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Ovarian Cancer

ovarian cancer


Women have two ovaries, one on either side of the uterus (womb) in the lower abdomen. Ovaries are small and round, each about the size of a walnut. The ovaries make eggs. In fertile women, each month an egg (ovum) is released from one of the ovaries. The egg passes down the Fallopian tube into the uterus where it may be fertilized by a sperm.
Ovarian cancer is a common cancer. There are various 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).
  • Germ cell ovarian cancer develops from germ cells (the cells that make the eggs).
  • Stromal ovarian cancer develops from connective tissue cells..

What causes (epithelial) ovarian cancer?

A cancerous tumor starts from one abnormal cell.  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. In contrast, not having children and having a late menopause slightly increases the risk.
  • 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.
  • Genetic factors
  • Family history and genetic testing

What are the symptoms of (epithelial) ovarian cancer?

  • In many cases, no symptoms develop.
  • Constant pain or a feeling of pressure in the lower abdomen (pelvic area).
  • Bloating in the abdomen that does not go away (not bloating that comes and goes).
  • Difficulty eating, and feeling full quickly.

Other symptoms that may develop include:

  • Loss of appetite.
  • Weight loss.
  • Pain in the lower abdomen.
  • Passing urine frequently
  • Change in bowel habit such as constipation or diarrhoea.
  • A more marked swelling of the abdomen. This is caused by ascites, which is a collection of fluid in the abdomen.

How is (epithelial) ovarian cancer diagnosed and assessed?

Initial tests

  • An examination by a doctor.
  • An ultrasound scan.
  • A blood test. A sample of blood 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.

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 done for staging may include:

  • Computed tomography (CT) scan of the lower abdomen.
  • 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.
  • If your abdomen has swollen with fluid leading to ascites then a sample can be taken.
  • Laparoscopy. This is a procedure to look inside your abdomen by using a laparoscope. A laparoscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen. A laparoscope is passed into the abdomen through a small incision (cut) in the skin.

Grading of the cancer cells

Grade 1 (a low grade) - the cells look reasonably similar to normal ovarian cells. The cancer cells are said to be well-differentiated. The cancer cells tend to grow and multiply quite slowly and are not so aggressive.
Grade 2 - is a middle grade.
Grade 3 - the cells look very abnormal and are said to be poorly differentiated. The cancer cells tend to grow and multiply quite quickly and are more aggressive.

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.

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. For example, the operation may involve removing the affected ovary, plus the uterus, the other ovary and also other affected areas in the lower abdomen.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells or stop them from multiplying.

Radiotherapy

Radiotherapy is a treatment that uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying.

What is the prognosis?

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. Even if a cure is not possible, treatment can often slow down the progression of the cancer.

 


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