Cancer

Ovarian cancer

About the ovaries

About the same size and shape as an almond, the ovaries are located in the pelvis, one on either side of the uterus. As part of the female reproductive system, ovaries produce eggs and female hormones (namely estrogen and progesterone) which determine the shape of a woman's breasts, body shape, and pubic hair. The ovaries also regulate the menstrual cycle and pregnancy. Each month as part of the menstrual cycle, an egg is released from one of the two ovaries in a process called ovulation.

Understanding cancer

To understand ovarian cancer, or really any cancer for that matter, it's important to understand the function of normal cells and what happens to cells when they become cancerous.

The body is composed of many different types of cells, which under normal circumstances, grow, divide, and produce more cells as part of their life cycle. This life cycle helps keep the body healthy. Occasionally, some cells may continue to divide even when new cells are not needed, forming a mass of new tissue called a growth or tumor.

Tumors may be benign or malignant.

Benign tumors are not cancerous and can be removed. Generally, benign tumors do not recur and the cells in benign tumors do not spread to other parts of the body. They are very rarely life threatening.

Malignant tumors, on the other hand, are cancer. Cells in such tumors divide without any rhyme or reason, invading nearby tissues and organs. Through a process known as metastasis, cancer cells can also spread from their original site to other parts of the body.

What is ovarian cancer?

Ovarian cancer refers to a malignant tumor that originates in the ovaries. Ovarian cancer can be of various types. The most common type of ovarian cancer, epithelial carcinoma, begins on the surface of the ovary. Germ cell tumors are tumors that originate in the ovaries' germ cells, those cells that produce eggs. Stromal tumors are rare and originate in the support tissue surrounding the ovaries.

Through a process called shedding, ovarian cancer cells can break away from the ovary and spread to other tissues and organs. When ovarian cancer sheds, new tumors tend to form on the peritoneum, the large membrane that lines the abdomen, and on the diaphragm, the thin muscle separating the chest from the abdomen. As a result of a condition known as ascites, fluid may collect in the abdomen, leaving a woman feeling bloated. Ascites may make a woman's abdomen appear swollen.

The body's lymphatic system consists of organs and tissues that produce and store cells that fight infection and disease. Ovarian cancer cells can also enter the bloodstream and lymphatic system and may travel and form new tumors in other parts of the body.

What causes ovarian cancer?

The causes of ovarian cancer are not known, although studies and research show that the following factors play a role in determining who is at greater risk of developing the disease.

Family history

The first-degree relatives (mother, daughter, sister) of a woman who has had ovarian cancer are at greater risk of developing ovarian cancer themselves. The risk is especially high if two or more first-degree relatives have had the disease. Though still above average, the risk is less if other relatives (grandmother, aunt, cousin) have had ovarian cancer. A family history of breast or colon cancer is also linked to an increased risk of developing ovarian cancer.

Age

The risk of developing ovarian cancer increases as a woman gets older. Most ovarian cancers affect women over the age of 50, with the highest incidence in women over 60.

Childbearing

Women who have never borne children are at greater risk of developing ovarian cancer than women who have had children. It seems the risk of ovarian cancer decreases with the number of children a woman has borne.

Personal history

Women who have had breast or colon cancer are at greater risk than women who have not had breast or colon cancer.

Fertility drugs

Researchers are studying the possible association between fertility drugs and ovarian cancer: it appears drugs that cause a woman to ovulate may slightly increase the risk of ovarian cancer.

Talc

Studies also show that women who have used talc in the genital area for many years may also have slightly higher risk of developing ovarian cancer.

Hormone replacement therapy (HRT)

Some clinical evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing ovarian cancer.

Having one or more of the risk factors mentioned does not necessarily imply that a woman will develop ovarian cancer, but her chances of developing the disease are higher than average. Women concerned about ovarian cancer should discuss their concerns with a gynecologist, gynecologic oncologist, or medical oncologist. These doctors specialize in treating women with cancer and may be able to suggest ways to mitigate the risk of developing ovarian cancer by developing an appropriate schedule for regular examinations.

Learning what causes ovarian cancer allows us to reduce the risk of developing the disease. Some studies have shown that breastfeeding and using birth control pills can decrease a woman's risk of developing ovarian cancer. The Pill decreases the number of times a woman ovulates; studies reveal that reducing the number of ovulations during a woman's lifetime may help reduce the risk of ovarian cancer.

Women who have had their fallopian tubes tied through tubal ligation or who have undergone a hysterectomy also have a lower risk of ovarian cancer. Additional research suggests that reducing overall fat in the diet may lower the risk of developing ovarian cancer.

Women who are at risk of developing ovarian cancer because of a family history of the disease may consider having their ovaries removed before cancer develops. Although the risks and side effects of prophylactic oophorectomy should be carefully considered, the procedure may protect a woman from developing ovarian cancer. If you are considering this surgery, be sure to discuss your unique situation, risks, and benefits with your doctor.

How is ovarian cancer diagnosed?

A woman's chance for recovery from ovarian cancer improves with early detection and treatment. Unfortunately, however, early detection of ovarian cancer is difficult: women with ovarian cancer quite often do not display any symptoms or display only mild symptoms until the disease has progressed to an advanced stage. By exploring the usefulness of measuring CA-125 and by evaluating the effectiveness of transvaginal ultrasound, scientists are now exploring ways of detecting ovarian cancer before symptoms develop. CA-125 is a substance often found in elevated quantities in the blood of women with ovarian cancer.

