Ovarian cancer

Symptoms Of Ovarian Cancer

The symptoms of ovarian cancer are usually missed at an early stage due to their resemblance with other medical conditions. Most of the following symptoms are recognizable at later stages of the condition: 

• Abnormal vaginal discharge

• Pain or pressure in the pelvic area

• Abdominal pain and fullness

• Nausea

• Indigestion

• Bloating

• Constipation

• Feeling full quickly

• Urgency to urinate

• Increased frequency of urination

• Fatigue

• Back pain

• Loss of weight

• Persistent or recurrent genital pain that occurs just before, during or after sexual intercourse

• Menstrual abnormalities

• Vaginal bleeding

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Types Of Ovarian Cancer

Ovarian cancer has four types based on the cells from which it arises:

1. Epithelial cell carcinomas

Epithelial ovarian cancers, making up 85-90% of cases, originate from the ovary's surface, often spreading to the pelvis, abdomen, and beyond. Types of epithelial ovarian cancer include:

• High-grade serous ovarian carcinomas (HGSOC): These types of cancer spread at a faster rate and usually remain undiagnosed in the initial stages. 

• Endometrioid carcinoma: This type of cancer spreads to the endometrium (inner lining of the uterus) 

• Low-grade serous ovarian carcinoma (LGSOC): LGSOC spreads slowly and usually affects people at a younger age (between 45 and 57).

• Mucinous carcinoma: In this, tumor (mass of cells) is made up of cells coated in mucus. 

• Ovarian clear cell carcinoma (OCCC): This cancer is characterized by the presence of a pelvic mass which causes symptoms such as abdominal pain and bloating. 

• Primary squamous cell carcinoma (SCC) of the ovary: They typically develop from noncancerous) conditions and respond well to treatment. 

2. Germ cell ovarian carcinoma

• This type of cancer originates from the reproductive cells of the ovaries. 

• This cancer is rarely observed and usually affects teenagers. 

3. Stromal cell ovarian cancer

• These cancers arise from connective tissue cells of the ovaries. 

• This type of cancer is often found in the early stages. 

• Vaginal bleeding is one of the most common symptoms of stromal cancer. 

4. Small cell carcinoma

• It is an extremely rare ovarian cancer whose exact origin is still not known. 

• It usually presents in younger females with features of hypercalcemia.

Causes Of Ovarian Cancer

Before knowing about the exact cause of ovarian cancer, it is important to understand the structure and function of ovaries. 

What are ovaries?

Ovaries are the primary reproductive glands in females that produce eggs. Women have two ovaries located on each side of their uterus. The egg produced by the ovaries travels through the fallopian tube and fuses with the sperm. This fertilized egg travels further and settles in the uterus. The uterus nourishes the developing fetus prior to birth.

The ovaries also produce estrogen and progesterone – the two main reproductive hormones of the women. 

The exact cause of ovarian cancer is not known. However, there are certain theories behind this which include:

• Incessant ovulation theory: The surface epithelial cells of the ovary experience physical injury during ovulation (the process in which a mature egg is released from the ovary). The repetitive trauma to the epithelium can sometimes cause cellular DNA damage. This can turn normal cells into cancerous cells.

• Fallopian tube theory: Some ovarian cancers originate from the epithelium of the fallopian tube which then spilled over the surface of the ovary. 

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Risk Factors For Ovarian Cancer

Various risk factors are associated with an increased chance of ovarian cancer: 

1. Genetic predisposition

Mutations (changes) in BRCA1 and BRCA2 genes significantly increase the risk of developing ovarian cancer. 

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2. Age

• It is seen that the risk increases steeply from around 45 years. 
  
  

3. Race

• Certain ethnic groups, including Eastern European, Ashkenazi Jewish, North American, and Northern European populations, have a higher risk of ovarian cancer due to the prevalence of BRCA1 mutations.
  
  

4. Family history

• A positive family history of breast, ovarian, and fallopian tube cancer increases the risk of ovarian cancer.
  
  

5. History of cancer

• Individuals having a history of breast cancer, uterine cancer, and colorectal cancer have higher chances of contracting ovarian cancer too.
  
  

6. Reproductive and hormonal factors

• Early menarche (menstruation before age 12) 

• Late menopause (menopause after age 50)

• Endometriosis (where uterine tissue grows outside the uterus)

• Nulliparity (women who have never given birth) are more susceptible to ovarian cancer.
  
  

7. Hormonal replacement therapy (HRT)

• Prolonged HRT use, especially estrogen beyond 10 years, can particularly raise the risk of ovarian cancer for postmenopausal women.
  
