CONDITIONS

Ovarian Cancer

What Is Ovarian Cancer

Ovarian cancer is characterized by the abnormal and uncontrollable growth of cells within the ovaries, the egg-producing organs of the female reproduction system. Often, uncontrollable cell growth leads to the development of tumors, which are masses of irregular tissue. Tumors may be benign (noncancerous), malignant (cancerous) or borderline cancerous (low malignant potential).  Tumors are further categorized by the cell type from which they arise:

Epithelial tumors start from the epithelial cells, which cover the outermost surface of the ovary. These account for the majority of ovarian tumors.

Germ cell tumors start from the germ cells, which are responsible for egg production.

Stromal tumors start from the cells responsible for the production of reproductive hormones estrogen and progesterone.

According to the American Cancer Society, an estimated 21,980 new cases of Ovarian cancer were diagnosed in 2014. Ovarian cancer is the fifth most deadly cancer for women, placing after breast, colorectal, and pancreatic cancers. If caught early, ovarian cancer has a relatively high success rate. However, because of its relatively undisruptive symptoms, many cases are not discovered until they have progressed to a later stage, significantly decreasing the chances of successful survival. New developments in treatment and detection technologies in the last several decades have helped to increase the expected survival rate for ovarian cancers across the board.

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What Causes Ovarian Cancer

Like most cancers, the exact causes of ovarian cancer have yet to be determined. Scientists believe that genetic mutations (whether inherited or acquired during a person’s lifetime) play a role in the abnormal cell division that leads to ovarian cancer. Researchers have also identified several risk factors associated with a woman’s risk of developing ovarian cancer.

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Risk Factors For Ovarian Cancer

Research has shown that the following factors may be associated with a woman’s risk of ovarian cancer:

  • Heredity.  According to the Ovarian Cancer National Alliance, about 10 to 15% of women diagnosed with ovarian cancer have a genetic tendency towards the disease. The two main genetic risk factors for ovarian cancer known to researchers are the BCR1 and BCR2 genes, the same genes associated with a higher breast cancer risk.
  • Family History. Women who have a close relative with ovarian cancer are still at an increased risk for developing the disease, even if they do not possess the BRC1 and BRC2 genes.  The risk of developing ovarian cancer for a woman with a close relative with the disease is 5% as opposed to the 1.4% risk in the general population.
  • Ethnicity. Women of Ashkenazi Jewish descent and Eastern European women are more likely to be carriers of the BCR1 and BRC2 genes, therefore raising their risk of developing ovarian cancer.
  • Age. Though ovarian cancer can occur at any age, women between the ages of 55 and 64 are most likely to develop the disease.
  • Reproductive history.A woman is more likely to develop ovarian cancer if she:
    • Began menstruation before age 12
    • Has not given birth to children
    • Is infertile
    • Experienced menopause after age 50
    • Has never taken oral contraceptives
  • Hormone replacement therapy. Hormone replacement therapy involves the administration of doses of estrogen and/or progesterone to help alleviate symptoms of sudden hormonal changes, most often the result of menopause. While this therapy is often helpful in reducing symptoms such as night sweats, hot flashes, and vaginal dryness, it is also associated with an increased risk of ovarian cancer.
  • Obesity.The Ovarian Cancer National Alliance reports that a 2009 study found an almost 80% increase in ovarian cancer risks among obese women ages 50 to 71.
  • Environmental factors.Some believe that the genetic mutations that contribute to the abnormal and uncontrollable division of cancerous cells is the result of exposure to environmental factors. Some theorized environmental causes of ovarian cancer include talc powder, pesticides, and herbicides. 
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Diagnosing Ovarian Cancer

In order to arrive at an ovarian cancer diagnosis, your doctor will most likely:

  • Conduct a pelvic exam. Pelvic exams are most often conducted regularly at gynecologist visits, and are essential for detecting abnormalities in the vagina, uterus, ovaries, and cervix that may be signs of ovarian cancer or other diseases. Growths on the ovaries or swelling of the stomach indicative of fluid in the abdomen can be signs of ovarian cancer.
  • Conduct a physical exam.In addition to a pelvic exam, your doctor will most likely conduct a general physical exam to check for other abnormalities in the body that could be associated with ovarian cancer or other diseases.
  • Ask about your medical and family history to assess your risk for the disease based on genetic susceptibility and previous conditions that may have increased the risk of ovarian cancer.
  • Consult with a specialist. If your general physician or gynecologist suspects you may have ovarian cancer, he or she may refer you to a gynecologic oncologist, a doctor that specializes in cancers of the female reproductive system.

