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Ovarian Cancer

cancer ovary


Most cases of ovarian cancer (cancer of the ovary) develop in women over the age of 50. The cause is not clear. Some ovarian cancers can be cured. In general, the more advanced the cancer (the more it has grown and spread), the less chance that treatment will be curative. However, treatment can often slow the progress of the cancer. Some women with a strong family history of ovarian cancer may benefit from regular screening.

The majority of cases are in women aged over 50 years, although it can occur in younger women.

Types of ovarian cancer.;They are classified by the type of cell from which the cancer originates:

Epithelial ovarian cancer is the most common type (about 9 in 10 cases). This type of cancer develops from one of the cells that surrounds the outside of each ovary. Mainly affects women who have had their menopause - usually women aged over 50. It is rare in younger women.
Germ cell ovarian cancer develops from the cells that make the eggs. About 1 in 10 cases of ovarian cancer are germ cell cancers. They typically develop in younger women Most cases of germ cell ovarian cancer are curable, even if diagnosed at a late stage, as it usually responds well to treatment.
Stromal ovarian cancer develops the cells that fill the ovary and produce hormones. This type of cancer is rare.

The treatments and prognosis (outlook) are different for each type of ovarian cancer.

What causes (epithelial) ovarian cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control.

In most cases, the reason is not known. However, there are factors which are known to alter the risk of ovarian cancer developing. These include:
Age. Most cases occur in women over the age of 50 years.

Ovulation factors. Factors that reduce the number of times a woman will ovulate slightly lower the risk. For example, taking the combined oral contraceptive pill (COCP), having children and breast-feeding. Being overweight or obese increases the risk.

Taking hormone replacement therapy (HRT) may slightly increase the risk.

Sterilisation or hysterectomy (removal of the uterus) appears to reduce the risk slightly.

Taking the COCP provides some protection from ovarian cancer. This protection seems to continue for many years after stopping the pill.

Family history and genetic testing

Most cases of ovarian cancer are not due to genetic or hereditary factors. Around one in twenty cases is due to faulty genes which increase the risk, if you have two or more close relatives who have had ovarian or breast cancer at a young age , you may benefit from genetic testing.

What are the symptoms of (epithelial) ovarian cancer?

In many cases, no symptoms develop for quite some time after the cancer first develops. Symptoms may only be noticed when the cancerous tumour has become quite large. As the tumour grows, the most common early symptoms include one or more of the following:

Constant pain or a feeling of pressure in the lower abdomen (pelvic area).
Bloating in the abdomen that does not go away .
 There may also be an actual increase in size of your abdomen.
Difficulty eating, and feeling full quickly.
Loss of appetite.
Weight loss.
Pain in the lower abdomen when having sex.
Passing urine frequently (as the bladder is irritated by the nearby tumour).
Change in bowel habit such as constipation or diarrhoea.
A more marked swelling of the abdomen, caused by collection of fluid in the abdomen.
If the cancer spreads to other parts of the body, various other symptoms relating to that organ may develop.

How is (epithelial) ovarian cancer diagnosed and assessed?

Initial tests to diagnose ovarian cancer may include:

An examination by a doctor. He or she may feel an enlarged ovary or another suspicious abnormality.
An ultrasound scan. The probe of the scanner may be placed on your abdomen to scan the ovaries. A small probe is also commonly placed inside the vagina to scan the ovaries to obtain more detailed pictures.
A blood test.can detect a protein called CA-125. The level of CA-125 is high in more than 8 in 10 women with advanced ovarian cancer and in about half of women with early ovarian cancer. Other non-cancerous conditions can also cause a high level. This means that this test does not conclusively diagnose or rule out ovarian cancer but it can be a helpful test. This test is also often used to monitor the effects of treatment for ovarian cancer.

Further tests

You may be advised to have further tests depending on the symptoms that you have and the results of the initial tests. These tests can help to confirm the diagnosis and to stage the disease. The aim of staging is to find out:

How much the cancer has grown and whether it has grown to other nearby structures, such as the uterus, bladder or rectum.
Whether the cancer has spread to local lymph glands (nodes).
Whether the cancer has spread to other areas of the body (metastasised).

The stages of ovarian cancer are as follows:
Stage 1 - just involving the ovaries.
Stage 2 - the cancer has spread outside the ovaries but not outside the pelvis.
Stage 3 - the cancer has spread outside the pelvis but not involved other areas of the body.
Stage 4 - the cancer has spread to other parts of the body such as the liver and lungs.

Tests that are used may include one or more of the following:

Computed tomography (CT) scan of the lower abdomen. This can provide detail of the structure of the internal organs.
A chest x-ray to check if the cancer has spread to your lungs.
Blood tests to assess your general health and to check if the cancer has affected the function of your liver or kidneys.
Scans of the bowel or urinary tract. For example, colonoscopy or CT scan. These tests are more likely to be needed if you have symptoms such as constipation or urinary frequency which may indicate the cancer has spread to these areas.
Aspiration of fluid. If your abdomen has swollen with fluid then a sample can be taken by fine needle inserted through the abdominal wall. This fluid can then be looked at under the microscope to look for cancer cells.
Laparoscopy. This is a procedure to look inside your abdomen by using a laparoscope,which is a thin telescope with a light source. A laparoscope is passed into the abdomen through a small cut in the skin. The ovaries and other internal organs can be seen. Also, biopsies (small samples) can be taken to be looked at under the microscope to detect and confirm cancer cells.

Even with the above tests, the exact stage (extent of spread) may not be known until after an operation to treat the cancer.

What are the treatment options for (epithelial) ovarian cancer?

Treatment options may include surgery, chemotherapy and sometimes radiotherapy. The treatment advised in each case depends on various factors such as the stage and grade of the cancer and your general health. A specialist will be able to give the pros and cons, likely success rate, possible side-effects and other details about the various possible treatment options for your type and stage of cancer.

Surgery

An operation is advised in most cases. If the cancer is at a very early stage (just confined to the ovary and not spread), then an operation to remove the affected ovary and associated Fallopian tube may be all the treatment required. However, in many cases the cancer has grown into other nearby structures or has spread. Therefore, a more extensive operation is often needed. which may involve removing the both ovaries, uterus also other affected areas in the lower abdomen.During the operation small biopsy samples from structures in the abdomen  are taken to see if any cancer cells have spread to these structures. This helps to give an accurate staging and helps to decide on further treatment.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying. Sometimes chemotherapy is given before surgery to reduce the size of the cancer. This may make surgery easier and more likely to be successful.

Radiotherapy

Radiotherapy is a treatment that uses high-energy beams of radiation to kill cancer cells or stops cancer cells from multiplying. (See separate leaflet called 'Radiotherapy' for details.) Radiotherapy is not often used for ovarian cancer.

What is the prognosis (outlook)?

There is a good chance of a cure if ovarian cancer is diagnosed and treated when the disease is at an early stage (confined to the ovary and has not spread). Unfortunately, most ovarian cancers are not diagnosed at an early stage. This is because symptoms often do not occur until after the cancer has grown quite large or has spread. In this situation, a cure is less likely but still possible.

In general, the later the stage and the higher the grade of the cancer, the poorer the outlook. Even if a cure is not possible, treatment can often slow down the progression of the cancer.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information about outlook given above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your stage and grade of cancer is likely to respond to treatment.

Is there a screening test for ovarian cancer?

Currently there is no ovarian cancer screening test. However, research is underway to see if a screening test will detect ovarian cancer early (when treatment is most likely to be curative). Screening tests being studied are the CA-125 blood test and regular ultrasound scan of the ovary.


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