As mentioned, ovarian cancer typically doesn't show signs or symptoms until it has reached an advanced stage. These signs and symptoms may include:

• general abdominal discomfort and/or pain (gas, indigestion, pressure, swelling, bloating, cramps)
• nausea, diarrhea, constipation, or frequent urination
• loss of appetite
• feeling of fullness even after a light meal
• weight gain or loss with no known reason
• abnormal bleeding from the vagina

Although these symptoms may be caused by other, milder medical conditions, they may also be indicative of ovarian cancer. Be sure to consult with your doctor if you have any of the above symptoms.

To determine the cause of symptoms, a doctor evaluates a woman's medical history, performs a physical examination, and requests a number of diagnostic tests.

Pelvic exam

During a pelvic examination, a doctor feels a woman's uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to detect any change in their size or shape.

Sonography (ultrasound)

Sonography or ultrasound uses high-frequency radio waves aimed at the ovaries to produce a picture of the ovaries. The sonogram allows a doctor to see not only healthy tissues, but also fluid-filled cysts and tumors, if present.

CA-125 assay

CA-125, a substance called tumor marker, is often found in higher-than-normal quantities in women with ovarian cancer. A blood test known as CA-125 assay is used to measure the level of CA-125.

Lower gastrointestinal (GI) series or barium enema

Pictures taken after a patient is given barium, a lower GI series or barium enema consists of a series of x-rays of the colon and rectum. Barium outlines the colon and rectum on the x-ray, allowing a doctor to more easily identify tumors.

Computed tomography (CT scan)

A CT scan consists of a series of detailed, digital pictures generated by a computer linked to an x-ray machine.

Biopsy

Biopsy refers to the removal of tissue for examination under a microscope. A surgeon performs a laparotomy, a procedure to open the abdomen to collect tissue, and if cancer is suspected, an oophorectomy (removal of the entire ovary) as well. Removal of the ovaries is important because merely removing a sample of tissue from the outer layer of the ovary could cause cancerous cells to escape and to spread to other areas of the body.

Tissues are sent to a pathologist for examination. If the pathologist confirms the diagnosis of ovarian cancer, the doctor will want to learn the stage of the cancer since staging is an attempt to learn whether the cancer has spread, and if so, to what other parts of the body. Staging may involve additional surgery, x-rays, imaging procedures, and laboratory tests. Knowing the disease's stage allows a doctor to tailor a treatment plan appropriate to the needs of the patient.

Treatment for ovarian cancer

Treatment, naturally, depends on a variety of factors, including the stage of a woman's cancer and her general health. Treatment is typically under the care of a team of specialists which may include a gynecologist, a gynecologic oncologist, a medical oncologist, and a radiation oncologist. These specialists, in concert, may recommend different treatments and different combinations of treatments to treat a woman's ovarian cancer.

Surgery

Surgery is typically the initial treatment for women with ovarian cancer. An operation known as a bilateral salpingo-oophorectomy is done to remove the uterus, ovaries, fallopian tubes, and cervix. Often with this procedure, the surgeon also removes the omentum (the thin tissue covering the stomach and large intestine) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen.

Staging during surgery typically involves the removal of the lymph nodes, samples of tissue from the diaphragm and other organs in the abdomen, and fluid from the abdomen. If the cancer has spread, the surgeon usually removes as much of it as possible in a procedure known as tumor debulking. This procedure reduces the amount of cancer that will have to be treated later with chemotherapy and/or radiation therapy.

Side effects of treatment

Following surgery, the short-term pain, discomfort and tenderness in the area of the operation can be controlled with medication. For several days following surgery, a woman may have difficulty urinating or having bowel movements. She should feel free to discuss pain relief options with her doctor.

When both ovaries are removed through an oophorectomy, a woman loses her ability to become pregnant. For some women, this causes feelings of sadness and loss which may interfere with intimacy. Counseling for both the woman and her partner may help deal with these emotions and barriers.

Removal of the ovaries also means that a the body's natural source of estrogen and progesterone is lost. As a result, a woman enters "forced" menopause and is likely to experience menopausal symptoms such as vaginal dryness and hot flashes soon after her surgery. These symptoms may be alleviated with hormone replacement therapy. The use of HRT is a personal choice and a woman should discuss its risks and benefits with her doctor.

Follow-up care

Important in detecting the recurrence of ovarian cancer as well as the presence of other types of cancer, regular follow-up care for ovarian cancer commonly includes a medical examination, pelvic exam, and Pap smear. The doctor may also recommend other tests such as a chest x-ray, CT scan, urinalysis, complete blood count, and CA-125 assay.

Women who have had ovarian cancer may be a increased risk of developing breast or colon cancer and should ask their doctor about checking for these and other types of cancer. Treatment with certain anticancer drugs may also increase a woman's risk of developing leukemia.

Emotional support

It goes without saying that cancer can ravage a woman's body, but it's important too not to lose sight of the havoc it can play on her emotions. Living with cancer is challenging, and a woman may face many anxieties, worries, fears, feelings and concerns that can make her daily living difficult. Women with ovarian cancer need help coping with the emotional—as well as the physical—aspects of the disease. This is why emotional support is also an integral part of a patient's treatment plan. The support of doctors, nurses, social workers, support groups, and patient-to-patient networks, while helping patients feel less isolated and distressed, also help improve quality of life.