Ovarian cancer

What is ovarian cancer?

Ovarian cancer is a type of cancer that begins in the ovaries, which are part of the female reproductive system. The ovaries are responsible for producing eggs and the hormones oestrogen and progesterone. Ovarian cancer is often referred to as a “silent killer” because it can develop without noticeable symptoms until it has reached an advanced stage. Early detection is crucial for improving the chances of successful treatment.

 

Types of ovarian cancer

Ovarian cancer can be classified into several types, depending on the cells where the cancer begins:

  • Epithelial ovarian cancer:  The most common type, accounting for about 90% of ovarian cancer cases. It starts in the thin layer of tissue that covers the outside of the ovaries. It includes several subtypes, including serous carcinoma and mucinous carcinoma.
  • Germ cell ovarian cancer:  A rare type that begins in the cells that produce eggs. It typically occurs in younger women and is usually treatable.
  • Stromal ovarian cancer:  A rare form that starts in the hormone-producing cells within the ovaries. It may cause symptoms related to hormone production, such as irregular periods or early puberty and may be diagnosed at an earlier stage than other ovarian cancers.

 

Symptoms of ovarian cancer

When ovarian cancer first develops, it might not cause any symptoms. When symptoms occur, they can be vague and easily mistaken for less serious conditions. Common symptoms include:

  • Persistent abdominal bloating
  • Pelvic or abdominal pain
  • Difficulty eating, indigestion, or feeling full quickly
  • Urinary symptoms (urgency or frequency)
  • Fatigue
  • Back pain
  • Changes in bowel habits, such as constipation
  • Unexplained weight loss or gain
  • Bleeding from the vagina after menopause

 

If these symptoms are new, frequent, and persistent, it is important to get them checked by a specialist because if they are caused by cancer, finding it early can mean it is more treatable.

 

Risk factors

While the exact cause of ovarian cancer is not known, several risk factors can increase the likelihood of developing the disease:

  • Age: Most ovarian cancers occur in women over 50, particularly after menopause. The risk is greatest in those aged between 75 and 79.
  • Family history: A family history of ovarian or breast cancer increases the risk, especially if it involves BRCA1 or BRCA2 gene mutations.
  • Genetic predisposition: A small percentage of ovarian cancer is caused by Inherited genetic mutations. BRCA1, BRCA2 genes (which also increase the risk of breast cancer), and gene changes associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D significantly increase the risk of ovarian cancer.
  • Reproductive history: Women who have never been pregnant, or who had their first full-term pregnancy after age 35, may be at higher risk.
  • Hormone replacement therapy (HRT): Long-term use of HRT has been associated with a slightly increased risk of ovarian cancer.
  • Age when menstruation started and ended: Beginning menstruation at an early age or starting menopause at a later age, or both may increase the risk of ovarian cancer.
  • Overweight and obesity: Increase the risk of ovarian cancer.
  • Endometriosis: A disorder in which tissue similar to the tissue that lines the inside of your uterus grows outside your uterus.

 

Diagnosis of ovarian cancer

Diagnosing ovarian cancer often involves several steps:

  • Pelvic examination: A physical exam to check for any lumps or abnormalities in the ovaries and surrounding areas. During a pelvic examination, the gynaecologist inserts gloved fingers into the vagina and simultaneously presses a hand on the tummy in order to feel the pelvic organs. The external genitalia, vagina and cervix are also visualised.
  • Imaging tests: Ultrasound, CT scans, or MRI may be used to visualize the ovaries and detect any masses or abnormalities.
  • Blood tests: The CA-125 blood test measures a protein that is often elevated in women with ovarian cancer. However, it is not definitive and is usually combined with other tests. Blood tests may also include organ function tests which help determine overall health.
  • Biopsy: If cancer is suspected, a biopsy may be performed to confirm the diagnosis. This involves removing a small sample of tissue for examination under a microscope.
  • Surgery: Sometimes the gynaecologist cannot be certain of a diagnosis until surgery has been performed to remove an ovary and have it tested for signs of cancer.
  • Genetic testing. The consultant may recommend taking a blood sample to look for gene changes that increase the risk of ovarian cancer. If it is known that there is an inherited change in the family DNA, this will assist the consultant in making decisions about the best treatment plan.

 

Staging and treatment

Once ovarian cancer is confirmed the consultant will use information from the tests and procedures to assign the cancer a stage. Ovarian cancer is staged based on how far it has spread from the ovaries:

  • Stage I: Cancer is confined to one or both ovaries.
  • Stage II: Cancer has spread to the pelvis.
  • Stage III: Cancer has spread to the abdomen.
  • Stage IV: Cancer has spread to distant organs, such as the liver or lungs.

 

Treatment of ovarian cancer

Treatment options depend on the stage and type of ovarian cancer, as well as the patient’s overall health and preferences. Common treatments include:

  • Surgery: The primary treatment for ovarian cancer, often involving the removal of the ovaries, fallopian tubes, uterus, and surrounding tissues. In advanced cases, debulking surgery may be performed to remove as much of the tumor as possible.
  • Chemotherapy: Uses drugs to kill cancer cells or stop them from growing. It is often used after surgery to eliminate any remaining cancer cells.
  • Targeted therapy: Focuses on specific molecules involved in cancer growth and spread. Drugs such as PARP inhibitors are used for certain types of ovarian cancer, particularly in patients with BRCA mutations.
  • Radiation therapy: Less commonly used for ovarian cancer but may be recommended in specific cases, particularly if the cancer has spread to other parts of the body.

 

Living with ovarian cancer

A diagnosis of ovarian cancer can be overwhelming, but there are resources and support available to help manage the emotional and physical challenges:

  • Follow-up care: Regular check-ups are essential to monitor for any signs of recurrence and to manage side effects from treatment.
  • Support groups and counselling: Connecting with others who have similar experiences can provide emotional support and practical advice.
  • Lifestyle and nutrition: Maintaining a healthy diet and staying active can help improve overall well-being and recovery during and after treatment.

 

Prevention and early detection

While there is no guaranteed way to prevent ovarian cancer, certain measures can reduce the risk:

  • Regular check-ups: While there is no routine screening for ovarian cancer, regular pelvic exams and reporting any unusual symptoms to your doctor can help with early detection.
  • Genetic testing: Women with a family history of ovarian or breast cancer may benefit from genetic testing to assess their risk.
  • Oral contraceptives: Long-term use of oral contraceptives has been shown to reduce the risk of ovarian cancer. Discuss this option with your healthcare provider to understand the benefits and risks.
  • Preventive surgery: In women at high genetic risk (e.g., BRCA mutation carriers), preventive removal of the ovaries and fallopian tubes (prophylactic salpingo-oophorectomy) may be considered to reduce the risk of developing ovarian cancer.

 

Contact Us

At Birmingham Gynaecology Clinic, we provide comprehensive care for women at risk of or diagnosed with ovarian cancer. Our team of specialists is here to guide you through every step of your journey, from diagnosis to treatment and beyond. If you have any concerns about ovarian cancer or need more information, please contact us today to schedule a consultation.

 

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