Ovarian Cancer

What is ovarian cancer?

Ovarian cancer is the abnormal growth of cells within the ovaries the part of the female reproductive system that makes eggs. This abnormal growth can lead to the formation of a tumor, which can be benign (not cancerous) or malignant (cancerous). Benign tumors may not pose a problem to your health, but malignant tumors are more aggressive and can spread to other parts of the body.

The symptoms of ovarian cancer often don’t appear until the later stages, which makes it harder to detect.

It can be treated with chemotherapy and surgery.

What causes ovarian cancer?

We don't know the exact cause of ovarian cancer, but there are certain risk factors that put you at an increased risk:

• Family history: If a close relative has ovarian cancer, or if you have the inherited BRCA1 or BRCA2 gene mutation
• An Eastern European (Ashkenazi) Jewish background
• If you have not been pregnant
• If you have had endometriosis
• A previous uterine, breast or colorectal cancer diagnosis
• The risk of ovarian cancer increases with age
• Lynch syndrome, an inherited disorder that increases your risk of certain cancers

Symptoms of ovarian cancer

Ovarian cancer often has no symptoms until the later stages, when it may have spread through the abdomen. Symptoms might include:

• Pain, bloating or discomfort in the abdomen
• Feeling full quickly or losing your appetite
• Bleeding or vaginal discharge that isn't normal (for example between periods or after menopause)
• Changes in your bowel habits
• Noticing lumps or an increase in size in your abdomen
• Needing to urinate more frequently or urgently

Gene mutations and ovarian cancer

There are two gene mutations associated with ovarian cancer, known as BRCA1 and BRCA2, which are also associated with breast cancer. If there is a strong family history of either of these cancers, your doctor may suggest genetic testing to identify these mutations. This can help identify women at high risk for ovarian cancer who can take steps to prevent the disease.

Diagnosing ovarian cancer

There are no screening tests available for ovarian cancer unfortunately. Testing usually happens once symptoms are present. Therefore, it is important to notify your doctor as soon as you notice something that is unusual for you, that has lasted for more than 2 weeks.

Your doctor will begin by discussing your medical history and performing a physical exam. A pelvic exam will look for any lumps or enlarged organs. If your doctor feels additional tests are needed, these might include:

• Pelvic ultrasound: This uses sound waves to get a picture of your organs, allowing your doctor to see any abnormal growths. Other imaging tests such as an MRI or CT scan may also be used to aid in the diagnosis of ovarian cancer
• Blood tests: These will look for increased levels of something called CA-125, which can be a sign of cancer. Sometimes the levels of CA-125 are increased when no cancer is present, or the cancer does not cause an increased level, so other diagnostic tests are always used
• Surgical evaluation: Surgery can be used to diagnose ovarian cancer
• Laparoscopy: This is a type of surgery that uses a thin camera (laparoscope), inserted via a small incision in the abdomen, to look at the cancer and perform biopsies. It can also be used to remove tumors

Staging ovarian cancer

Staging indicates how far your cancer has spread and helps doctors decide on the most appropriate treatment plan. Factors such as which organs it has spread to, and how they have spread, are taken into consideration. The stages are as follows:

• Stage I: Further divided into sub-stages:
• Stage IA: the cancer is in one ovary only, or one fallopian tube
• Stage IB: cancer is in both ovaries or both fallopian tubes
• Stage IC: the cancer is in both ovaries or both fallopian tubes. It is also outside of the ovary
• Stage II: Also divided into sub-stages:
• Stage IIA: the cancer has spread from the ovary to the uterus
• Stage IIB: cancer has spread to nearby organs in the abdomen
• Stage III: This stage also has 3 sub-stages:
• Stage IIIA: the cancer is beyond the abdomen and through the lymph nodes
• Stage IIIB: the cancer has spread beyond the abdominal space and is at least 2cm in size
• Stage IV: The most severe stage when the cancer has spread through the body

Treating ovarian cancer

Treatment of ovarian cancer often requires a combination of surgery and chemotherapy.

Surgery: A minimally invasive procedure called laparoscopy (also used for diagnosis) can be used to treat ovarian cancer. Alternatively, laparotomy, a surgical procedure in which the abdomen is opened, and the ovaries and other affected organs are removed, can be used.

Chemotherapy: This involves taking medication that targets and kills cancer cells. The type of chemotherapy you receive will depend on many factors, including the stage of your cancer. Chemotherapy can be given before or after surgery.

Surveillance

After you have received treatment for ovarian cancer, you will need to see your doctor regularly to discuss any possible symptoms and to check the cancer hasn't returned. Observation following ovarian cancer is very important.

Preventing ovarian cancer

Ovarian cancer cannot be completely prevented and unfortunately there are no screening tests for it. However, there are things you can do to decrease your risk of getting cancer as you get older, such as maintaining a healthy weight, eating well and exercising regularly. Being aware of your family history is also important. Studies have shown that women who have had children or have used oral contraceptives for more than 5 years are less likely to develop ovarian cancer.