  

8. Medical and genetic conditions

• Diabetes

• Lynch syndrome

• Peutz-Jeghers syndrome (PJS)

• Nevoid basal cell carcinoma syndrome (NBCCS)

• Li-Fraumeni syndrome and ataxia-telangiectasia
  
  

9. Lifestyle factors

• Obesity
  
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• Smoking
  
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Diagnosis Of Ovarian Cancer

The tests that help detect ovarian cancer are: 

1. Rectovaginal pelvic exam

A rectovaginal exam examines and identifies abnormalities in the pelvic area, including the cervix, uterus, ovaries, fallopian tubes, anus, and rectum.

2. TVUS (transvaginal ultrasound)

• In this, an ultrasound wand is put into the vagina to examine the uterus, fallopian tubes, and ovaries. 

• It helps in the identification of any mass but cannot confirm its cancerous nature.

3. Blood tests

• CA-125: This test measures the amount of a protein called CA-125 which is known to be elevated in ovarian cancer 
• Human epididymis protein 4 (HE4): The level of HE4 in the blood is a more sensitive marker to predict ovarian cancer. 

4. Laparoscopy

• In this, the ovaries are examined through a thin tube inserted through a small cut in the abdomen. 

5. Biopsy

• A biopsy is an examination of tissues or fluids under a microscope that helps confirm the diagnosis of ovarian cancer.

•  It helps to identify the type of illness and the stage of disease, and to choose the most suitable treatment. 

6. CT scan

• This imaging test uses X-rays to generate a detailed picture of the internal organs to detect the spread of cancer.
  
  

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Prevention Of Ovarian Cancer

Some factors may help to decrease the risk of ovarian cancer, even though complete prevention against it is not possible. Some of them include:

1. Pregnancy

• Full-term births can greatly reduce the risk of ovarian cancer.

2. Contraceptive Pills

• The use of oral methods for at least three years reduces ovarian cancer risk, and the effect may persist for as long as three decades.

3. Breastfeeding

• Breastfeeding for one year or longer significantly diminishes the risk of ovarian cancer; the duration during which breast milk is provided also seems to add further risks.

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4. Surgical procedures

• Women who have had a hysterectomy (removal of the uterus) may have a lower risk of developing ovarian/fallopian tube cancer.

• Tubal ligation (tying of fallopian tubes) to avoid pregnancy also decreases the risk of ovarian cancer. 

Specialist To Visit 

Cancer requires multispecialty comprehensive care. Doctors who take care of patients with ovarian cancer and help in diagnosing and formulating a treatment plan are:

• Gynecologist
• Gynecologic oncologist
• Surgeon
• Medical oncologist

A gynecologist specialize in diagnosing and treating diseases of the female reproductive system and refer them further to super speciality doctors.

A gynecologic oncologist is  are doctors who have been trained to treat cancers of a woman’s reproductive system. 

A surgeon help in operative procedures that are essential for almost all ovarian cancers. 

A medical oncologists help in managing ovarian cancer through medications.

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Treatment Of Ovarian Cancer

The treatment of ovarian cancer depend upon the stage of cancer. It includes:

1. Debulking surgery

• The major aim of debulking surgery is to remove the tumor. 

• The unilateral salpingo-oophorectomy (removal of one ovary along with the fallopian tube) is usually done in the early stage of ovarian cancer. 

• The hysterectomy/bilateral salpingo-oophorectomy or BSO (removal of both ovaries and fallopian tubes along with the uterus)  in advanced-stage ovarian cancer may be required.

• Sometimes, the spleen, gallbladder, a part of the stomach, liver, pancreas, and part of the colon are also removed depending upon the spread of cancer. 

2. Radiation therapy

• It uses high-energy X-rays to kill cancer cells. 

• The procedure is painless and each session takes a few minutes. 

3. Chemotherapy

It involves the use of medications to kill cancer cells. Chemotherapy is mostly useful to kill small-sized tumors that have left even after surgery. In most cases, a combination of drugs is used as it seems to work better for ovarian cancer. The drugs used during chemotherapy are:

• Paclitaxel
• Altretamine 
• Capecitabine 
• Cyclophosphamide 
• Etoposide 
• Gemcitabine 
• Ifosfamide 
• Irinotecan 
• Melphalan
• Pemetrexed 
• Topotecan
• Vinorelbine

4. Hormonal therapy

It involves the use of hormones to treat cancer. It is mainly used to treat ovarian stromal tumors. The class of drugs used in hormonal therapy are:

• Luteinizing hormone-releasing hormone (LHRH) agonists: These drugs block the production of hormone estrogen by the ovaries. The common examples are goserelin and leuprolide. 

