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Ovarian cancer

Cancer is the disease that start when cells in the body start to divide and grow out of control. When this out of control growth happens to ovarian cells, it is called ovarian cancer. In order to understand well about ovarian cancer, one needs to at least have some knowledge about ovary and its functions.


About the ovary

Ovary is a part of female reproductive system. Female reproductive system consist of ovaries, fallopian tubes, uterus (womb), cervix and vagina. The system consist of two ovaries (one on each side of the uterus close to the end of fallopian tube) Ovaries are oval shaped organs about 3cm long and 1cm thick. Ovaries are found in the pelvic cavity. Ovaries are covered by a layer of cells called epithelium. Inside the ovaries are cells called germ cells that eventually mature to female eggs (ovum). One egg is released every month from one of the ovaries. Egg travels down to the uterus through fallopian tube. If the egg is fertilized by sperm, it can grow into a baby, but if it is not fertilized it will disintegrate together with lining of the uterus and pass out through vagina in the monthly period (menstruation). Also ovaries produce female hormones estrogen and progesterone. These hormone are produced from stromal cells in the ovary. Stromal cells are connective tissue cells that hold ovary together. As a woman grows older, ovaries start producing less hormones. Production of matured eggs also decreases and woman`s periods begin to be irregular and finally stops. This is known as menopause and at this age, a woman is not able to bear a child.

Types of ovarian cancer

There are three main types of ovarian cancer depending on the cells from where cancer starts.
• Epithelial carcinoma. Epithelial carcinoma of ovary start from epithelial cells of the ovary. It is the most common type of ovarian cancer. Epithelial carcinoma is histologically subdivided into serous, endometrioid, mucinous and clear cell carcinoma.
• Germ cell malignancies Type of ovarian cancer that start form egg producing cells in the ovary. It is not very common type of ovarian cancer and normally affects young women. Germ cell tumors are subdivided into dysgerminomas, immature teratoma and endodermal sinus tumors (called EST and yolk sac tumors), which include embryonal carcinoma.
• Stromal cell malignancies Type of ovarian cancer that start from connective tissue cells in the ovary. These cells also that produce hormones (estrogen and progesterone). This type of ovarian cancer can lead to production of excess hormones such as estrogen that may lead to abnormal vaginal bleeding.

Risk factors of ovarian cancer

When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but it does not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. The risk factors for ovarian cancer include the following;

• Reproductive history. A woman with no history of bearing a child or those who had their first child at the age of over thirty years, are said to be at slightly more risk of developing this type of cancer.
• Family history of the disease. Being in a family with the history of this disease to either mother, sister or daughter, increases your chance of developing ovarian cancer. Also being in a family with history of breast cancer and colorectal cancer, is said to increase woman`s chance of developing ovarian cancer.
• Obesity. Different researches reveals that, risk of developing ovarian cancer is slightly higher to obese women.
• Age. Being older also increase your risk of developing ovarian cancer.
• Endometriosis. This is the condition where by the inner lining of the uterus grows outside the uterus. This condition is linked to development of endometrioid and clear cell ovarian cancer.
• Hormone replacement therapy. The use of some hormone replacement therapy may increase a woman`s chance of developing ovarian cancer. Some studies suggest that, women using estrogen as hormone replacement therapy after menopause, are at slightly higher risk of developing ovarian cancer.

Prevention of ovarian cancer

To prevent anything, you need to know what causes it. Since the specific cause of ovarian cancer is not known, then there is no possible way of completely preventing development of ovarian cancer. However there are ways of reducing the risk of developing ovarian cancer. These ways include the following;

