A woman has two ovaries, which are part of the female reproductive system. Each is the size of a walnut and located at the pelvis on either side of the womb (uterus). The ovaries contain eggs and produce the female hormones, oestrogen and progesterone. Ovarian cancer occurs in ovaries, which are composed of three main types of cells. Each type of these cells may develop into different kinds of tumors. They are:
- Epithelial tumors: Most common type of ovarian malignant tumors that starts from the cells which cover the outer surface of the ovaries
- Germ cell tumors: Start in the cells that produce the ova (eggs)
- Stromal tumors: Start from the cells of the structural tissue that holds the ovary together and produces female hormones (oestrogen and progesterone)
Most of the tumors that begin in the ovaries are non-cancerous and they usually do not spread beyond the ovaries. Such benign tumors can be treated by removing either the ovary or the part of the ovary that contains the tumor.
Malignant or low malignant potential ovarian tumors can metastasize to other areas of the body and can be fatal.
Unfortunately, ovarian cancer is often undetected until it spreads to the pelvis and abdomen. At this point, it is difficult to treat and is frequently fatal. However if ovarian cancer is detected while it is still confined to the ovary, it is more likely to be treated successfully.
ARE YOU AT RISK?
The following are associated with a high risk of ovarian cancer:
- High fat diet
- Infertility or not having children until late in life
- Early menarche and late menopause
- Family history of ovarian, breast or colorectal cancer
SYMPTOMS OF OVARIAN CANCER
In certain cases, ovarian cancer may produce early symptoms. The most common ones are:
- Bloating frequently
- Pain in stomach or pelvis
- Feeling full or trouble eating
- Urinary problems (Urgent need to urinate or urinating more frequently)
If you experience one or more of these symptoms and it occurs daily for more than two weeks, speak to your doctor. These symptoms may also be common for some women. This does not mean you have ovarian cancer. However, the early symptoms of ovarian cancer typically follow a pattern:
- Sudden occurrence
- Different to your normal digestive or menstrual problems
- Occurs daily and doesn’t cease
Some other symptoms include:
- Pain in back
- Pain during intercourse
- Change in menstrual cycle
However, these symptoms are also common in some women who don’t have ovarian cancer. That is why it is important you seek the advice of a good Gynecologist first who would be able to understand and refer you to a Oncologist if they think it is required.
TREATMENT OPTIONS AVAILABLE FOR OVARIAN CANCER
The operation, laparotomy is normally performed first. It is also the main way of diagnosing the disease. During laparotomy, the surgeon will find and remove as much of the tumor as possible through a long vertical cut in your abdomen. Most of the time, the surgeon will perform a biopsy at the start of the surgery to confirm it is cancer. This is known as the frozen section. If it is confirmed that the tumor is cancerous, the operation will continue.
The removal of the ovaries, fallopian tubes, uterus, the omentum, the appendix and some of the lymph glands in the area are necessary in most women. In come cases, part of the bowel also might be removed.
In most cases, chemotherapy will be required. The drugs used in this treatment attack the cancer cells and stop or slow their growth while causing the least possible damage to normal cells.
This therapy works best when the tumor is small and the cancer cells are actively growing. It is best used after surgery as there may be some cancer cells left even though most of the cancer may have been removed.
After surgery, you will normally be consulted by an oncologist to discuss your treatment plan. Chemotherapy for ovarian cancer is normally administered through an intravenous (IV) drip in an outpatient clinic at your treatment hospital.
Most women will go through six cycles of treatment with a three or four week interval. A blood test will be performed to ensure that your body’s normal cells had time to recover. Blood tests and possibly a CT scan will also be performed to measure the response to treatment.
Further chemotherapy may be needed if your cancer does not respond completely to the initial treatment. If your ovarian cancer returns in the future, you may also require further treatment (second line chemo). The drugs that will be used in further treatment will depend on the drugs used in the first round, the rest time you have had and the aims of the treatment in the initial treatment.
Due to the fact that chemotherapy can damage healthy cells in your body, it can cause a variety of side effects. These side effects are temporary and there are many steps your doctor can advice you on how to cope.
This method of treatment is not frequently used for ovarian cancer. During the course of cancer cells eradication, special X-rays are aimed at the specific site of the cancer to destroy it and prevent a tumor from growing. The x-ray energy damages the DNA (genetic code) in the cancer cells and this damage kills the cancer cells when they try to grow. Radiotherapy is usually used if the cancer in confined to the pelvic space.
It may also be used where the cancer is advanced to reduce the size of the tumor and help to relieve symptoms. This treatment can be given externally or internally over a number of weeks.
DIAGNOSING OVARIAN CANCER
- History taking and physical exam: Your doctor will take a look at your history and perform a physical exam to look for ovarian cancer signs. These signs include an enlarged ovary and signs of fluid in the abdomen (ascites).
If you suspect that you have ovarian cancer based on your symptoms or physical exam, some tests will be ordered to further confirm this disease.
- Imaging tests: like CT scans, MRI scans and ultrasound, it can confirm whether a pelvic mass is present. Even though these tests can’t confirm that the mass is cancer, it may be useful to check if your cancer has spread to other tissues and organs.
- Ultrasound: Sound waves are used to create an image on a video screen. A small probe is placed in the woman’s vagina or the surface of her abdomen to capture images.
Echoes are created by the sound waves as they enter the ovaries and other organs. The echoes bounce back and a computer translates it into an image.
- Computed tomography (CT) scans: A CT scanner takes many images as the machine rotates around you instead of just one image.
A computer then combines these images into an image of a part of your body. The machine will take images of multiple parts of your body that is being studied.
- Magnetic resonance imaging (MRI) scans: Radio waves and strong magnets and used in MRI scans instead of X-rays. The energy is absorbed and released in a pattern formed by the type of tissue and the type of disease.
A computer will translate the patterns given off by the tissues into a detailed image of the parts of the body. This does not only produce cross-sectional slices of the body like a CT scanner but it can also produce slices that are parallel with the length of the body.
Like the CT scan, a contrast material might be injected into a vein. When diagnosing ovarian cancer, MRI scans are not often used.
STEPS TO TAKE AFTER TREATMENT FOR OVARIAN CANCER
- Temporary abstinence from sexual intercourse for 6 weeks to allow for normal healing.
- If both ovaries are removed, the patient will experience the symptoms of menopause. Hormone replacement therapy (HRT) may be prescribed to relieve the menopausal symptoms.
- Regular check-up with blood tests and if necessary, X-rays should be kept with the oncologist.