Several imaging tests may be used by your doctors in order to aide in an ovarian cancer diagnosis. These include:

  • Ultrasound, in which sound waves are used to produce imaging of the ovaries and other abdominal and pelvic organs.
  • Radioiodine scan, in which radioactive iodine is injected or swallowed and later absorbed into the ovaries. A special camera is then used to look at where the iodine has collected. Abnormalities in absorption levels indicate potentially cancerous cell growths
  • Chest x-ray, in which x-rays are used to produce an image of the torso.
  • CT scan, in which a specialized computer scanner compiles a series of photos to create detailed cross-sectional images of the body.
  • PET scan, in which a radioactive substance is injected into the body and later absorbed by the bodily cells. A special camera allows for doctors to see where the radioactive material has collected.
  • MRI scan, which uses magnetic waves to produce and image of the body. 
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Symptoms of Ovarian Cancer

Many of the warning signs of ovarian cancer can also be caused by other conditions. Early stages of ovarian cancer often do not cause any symptoms, so it is important to visit your gynecologist regularly for check-ups.  If you experience any of the following symptoms, make an appointment with your gynecologist as soon as possible. He or she will be able to determine whether or not your symptoms are indeed a result of ovarian cancer.

Warning signs of ovarian cancer include:

  • Frequent urination
  • Changes in bowel habits
  • Pain in pelvic area
  • Weight loss
  • Abdominal bloating or swelling
  • Quickly feeling full when eating
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Prognosis

The prognosis for ovarian cancer largely depends on how early on the cancer is detected. The earlier ovarian cancer is detected, the more likely it is to respond to treatment. Unfortunately, ovarian cancer often does not show symptoms in the early stages. Only 15% of ovarian cancers are found at a localized (early) stage; 18% are found at a regional (more progressed) stage, and 61% are found at a distant stage (far advanced).

The five year survival rates for ovarian cancer are as followed:

  • Overall (all stages) – 44%
  • Early stage (localized) – 92%
  • Progressed stage (regional) – 72%
  • Advanced stage (distant) – 27%
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Living With Ovarian Cancer

Receiving a diagnosis of ovarian cancer can be a challenging experience. The following tips can help you live well through your diagnosis, treatment, and recovery process.

  • Ask questions.Don’t be afraid to ask your doctor questions about your treatment, prognosis, and recovery. Being informed about your condition can help you through it.
  • Don’t dwell on statistics.The survival rates for certain ovarian cancers can be discouraging, but know that these are only numbers. Detection and treatment technologies are improving each day with new research, and keeping an overall positive outlook and healing mentality through your treatment will help in your recovery.
  • Keep a balanced diet and exercise regularly. This will help you to keep your body healthy and strong throughout the treatment process.
  • Join a support grouponline or in your community. Talking to others who have shared similar experiences can help you through difficult times.
  • Don’t give up on what you love. Keeping up with hobbies and favorite activities is a great way to keep your mind off treatment.
  • Talk to trusted family and friends. Communication with your loved ones is key to creating a strong support network.  
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Screening

According to the National Cancer Institute, there is no single recommended screening routine for ovarian cancer because screening for the disease has not been proven to decrease the risk of death from the disease. Most doctors will, however, recommend that you visit a gynecologist regularly to check for any abnormalities in the reproductive system, including ovarian cancer. If your doctor suspects you may have ovarian cancer, he or she will most likely conduct a series of diagnostic tests.

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Prevention

There is no single way to prevent ovarian cancer. Keeping a normal body weight can help decrease your risk of ovarian cancer. Many women with the BRC1 or BRC2 genes, or who have a close relative with ovarian cancer, choose to take extra preventative measures to help decrease their risk of ovarian cancer. These include:

  • Oral contraceptives have been shown to decrease the risk of ovarian cancer by 50%, however there are other risks associated with them, so you should consult with your doctor before choosing.
  • Surgery. Women with a high risk of developing ovarian cancer may wish to get a salpingo-oopherectomy (removal of both ovaries and fallopian tubes) surgery, which greatly decreases the risk of ovarian cancer. This procedure is most often recommended for women who are not planning on having children or who have finished having children and are at a very high risk of developing the disease. 
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Medication And Treatment

The following treatment methods are available for ovarian cancer:

Surgery. Surgical removal of the cancerous areas of the ovaries, fallopian tubes, and/or uterus is the most common form of treatment for ovarian cancer and is used to treat all types of ovarian cancer.