• Pregnancy. Since not bearing a child or bearing a first child at the advanced age (above 30) increase a woman`s risk of developing ovarian cancer. Then being pregnant at the right age should reduce the risk of ovarian cancer.
• Using contraceptive pills. Various studies shows that, women who have used contraceptive pills for a certain period of their life, have a reduced risk of developing ovarian cancer. The risk lowers the longer the pill is used. This lower risk continues for many years after stopping using the pills.
• Breastfeeding. Breastfeeding is said to reduce the risk of developing ovarian cancer.
• Gynecologic surgery. Tubal ligation (tying up fallopian tubes) reduces the risk of ovarian cancer. Also doing hysterectomy (surgical removal of uterus) will reduce the risk of developing ovarian cancer.
Early detection and screening When it comes to cancer, early detection normally provide better outcome. When ovarian cancer is found early at a localized stage, chance for better outcome is very high.
Screening is the process of running some tests to someone with no symptoms of the disease with the intention of determining presence or absence of the disease. For several other types of cancers, screening has helped in their early detection. However currently there is no screening test recommended for ovarian cancers.
Some few cases of ovarian cancer are detected while still at an early stage to those women who attend regular pelvic examination. Although in most cases, early detection of ovarian cancer as a result of pelvic examination is very difficult or impossible for even the most skilled examiner.

Signs and symptoms of ovarian cancer

Normally ovarian cancers do not show symptoms until the disease is at advanced stage. Although some cases may show symptoms while still at an early stage. Some of the symptoms of ovarian cancer are similar to those of other health conditions so it is very important to see a doctor when you start experiencing any of those symptoms. Among the signs and symptoms of ovarian include the following;

• Swollen or bloated abdomen
• Discomfort or pain in the abdomen or pelvis
• Loss of appetite
• Feeling full quickly
• Urinary symptoms such as urgency or frequency
• Pain during sex
• Changes in menstrual pattern
• Weight loss
• Fatigue
• Upset stomach.

Diagnosis of ovarian cancer

Medical diagnosis simply means identification of nature of an illness by elimination of the symptoms. Normally people don`t go to hospital knowing they have cancer but during diagnostic procedures is when doctors detect the disease. Following suspicion of the disease, doctors normally run combination of tests to determine whether there are cancerous cells in the body or not and if there are cancer cells, how far have they spread. Along with thorough medical history and physical examination, doctors normally use combination of the following tests to diagnose cancer. Laboratory tests. Laboratory tests are important in ruling out other conditions and confirming diagnosis. For cancer diagnosis laboratory tests normally include blood tests, urine tests, tumor markers and other body fluids tests.

• Blood tests. Blood tests help to reveal level of different substances in the blood which will help doctors to know if there is anything wrong in the body. From blood tests doctors can see complete blood count which indicates number, size and maturity of blood cells. Also from the blood tests doctors can analyze if kidney and liver are working properly.
• Urine tests. Urine tests (urinalysis) involve laboratory examination of urine to check presence of blood, proteins, and other substances such as drugs. For instance, blood in the urine may be an indication of benign condition, infection or other health problem.
• Tumor markers. These are biomarkers (proteins) that can be produced by both cancer cells and normal body cells in response to cancer. Tumor markers are released into the blood or urine. Although studies are still conducted to determine role of these markers in diagnosing cancer because sometimes people with benign condition will have elevated level of these proteins. Also not all tumors have their markers and some markers are not specific to one type of tumor.
• Other body fluids. Despite being rarely used, sometimes body fluids can be tested in the lab during diagnosis of cancer. For instance, the use of cerebral spinal fluid (CSF) and pleural fluid. CSF is used in diagnosis of brain tumors while pleural fluid for lung cancer.

