Ovarian Cancer


Ovarian cancer or ovarian cancer is one of the most common types of cancer in women. The ovaries are a pair of small organs in the lower abdomen that are attached to the uterus and store a woman's eggs. Ovarian cancer mainly affects women who have gone through menopause (usually over 50), but can sometimes affect younger women as well.

symptoms

It can be difficult to recognize the symptoms of ovarian cancer, especially in the early stages. It is often the same as the symptoms of less serious conditions such as irritable bowel syndrome (IBS) or PMS (premenstrual syndrome). The most common symptoms of ovarian cancer are:

- Constantly feeling bloated

- a bloated stomach

- Discomfort in your abdomen or pelvic area

- Feeling full quickly or loss of appetite while eating

- needing to urinate more often or more urgently than usual

Other symptoms of ovarian cancer may include:

- Persistent indigestion or feeling sick

- Pain during sex

- A change in your bowel habits

- Back pain

- Feeling tired all the time

- Weight loss

When is the doctor seen?

- Especially if you feel bloated more than 12 times a month

- You may be at higher risk, especially if you are over 50 or have a family history of ovarian or breast cancer

- If you have other symptoms of ovarian cancer that do not go away

The odds of you getting cancer are low, but it's best to get it checked out. A doctor can do some simple tests to see if you have ovarian cancer.

Reasons

Ovarian cancer occurs when cells in the ovaries grow and multiply uncontrollably, forming a clump of tissue called a tumor. It's not entirely clear why this happens, but there are factors that can increase your risk of developing ovarian cancer.

1. Advanced age

The risk of ovarian cancer increases as you get older, and most cases happen after menopause. About 8 in 10 women diagnosed with ovarian cancer are over the age of 50, but some rare types of ovarian cancer can occur in younger women.

2. Family history and genes

You are more likely to have ovarian cancer if you have a family history, especially if you have a close relative (sister or mother). Sometimes this is because you have inherited a faulty version of a gene called BRCA1 or BRCA2. These increase your risk of developing both ovarian and breast cancer. But having relatives with ovarian cancer doesn't necessarily mean you have a faulty gene. Only 1 in 10 ovarian cancers are thought to be caused by one of these genes. Talk to a doctor if you're worried that your family history may mean you have a higher risk of ovarian cancer. They may refer you to a genetic counselor who may recommend that you have a test to check for faulty genes.

3. Hormone replacement therapy (HRT)

It has been suggested that taking hormone replacement therapy (HRT) may increase your risk of ovarian cancer. But studies looking at this have so far yielded conflicting results. If there is an increased incidence of ovarian cancer in women taking HRT, the risk is thought to be minimal. The risk of ovarian cancer is also thought to increase after you stop taking HRT.

4. Endometriosis

Studies have shown that women with endometriosis may be more likely to develop ovarian cancer. In endometriosis, the cells that usually line the uterus grow elsewhere in the body, such as the ovaries or abdomen. These cells behave as if they are still in the womb, including bleeding during menstrual periods. But since the bleeding has no way to exit the body, it becomes trapped and causes pain in the affected area.

5. Other factors

Being overweight or obese – losing weight through regular exercise and a healthy diet can help reduce your risk

- Smoking - quitting smoking can help reduce your risk of ovarian cancer and many other serious health problems.

- Asbestos exposure - a whitish material that was used in the past for insulation, flooring and roofing in buildings, but is no longer used

- Using talcum powder - some research has suggested that using talcum powder between your legs may increase your risk of ovarian cancer, but the evidence for this is inconsistent and any increase in risk would likely be very small.

Diagnosis

See a doctor if you have symptoms of ovarian cancer. They may do some initial testing and you may also need more testing in the hospital. Doctor:

- Asks about your symptoms and general health

- Examines your abdomen to check for any swelling or lumps

- Performs an internal review

- Asks if there is a history of ovarian or breast cancer in your family

- Takes a blood sample - this will be sent to a lab and checked for a substance called CA125.

In some cases, you may be asked to do further testing without a blood test.

