultrasound, MRI scan, or a CT scan.
· Laparoscopy: A healthcare professional will insert a thin tube with a camera attached through a small hole in the abdomen to see the ovaries and perhaps take a tissue sample for a biopsy.
· Biopsy: This involves the microscopic examination of a tissue sample. Only a biopsy can confirm that a person has cancer. A healthcare professional may do this as part of the initial assessment or following surgery to remove a tumor.
Treatment
Treatment will depend on many factors, including:[9]
· The type, stage, and grade of the cancer
· The individual’s age and overall health
· Their personal preferences
· Accessibility and affordability of treatment
Options tend to include:
· Surgery: The choice will depend on the type of cancer and how far it has spread. Surgical options include a hysterectomy (removing the uterus/womb), removing one or both ovaries, and removing affected lymph nodes. A doctor will discuss suitable options with the patient.
· Chemotherapy: These drugs aim to kill cancer cells. If a person takes chemotherapy drugs by mouth or as an injection or infusion, they will affect the whole body. Another option is intraperitoneal chemotherapy. In this case, a tube delivers the drug directly to the body area affected by cancer. Chemotherapy can have widespread adverse effects, especially if it affects the whole body.
· Targeted therapy: Some treatments target specific cells that help promote cancer growth. Examples include monoclonal antibody therapy and angiogenesis inhibitors. Targeted therapy aims to limit the adverse effects by targeting specific functions.
· Radiation therapy: This technique uses X-rays to kill cancer cells. One way to do this is by introducing a radioactive liquid into the peritoneum. This may help people with advanced ovarian cancer.
· Immunotherapy (biotherapy): This aims to boost the immune system’s ability to defend the body against cancer. Vaccine therapy involves injecting substances that will find and kill a tumor. It may help people with advanced ovarian cancer.
· Follow up: One usually have appointments and blood tests, x-rays and scans every few months.
· Reoccurrence: The main treatment is chemotherapy; however, some might have surgery or targeted cancer drugs.
Survival For All Stages Of Ovarian Cancer Patients
· More than 70% will survive their cancer for 1 year or more after they are diagnosed
· Almost 45% will survive their cancer for 5 years or more
· 35% will survive their cancer for 10 years or more
Prevention
Though there is no known way to prevent ovarian cancer altogether, certain factors have an association with reduced risk, including:[10]
· Taking birth control pills for 5 years or more
· Having given birth
· Breastfeeding for at least a year
· Undergoing certain surgical procedures, such as an oophorectomy (Oophorectomy is the surgical removal of the ovary and can be unilateral or bilateral), tubal ligation, or hysterectomy
Doctors also recommend following a healthy, mutritious diet, maintaining a moderate weight, and quitting smoking, if applicable, to reduce the risk. Additionally, regular exams and discussing any symptoms with a doctor can help detect ovarian cancer early, improving a person’s outlook.
Ovarian cancer, as one of the major gynecological cancers, kills many women around the world, and this mortality varies from country to country. Various factors affect the occurrence of ovarian cancer, from which genetic, environmental and lifestyle factors are among the most important ones. Many factors such as pregnancy, lactation, and oral contraceptive pills play a role in reducing the risk of this disease.
All types of ovarian cancer may be treatable if a person receives a diagnosis in the early stages. Some types are also highly treatable in the later stages. When considering survival statistics for ovarian cancer, it is worth noting that medical advances have been improving the outlook over the past 20 years. Nevertheless, seeking help if any symptoms appear can often lead to an early diagnosis, and this will increase the chance of receiving effective treatment.
References
1. What is Ovarian Cancer, Ovarian Tumor and Cysts”www.cancer.org. Retrieved 2 November 2023.
2. "Defining Cancer". National Cancer Institute. 17 September 2007. Archived from the original on 25 June 2014. Retrieved 10 June 2024.
3. “Basic Information About Ovarian Cancer". Centers for Disease Control and Prevention. 31 August 2022. Retrieved 9 October 2022
4. "SEER Stat Fact Sheets: Ovary Cancer". NCI. Archived from the original on 6 July 2014. Retrieved 18 June 2024.
5. Ebell MH, Culp MB, Radke TJ (March 2016). "A Systematic Review of Symptoms for the Diagnosis of Ovarian Cancer". American Journal of Preventive Medicine. 50 (3): 384–394.
6. “ Ovarian Cancer Risk Factors”. www.cancer.org. Retrieved 2 November 2022.
7. WHO Classification of Tumors Editorial Board, ed. (2020).
8. “Ovarian cancer tests” www.cancerresearchuk.org. Archived from the original on 18 May 2015. Retrieved 16 May 2015.
9. Treatment of cancer (6th edition)K Sikora and P. Price (editors)
CRC Press, 2015
10. "Ovarian Cancer Prevention". NCI. 20 June 2014. Archived from the original on 6 July 2014. Retrieved 1 July 2024.