Diagnostic imaging

Diagnostic imagings involve tests that create pictures of inside the body that help the doctor to see if there is tumor or not. There are several imaging tests used in cancer diagnosis depending on the type and location of cancer suspected. These imaging tests include;
• Computed tomography (CT) scan. CT scan machine is a donut-shaped scanner that uses x-rays to create series of pictures of body organs from different angles. This machine is linked to a computer where those series of pictures taken will be combined to create a 3D- image of inside the body. During the scanning process patient will lie still on the table which will slide into the scanner. In order to get a clear image, sometimes the doctor will inject the patient with a contrast material before scanning. From the images the doctor will be able to differentiate between healthy and unhealthy tissues.
• Magnetic resonance imaging (MRI). MRI is an imaging technique that uses powerful magnet and radio waves to take series of pictures of body organs and create a 3D image in a computer linked to a machine. Just like in CT, during MRI procedure the patient will lie on a table that will slide into a long round chamber. Also during this procedure, the doctor may inject the patient with a contrast material for clear image view.
• X-ray. This is an imaging technique that is uses low dose of radiation to create pictures of inside your body. Technician will position the patient and direct the x-ray beam to the intended part of the body.
• Ultrasound. Ultrasound is a diagnostic imaging procedure that uses high energy sound waves to produce images of organs inside the body. During the examination, a patient will lie on the table while the technician will slowly move a device called transducer on the skin over the part of the body that is being examined.
• PET scan. Positron emission tomography (PET) scan is an imaging test that uses radioactive glucose to create 3-D images of areas inside the body. Radioactive glucose is used for this test because cancer cells tend to absorb more glucose than normal body cells, so the scan will show which areas of the body has more glucose than others. Before the scan, doctor will inject the patient with tracer called radioactive glucose then during imaging the patient will be asked to lie on the table that will be moving back and forth through the scanner.
• Bone scan. Bone scan is used to examine bones. When it comes to cancer, bone scan is used for diagnosis of bone cancer or cancer that has metastasized into the bones. Before the test, patient will be injected with small amount of radioactive material that tends to collect more on abnormal parts of the bones. Then pictures that will be taken by a scan will indicate the distribution of those radioactive materials in the bones throughout the body.

Biopsy

Biopsy is a diagnostic procedure that involves removing a tissue sample from the body and examines it under microscope in the laboratory. Examination in the laboratory is normally done by a pathologist who will check if the cells in the tissue are cancerous or not. In most cancer cases, biopsy is considered to be the confirmatory test. Depending on the location and type of cancer, biopsy can be obtained in different ways. Some of them include;
• Using needle. By using a thin needle, doctors can draw same tissue or fluid for examination under microscope. This method can be used to draw some fluid (spinal tap), bone marrow (bone marrow aspiration), blood or small amount of tumor from the suspected organ such as liver and breast (fine needle aspiration).
• Surgery. Abnormal tissue samples are obtained while the doctor is performing the surgery. Tissues are then sent to the lab for examination during the surgery. If the surgeon removes just a portion of abnormal area, it is called incisional biopsy while when the entire tumor (abnormal site) is removed it is called excisional biopsy.
• Using endoscope. Endoscope is a thin, lighted tube with a camera (focusing telescope) at the end. It is used for viewing inside the body through natural openings like mouth and anus. During an examination if the doctor sees any abnormal tissue, then endoscope can also be used to take sample for that tissue. There are different kinds of endoscopy exams depending on the site of the body being examined. Some of the exams include colonoscopy (for rectum and colon), bronchoscopy (for trachea, bronchi and lungs) and esophagogastroduodenoscopy EGD (for esophagus, stomach and duodenum)
In addition to medical history and physical examination, diagnosis of ovarian cancer normally involves the use of blood tests through which the level of CA 125 (tumor marker) will be assessed, transvaginal Ultrasound, CT Scan, Colonoscopy, PET Scan and biopsy.

Stages of ovarian cancer

Staging is the process of describing the location of cancer, how far has the cancer spread and explain whether other organs are involved or not. Staging helps doctors plan for treatment and predict the outcome of treatment. For ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) is the preferred staging system. It divides ovarian cancer into four stages and each stage is further divided into sub-stages, such as A, B, C. Description of stages of ovarian cancer is as follows;
• Stage I. Cancer is still in the ovary (one or both ovaries)
• Stage II. Cancer is in the ovary (one or both ovaries) but has spread to nearby organs in the pelvis such as uterus, bladder and rectum.
• Stage III. Cancer is in ovary (one or both ovaries) but has spread beyond pelvis to the abdominal lining (peritoneum) bowel or lymph nodes.
• Stage IV. Cancer has spread further to distant organs such as lungs and liver.