You may be referred directly to a hospital specialist (usually a gynecologist).

a) Blood test (CA125 test)

If the doctor thinks your symptoms may be due to ovarian cancer, he or she will recommend having a blood test to check for a substance called CA125. CA125 is produced by some ovarian cancer cells. A high level of CA125 in your blood can be a sign of ovarian cancer. However, an elevated CA125 level does not necessarily mean you have cancer, as it can also be elevated in other conditions, such as endometriosis, fibroids, normal menstrual periods, and even pregnancy. If the test shows high levels of CA125, you will be referred to a gynecologist to be checked for possible causes. Sometimes your CA125 level may be normal in the early stages of ovarian cancer. If you have a normal blood test result but your symptoms do not improve, you may need to be retested.

b) Ultrasound scan

Your doctor will arrange for you to have an ultrasound scan if a blood test suggests you may have ovarian cancer. This is a type of scan in which high-frequency sound waves are used to create an image of the inside of your body. There are 2 ways to do this:

1. Abdominal ultrasound - a small device called an ultrasound probe is moved over your abdomen to create an image of your ovaries

2. Transvaginal ultrasound - an ultrasound probe is passed into your vagina to create a clearer image of your ovaries

The scan can show changes in your ovaries that may be caused by another problem, such as cancer, endometriosis, or fluid buildup. If any abnormality is found, you will be referred to a specialist for further testing to confirm the cause.

c) Other tests

- CT scan - a type of scan in which X-rays are taken from different angles to create a detailed image of your ovaries

- A chest X-ray to check if the cancer has spread to your lungs

- a needle biopsy - a needle is passed through your abdomen to remove a sample of ovarian cells or fluid around the ovaries so it can be checked for cancer

- Laparoscopy - a small incision is made in your abdomen and a thin tube with a camera at the end is inserted so that your ovaries can be examined; a small tissue sample may also be taken for testing

If ovarian cancer is found, these tests can also help determine how far the disease has spread.

Stages and grades of ovarian cancer

If ovarian cancer is diagnosed, it is given a "stage". This explains the extent of the cancer and how far it has spread. It can help your doctors plan the best treatment for you.

The 4 stages of ovarian cancer are:

Stage 1 - cancer affects only one or both ovaries

Stage 2 - cancer has spread from the ovary to the pelvis or uterus

Stage 3 - cancer has spread to the lining of the peritoneum, the surface of the intestine, lymph nodes in the pelvis or abdomen

Stage 4 - cancer has spread to other parts of the body, such as the liver or lungs

Your cancer will also be given a "degree". This is one way of describing how quickly the cancer will grow or spread. The grades range from grade 1 (more likely to grow slower) to grade 3 (more likely to grow faster).

Treatment

Treatment for ovarian cancer depends on how far it has spread, your overall health, and whether you can still have children. Most patients receive a combination of surgery and chemotherapy. The goal of treatment is to cure the cancer, if possible. If the cancer is too advanced to be treated, treatment aims to relieve symptoms and control the cancer for as long as possible. You will be cared for by a team of healthcare professionals who will create a treatment plan and support you throughout your treatment.

1) Surgery

The main treatment for ovarian cancer is surgery. The goal is to remove all or as much of the cancer as possible. Surgery usually involves removing:

- Both ovaries and fallopian tubes

- Uterus (hysterectomy)

- The omentum, which is a layer of adipose tissue in the abdomen

If the cancer is in only one or both ovaries, only the ovaries or ovaries may need to be removed, leaving your uterus intact. This means you can still have children. The surgery is performed under general anesthesia. You'll likely need to stay in the hospital for a few days, but it may take weeks to fully recover.

2) Chemotherapy

Chemotherapy is treatment in which medication is used to kill cancer cells. Most women with ovarian cancer undergo chemotherapy as well as surgery.

- To kill the remaining cancer cells after surgery,

- To shrink the cancer and make it easier to remove before surgery,

- It can be used if ovarian cancer recurs after the first treatment.

Chemotherapy medication is usually given intravenously, but is sometimes given as tablets. Treatment is given in cycles with a treatment period followed by a rest period to allow your body to heal. Most people receive 6 cycles of chemotherapy, each cycle lasting 3 weeks.

Chemotherapy can cause some unwanted side effects, such as:

- Tiredness

- Nausea and vomiting

- loss of appetite

- Hair loss

- Diarrhea

- Increased risk of infection

Most side effects can be controlled with your doctor's medications and go away when treatment is stopped.