• Tamoxifen: The primary function of tamoxifen is to reduce the level of the female sex hormone, estrogen. This restricts the growth of cancer cells. 

• Aromatase inhibitors: These drugs block an enzyme known as aromatase which converts other hormones into estrogen. The drugs that belong to this category are letrozole, anastrozole, and exemestane. 

5. Targeted drug therapy

Targeted therapy targets specific proteins that help in the growth, division, and spread of cancer cells. The examples include: 

• Bevacizumab

• Olaparib

• Rucaparib

6. Immunotherapy

In this, the immune system is modified to destroy cancer cells. This is done through following medications such as pembrolizumab.

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Home-care For Ovarian Cancer

Certain dietary additions may help manage symptoms associated with ovarian cancer and its treatment. However, always consult your doctor before incorporating these into your routine.

Shiitake mushrooms: Also known as medicinal mushrooms, they contain an active ingredient called lentinan, which helps inhibit the growth of cancers, including ovarian cancer. To use, boil the mushrooms in water, strain the liquid, and consume the extract.

Soybean: Isoflavones present in soybeans help inhibit ovarian tumors growth. They also help in curing the body from the harmful impacts of chemotherapy and other conventional cancer treatments.

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Peppermint tea: It helps in relieving abdominal pain which is the most characteristic symptom of ovarian cancer. It can be easily prepared by boiling around four or five torn peppermint leaves into the water. 

Ginger (Adrak) tea: It helps in relieving symptoms such as pain and cramping that is associated with ovarian cancer. Studies also suggest that ginger stops the growth of ovarian cancer cells. It can be prepared by boiling a few slices of ginger with water. 

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Complications Of Ovarian Cancer

Untreated ovarian cancer can lead to:

• Ascites (accumulation of fluid between the layer of the abdomen and pelvis)

• Obstruction in the small or large intestine

• Pleural effusion (build-up of fluid between the tissues that line the lungs and the chest)

• Bladder obstruction (blockage in the urinary system)

• Nutritional disorders

• Spread of cancer to other parts of the body

• Chronic pain

Alternative Therapies For Ovarian Cancer

Certain therapies help in managing symptoms and help cope with the side effects of chemotherapy. They also aid in relieving stress and improving overall quality of life. 

1. Tai chi

• It is a form of physical activity that helps increase mental concentration through breathing control. 

• It helps in reducing stress. It also alleviates pain through improving flexibility, strength, and balance. 

2. Acupuncture 

• It is a very ancient technique that is used in China and Japan. 

• Fine metal needles are inserted into the skin at specific points. 

• This helps in alleviating symptoms of ovarian cancer such as pain and other side effects of chemotherapy. 

• Sometimes, needles are stimulated by electricity which is known as electro-acupuncture. 

3. Relaxation response

• It involves methods such as quiet sitting, progressive muscle relaxation, and repetition of a particular word during inhale and exhale. 

• Practicing for 10-20 minutes daily helps in providing emotional stability. 

4. Biofeedback

• The technique records the responses of the individuals such as heart rate, muscle tension, brain activity, etc after stimulation.  

• It helps in alleviating physical and emotional symptoms by analyzing the triggers. 

Living With Ovarian Cancer

Whether you are a patient who has been diagnosed with ovarian cancer or care for someone who has the disease, it will have a large impact on their lives. Things that the caregiver and the patient should take into consideration include:

1. Stay hydrated

• Hydration is very important to curb the most important symptoms of ovarian cancer such as diarrhea and constipation.

• This also helps with smooth digestion and reduces gastrointestinal symptoms. 

2. Managing side effects

• Take an active role in your treatment plan. This helps you in knowing about possible side effects well in advance. 

• Talk about the side effects to your doctor which may help you in alleviating and preventing the side effects.

• Maintain a journal in which you can write about your experiences. 

• Talk about your fear to your loved ones. This will reduce your anxiety. 

3. Managing emotional and social effects

• Engage yourself in activities you like such as crafting, painting, and singing. 

• Do regular exercise as it helps in reducing stress.

• Join any support group either online or offline.

• Ask for help from a professional counselor.

• Meet someone who is undergoing the same type of treatment.

4. Managing the cost of cancer treatment

• Understanding the cost of therapy well in advance. 

• Communicating any financial issues with the cancer team. This will help doctors to look for affordable alternatives.

• Finding financial support resources through oncology social workers, oncology nurses, doctors, or online. 

• Taking help through your health insurance partners.