Treatment of ovarian cancer

Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps. After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option. Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored. In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials. If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time

Treatment options

Treatment of ovarian cancer requires a team of doctors and other health care professionals who will work together in providing good care. This team is called multidisciplinary team. Depending on treatment option used, this team consists of gynecological oncologist, gynecological pathologist, medical oncologist, radiation oncologist, radiologist, oncologist nurse, physiotherapist and occupational therapist, dietitian, palliative care team and clinical psychologist. >Surgery
Surgery is the treatment of cancer by removing tumor through operation. Surgery is the main treatment used for ovarian cancer. During surgery is when biopsy is normally taken for more examination in the laboratory by gynecological pathologist. Biopsy will enable doctors to know the type and stage of ovarian cancer. Knowing stage and type will enable doctors to know type and extent of surgery required. Before surgery it is important to talk with your doctor about possible side effects from the treatment. Depending on the stage and type of ovarian cancer, surgery of ovarian cancer can be done in the following ways;
• Salpingo- oophorectomy. This is the type of surgery that involves the removal of ovary and fallopian tube. If both ovaries and fallopian tubes are removed it is called bilateral salpingo-oophorectomy but if only one ovary and fallopian tube is removed it is called unilateral oophorectomy.
• Hysterectomy. This involves the removal of uterus. This can either be partial that removes only uterus or can be total hysterectomy that removes uterus and cervix. Sometimes hysterectomy can be combined together with salpingo-oophorectomy (total hysterectomy with bilateral salpingo oophorectomy).
• Omentectomy. This is the surgery that involves the removal of omentum which is a sheet of fatty tissue that is attached to the stomach and bowel and hangs down in front of the intestines. Ovarian cancer at some stages can spread to omentum.
• Lyphadenectomy. This is the surgical removal of affected lymph nodes. Normally nodes in the pelvis and par aortic region.
• Colectomy. if cancer has spread to the bowel, the part of the bowel with cancer is cut out and the healthy parts are sewn back together. Sometimes a new opening called a stoma is created (colostomy).

Side effects of surgery

Side effects may vary depending on the type of surgery. It is important to talk to the doctor about possible side effects of your treatment. Following surgery, a woman may experience the following;
• Pain
• Tenderness
• Loss of blood
• Possible reaction from anesthesia
• Possible risk of infections
Some of the side effects may go away on their own while others will require the use of medications to relieve. For a woman who has undergone bilateral salpingo oophorectomy can no longer become pregnant so she will experience premature menopause. So soon after surgery a woman is likely to experience symptoms of menopause such as hot flashes and dryness of vagina.

Chemotherapy

Chemotherapy is the treatment of cancer by using ant cancer drugs to destroy cancer cells while causing minimal damage to normal healthy cells. Chemotherapy is a preferred treatment option for those advanced cases of ovarian cancer. Chemotherapy can also be given in combination with surgery either before surgery (neo-adjuvant therapy) or after surgery (adjuvant therapy). Side effects of chemotherapy Chemotherapy can affect healthy cells in the body, which may cause side effects. Not all women will have side effects and effects will vary according to the dose and drugs you are given. The side effects are normally temporally and can also be relieved by medications if they become serious. Some of the possible side effects include;
• Fatigue. Loss of red blood cells (hemoglobin) can cause you to feel tired and short of breath
• Nausea.
• Hair loss
• Change of bowel movement. This can cause constipation and diarrhea.
• Risk of infections. Due to decreased white blood cells that fight infections.
• Joint and muscle pain.

Radiation therapy

Radiation therapy is the treatment of cancer by using high energy x-rays or other radiation particles to destroy cancer cells. Radiation therapy is less often used for ovarian cancer. Doctors normally recommend radiotherapy when surgery or chemotherapy cannot work. Radiotherapy is also used to relieve symptoms of the disease that are not responding to chemotherapy or chemotherapy can no longer be given.
Side effects of radiation therapy

Side effects of radiation therapy vary depending on the dose of radiations given. Most of the side effects are temporary and disappear within few weeks after treatment. Side effects include the following;
• Skin reactions (sun burn like) around treatment site
• Feeling tired
• Need to urinate more frequent and feeling burning while urinating
• Diarrhea
• Nausea and vomiting.

Targeted therapy

Targeted therapy is the treatment option that uses drugs to target specific genes, proteins or any tissue environment that contribute to cancer growth and survival. One of these new treatments is called bevacizumab (Avastin). It works by stopping the cancer developing new blood vessels and growing. Side effects of targeted therapy Side effects of this type of treatment depend on the dose and type of drug that has been used. Side effects of this type of therapy include feeling tired, high blood pressure, low white blood cell count, mouth sores, loss of appetite and diarrhea.

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