3) Radiotherapy

Radiotherapy uses carefully directed beams of radiation to kill cancer cells. It is not used very often to treat ovarian cancer, but can be used in:

- To kill any cancer cells left behind after early ovarian cancer surgery

- To shrink tumors and reduce symptoms if ovarian cancer has spread and cannot be cured

Common side effects of radiotherapy include sore skin, fatigue and hair loss in the treated area. These go away after treatment is stopped.

4) Targeted therapies

Targeted therapies are drugs that change the way cells work and help stop the growth and spread of cancer. Not all types of ovarian cancer can be cured with targeted therapies. There are 2 targeted therapy drugs for ovarian cancer:

- Olaparib (Lynparza)

- Niraparib (Zejula)

These drugs are only suitable for some types of ovarian cancer and may be given if the cancer comes back after chemotherapy. They are taken as tablets or capsules. Side effects of targeted therapies include:

- Shortness of breath

- Nausea and vomiting

- loss of appetite

- Diarrhea

- Tiredness

5) Clinical trials

Research into newer and better treatments for ovarian cancer continues with clinical trials. If you are interested in participating in a trial as part of your treatment, talk to your care team. They can tell you about any research you may be involved in. It is important to know that you may not receive an experimental treatment (a standard treatment may be given compared to a new one) and there is no guarantee that a new treatment will be more effective.

Living with ovarian cancer

Having ovarian cancer can affect your daily life during and after treatment.

Post-operative recovery period

Surgery to treat ovarian cancer is a major operation. It may take up to 3 months to fully heal. You'll need to make things very easy for at least the first few weeks. Rest as much as possible and try not to stay on your feet for too long. You can slowly begin to return to your normal activities over the following weeks, but be careful not to do too much too soon. Your care team will advise you of everything to avoid while you recover. For example:

- You will probably need to take 1 to 3 months off work

- You may not be able to drive for about a month

- You may need to avoid strenuous lifting or intense exercise for at least 3 months

A physical therapist can design an exercise plan to help you recover. If your ovaries were removed in the premenopausal period, you will enter menopause after surgery. Your doctor may recommend taking hormone replacement therapy (HRT) to control any menopausal symptoms, at least until you reach the natural age for menopause (between 45 and 55).

Follow-up appointments

After your treatment is finished, you will be invited for regular check-ups to see how you are doing. These are usually every 2 to 3 months initially, but tend to become less frequent over time. These appointments are an opportunity to talk to your care team about any problems you have or any questions you have. It is quite common for ovarian cancer to recur within a few years after treatment ends, so you can have regular blood tests and screenings to check for this. If any of your symptoms come back after treatment, tell your doctor as soon as possible. Don't wait until your next appointment.

Help and Support

Dealing with cancer can be a huge challenge for you, your friends and family, both practically and emotionally. Talking to someone about your feelings or problems can help.

- Talk to your care team or doctor - they can arrange professional support such as counseling

- Talk to your friends and family - be open about how you're feeling and what they can do to help; don't be afraid to tell them you need some time

- Contact a support group or charity - many organizations have helplines, online forums, and local support groups where you can meet other people in a similar situation.

Sexuality and fertility

your sex life

Ovarian cancer can affect your sex life in a number of ways. Probably avoiding sex for a few weeks after surgery is recommended so that your wound has time to heal properly. But even after your wound has healed, it's normal not to want to have sex right away. Many women take much longer to feel ready. This may be because surgery triggers menopause, or it may be a combination of fatigue and emotional stress associated with cancer diagnosis and treatment. Talk to your partner about how you're feeling and don't force yourself to have sex too soon.

Fertility and pregnancy

For some women, ovarian cancer treatment triggers early menopause, meaning they can no longer have children. If you are concerned about this, talk to your care team about it. If you still want to have children and the cancer has not spread to both ovaries, it may be possible to have treatment that preserves your fertility. It is normal to experience a sense of loss or grief if you lose your fertility. It may be helpful to discuss your feelings with your spouse, relative or close friend, or with your specialist nurse. If your treatment includes chemotherapy and you can still have children, it is usually recommended to avoid getting pregnant for several years in case the cancer comes back and you need further treatment.