Epithelial cell ovarian cancer is more likely to spread than other cancer types, making the initial surgery especially important. Epithelial cell cancer surgeries are generally divided into two stages:

Staging, in which the ovaries, fallopian tubes, uterus, and omentum (layer of fatty tissue that lines the abdominal wall near the reproductive organs) are removed. This is done to stop the possible spread of the cancerous cells

Debulking. For more advanced cases of ovarian cancer, there may be tumors present on the colon or in the intestinal cavity. Debulking aims to remove as much of all the tumors as possible, leaving behind no tumors that are more than 1cm in diameter. This greatly increases the likelihood of survival after surgery.

For stromal and germ cell ovarian cancer, the main surgical goal is to remove all of the cancerous material (as with these kinds it is most often contained to a localized area). This may involve the removal of one or both ovaries, fallopian tubes, or the uterus.

Chemotherapy. Chemotherapy for ovarian cancer involves the intra-venous delivery of anti-cancer drugs that then travel throughout the body. Though each patient has an individualized chemo regimen based on her condition, the average chemotherapy will last 3 to 6 cycles of drug administration and rest periods.  Chemotherapy has some serious side effects, most of which discontinue after treatment has finished.

Common side effects of chemotherapy include:

  •  Nausea/vomiting
  • Mouth sores
  • Hand and foot rashes
  •  Loss of appetite
  •  Loss of hair
  • Increased chance of infection
  • Easy bleeding or bruising
  • Fatigue

Radiation therapy. Radiation therapy uses concentrated x-rays to kill cancer cells. External beam radiation therapy is the most common form of radiation treatment for ovarian cancer, and involves x-rays being delivered from a machine outside the body in a procedure similar to a standard x-ray.

Hormone replacement therapy.Hormone replacement therapy uses administered dosages of hormones or hormone-inhibiting drugs to control the cancerous growth of cells. This type of therapy is most often used for the treatment of stromal tumors.

Targeted therapy. Targeted therapy uses specific biologic agents to target cancerous cells within the body. This is a relatively new form of treatment and research is still ongoing about its effectivity. 

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Complementary and Alternative Treatment

Because the traditional treatment for ovarian cancer (surgery, chemotherapy, etc.) can be hard on the body, many women seek alternative treatments. Though there is anecdotal evidence that supports the effectiveness of some alternative treatments, there is a limited amount of scientific research on these procedures. Consult with your doctor before choosing an alternative or complementary therapy to best asses your health risks and needs.

  • Pancreatic enzyme treatment. Many patients have had success treating ovarian cancer with a combination of pancreatic enzymes and supporting supplements. The enzyme is thought to have an effect on the switching on and off of the gene that contributes to abnormal cell division. The method has shown to increase survival rates for cancer patients in past trials though current testing is controversial.
  • Vitamin C. Some researchers claim that high dosages of vitamin C and other immune-boosting compounds are enough to give the immune system the strength it needs to fight off the cancer.
  • Acupuncture. Acupuncture treatments use a series of needles placed in the body to stimulate cell function and bodily energy. Physical responses to acupuncture have been observed in the nerve cells, pituitary gland, and brain, possibly assisting in the release of chemicals and hormones that help regulate body function. Acupuncture can be used as either a complimentary therapy (i.e., to reduce side effects of chemotherapy) or as an alternative therapy (to boost the immune system to fight off cancer cells).
  • Mind/body approaches. Mind/body approaches such as Reiki, yoga, and guided meditation, have been said to help redirect  bodily energy and therefore give the body the strength that it needs to fight off cancer. 
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When To Contact A Doctor

If you experience any of the following symptoms, call your doctor. These may be signs of ovarian cancer:

  • Abdominal swelling/pain
  • Sudden weight loss
  • Changes in eating habits
  • Changes in bowel movements

If you are undergoing treatment for ovarian cancer, call your doctor if you experience any of the following:

  • Prolonged vomiting or diarrhea
  • Excessive bleeding or bruising
  • Extreme fatigue
  • Fever higher than 100.5ºF
  • Persistent cough
  • Rapid or irregular heartbeat
  • Sudden onset pain (anywhere in body)
  • Inability to eat/extensive weight loss
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Questions For A Doctor

If you have received an ovarian cancer diagnosis, you probably have many questions for your doctor. You may want to write these questions down beforehand on a piece of paper and bring it to your appointment with you. This will help you remember to ask all of your questions while you are with your doctor.

Some questions you may want to ask include:

  • What stage is my cancer?
  • What are my treatment options?
  • What are the success rates of the treatment options?
  • Are there alternative or complementary treatment options I should pursue?
  • What is the survival rate for my cancer stage?
  • Should my family concerned about their risk for the disease?
  • What can I do to help along my treatment?
  • How long will treatment last?
  • What are the side effects of treatment?
  • Should I consider surgery?
  • What if I want to have children in the future?
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