Ovarian cancer is a cancer that arises from the ovaries. Ovaries are a pair of organs that produce eggs and hormones in the female. Ovarian cancer is typically portrayed as a “silent” killer, without much signs or symptoms until it is an advanced disease. The sooner the cancer is detected and treated, the better a woman’s chance for recovery. Approximately 70% of women are diagnosed at late stage 3 or 4 of the disease. Early detection can save lives and improve quality of life. Remember, AGAIN “ovarian cancer does not shout, it whispers”.
Ovarian cancer is the fourth most common cancer among Malaysian women. The incidence is 7.6 in 100,000 population. Ovarian cancer is common in women above 40 years and peaks among 55 to 60 years of age, but it can also occur in women of less than 20 years old.
Ovarian cancer is the seventh most common cancer in women (and the 18th most common cancer overall) worldwide. Approximately *239,000 cases were recorded in 2012, accounting for nearly 4 percent of all new cases of cancer in women (2 percent overall). This cancer is usually fatal, and is the eighth most common cause of cancer death in women worldwide (14th overall).
(*https://www.wcrf.org/dietandcancer/ovarian-cancer)
There are three types of ovarian tissue that can produce cancers: epithelial cells, which cover the ovary; stromal cells, which produce hormones; and germ cells, which become ova (eggs). About 85 to 90% of ovarian cancers are epithelial carcinomas.
Risk factors of ovarian cancer:
Life events
The risk of ovarian cancer is affected by the number of menstrual cycles during a woman’s lifetime. Not bearing children, early menarche (before the age of 12) and late natural menopause (after the age of 55) all increase the risk of ovarian cancer. The reverse also applies: bearing children, late menarche and early menopause all reduce the risk of ovarian cancer. Tubal ligation (sterilisation) also decreases the risk of ovarian cancer.
Medication
Oral contraceptives protect against ovarian cancer. Use of hormone replacement therapy has been shown to increase risk.
Smoking
Smoking tobacco increases the risk of mucinous ovarian cancer. It is estimated that 17% of mucinous ovarian cancer cases are due to smoking tobacco.
Family history
Most ovarian cancers occur spontaneously, although five to ten per cent of cases develop due to a genetic predisposition. The latter, involving dysfunctional BRCA1 or BRCA2 genes, produces high-grade carcinomas, with poorer prognosis. The same genes that can cause breast cancer as well.
Previously talcum powder applied to the vulva had been associated with ovarian cancer and this prompted a study done in South Africa. It was later found that the talcum powder used had contained a high level of asbestos. Talcum powders nowadays no longer contain asbestos and it is found to be safe to use.
Symptoms / Signs of Ovarian Cancers
In its early stages, ovarian cancer usually has no specific symptoms. Some women may experience bloating, whilst some may be suffering from diarrhoea or constipation. These conditions are often thought to be due to common intestinal problems and unfortunately not given the attention it deserves.
Swelling in the abdomen at an early stage can occur and it is usually thought as normal weight gain. Severe pain is very rare, unless there is twisted ovarian cyst or there is bleeding in the ovaries. Swelling of the abdomen may be due to accumulation of fluid (ascites) produced by ovarian cancer. This fluid makes the patient’s abdomen enlarged. Often, at this stage, the ovarian cancer has already spread.
Ovarian cancer can also cause other symptoms, such as:
- fatigue
- indigestion
- heartburn
- back pain
- menstrual irregularities
- painful intercourse
- dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles)
These symptoms may occur for any number of reasons. They aren’t necessarily due to ovarian cancer. Many women have some of these problems at one time or another. These types of symptoms are often temporary and respond to simple treatments in most cases.
How is ovarian cancer diagnosed?
It’s much easier to treat ovarian cancer when diagnosed in the early stages. However, it’s not easy to detect.
Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumor. There’s no routine diagnostic screening available for ovarian cancer. That’s why it’s so important for you to report unusual or persistent symptoms.
As the tumor grows, it presses against the bladder and rectum. So, these irregularities might be able to be detected during a rectovaginal pelvic examination.
Some may also do the following tests:
- Blood test to measure cancer antigen 125 (CA-125) levels. This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
- Transvaginal ultrasound (TVUS). This is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help determine whether tumors are cancerous.
- Abdominal and pelvic CT scan. If you’re allergic to dye, a pelvic MRI scan can be done.
- Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way to confirm whether you have ovarian cancer.
General ovarian cancer staging is done as below:
- Stage 1- Cancer limited to ovary.
- Stage 2- Cancer within the organ surrounding the hip
- Stage 3- Cancer within the abdominal cavity
- Stage 4- Cancer spread to distant organ
Treatments
Woman with ovarian cancer will be sent for a keyhole surgery (laparoscopic staging) , to stage the severity and involvement of the cancer. Treatment of ovarian cancer varies with the staging results.
After the cancer is confirmed, surgical removal of the cancer mass is often done. The removal of the surrounding organs which are affected by the cancer may be necessary as well.
Patients with advanced stage may require chemotherapy and radiotherapy.
For women still in their reproductive age, conservative surgery where the uterus and perhaps one of the ovaries may be left behind. If you want to become pregnant in the future, preserving your fertility is the way to go. Egg freezing or embryo freezing can be done.
Cancer treatment is often expensive and costly. For cancer patients who need help they will usually be referred to the National Cancer Council (MAKNA)
Coping
A diagnosis of ovarian cancer can leave you and your loved ones feeling uncertain, anxious and overwhelmed. There are important treatment decisions to make, emotional concerns to manage, and insurance and financial paperwork to organize, among other practical concerns.
It is helpful to keep in mind that there are many sources of information and support for people coping with ovarian cancer. By learning about this diagnosis and its treatment options, communicating with your health care team, and surrounding yourself with a support network, you will be better able to manage ovarian cancer and experience a better quality of life.
Next read: Molluscum Contagiosum
