The Signs and Symptoms of Ovarian Cancer including Treatment

The Signs and Symptoms of Ovarian Cancer including , epidemiology, prevalence, causes,  risk factors,  protective factors,  diagnosis,  tests,  treatments and prevention .

 

A woman has two ovaries.. The ovaries are a key part of the reproductive system of the females and are the organs responsible for the release of eggs or ova during ovulation . However, like every other organs in the human body,   the ovaries can be diseased and become a huge problem to a woman during her life time.

One of the commonest diseases of the ovaries is cancer. Though it is preventable and curable when detected early , ovarian cancer is the third commonest cause of death in women globally and the second commonest gynaecological malignancy worldwide.  Studies show that lifetime dying from an ovarian cancer of a woman is almost 1%.

Ovarian cancer
Cancer of the ovaries is every woman’s worry

 

Epidemiology and Prevalence

  • Ovarian cancer is a common malignancy with a worldwide distribution but commoner years after menopause; although it has been diagnosed occasionally among pre-menopausal females.
  • In general, ovarian cancer is a disease of the post­menopausal woman, with the highest incidence among female ages 60–75 years
    The mean age at diagnosis of ovarian cancer is 69 years.
  • Ovarian cancer has also been found in women still menstruating so age may sometimes not really be a factor here.
  • In Nigeria, ovarian cancer is the third killer of Nigerian women after cervical and breast cancer from epidemiological and clinical  studies.
  • There is no national study on  cancer of the ovaries in  Nigeria.
  • African–Americans are reported to have a lower incidence of ovarian cancer but have a poorer prognosis compared to their white counterparts.

 

 

Risk factors/Causes

There are no known actual causes of
ovarian cancer but here here possible risk factors
that makes one stand a high chance of developing this malignancy. They are:

–  Age is a risk factor as most cases of ovarian cancer occur after menopause .­

– high number of lifetime ovulations (early first menstruation and late menopause): menstruation inflicts repeated injuries in the ovaries making them prone to cancer
­

– infertility (women unable to achieve pregnancy stand a good chance of developing cancer of the ovaries research repeatedly shown). Women without children also do not breastfeed increasing their risk of cancer.
­

– family history/genetic inheritance (women whose grandmothers,  mothers,  aunties or sisters had ovarian malignancy,  breast cancer,  or uterine cancer stand a high chance of developing cancer of the ovary)
­

– eating diets high in saturated animal fats exposes women to cancer of the ovaries.
­

–  talcum powder genital exposure (talcum powder rubbed on the pubic area can escape into the vagina and irritate the ovaries)

– Obesity

– use of fertility drugs have be shown to increase the chances of developing cancer of the ovaries that is drugs that stimulates ovulation.

–  Previous personal history of breast cancer

– previous personal history of colon cancer

– Previous personal history of uterine cancer

– Endometriosis

– Genetic mutations in genes that protects women against ovarian and breast cancer called BRCA1 and BRCA2 genes.

 

Protective Factors against cancer of the ovaries 

The following factors protects women against ovarian cancer. These are conditions that basically
decrease the total number of ovulations thereby reducing the possibility of ovarian cancer:
­

pregnancy

breastfeeding

use of oral contraceptive pills

short reproductive life (late first
menstruation and early menopause)

Prophylactic oophorectomy (removal of the ovaries)

Having more children have been found to offer protection against cancer of the ovaries.

Surgeries such as hysterectomy and tubal ligation may confer a weak protective effect against ovarian cancer.

 

Symptoms and Signs of ovarian cancer

1. Most women with ovarian cancer are asymptomatic and even when they develop symptoms, they are usually non specific.

2. Abdominal swelling/distension

3. Abdominal pain/tenderness

4. Gastro­intestinal discomfort/dyspepsia

5. Weight loss/cachexia

6. Loss of appetite/anorexia

7. Nausea

8. Vomiting

9. Leg swelling

10. Easy satiety

11. Breathing difficulty

12. Urinary frequency (frequent urge to urinate)

13. Cough

14. Diarrhoea

15. Heart burns

16. Menstrual irregularity in women still seeing their period.

17. Back pains

18. Muscle pains

19. Constipation

 

 

Types/Classification of ovarian cancer

(A) In terms of cancer origin:

Primary – ­Arising from the ovary (commoner)

Secondary/Metastatic-­ Originating from other site(s) or organs and not from the ovary .i.e. spread from other cancerous organs to the ovaries.

(B) In terms of occurrence:

Sporadic- about 90 to 95% of cases.

Familial/Inheritance -­ about 5 ­to 10% of cases

(C) In terms of histological cell type:

– Epithelial (commonest)
– Germ cell
– Sex cord and Stromal

(D) Surgical staging and Prognosis (possible outcome).

 

Diagnosis/Tests

The diagnosis of cancer of the ovaries starts with history taking and physical evaluation before investigations which will be blood tests radiological, histological and surgical staging.

The tests include:

Baseline ­ Full Blood Count, Electrolytes/
Urea/Creatinine, Liver Function Test

Pelvic Ultra­Sound Scan (USS)

Plain X-­Ray (Chest X-ray; Abdominal X­rays)

CT Scan (Abdomen/pelvic)

Tumour markers ­ Ca125, CEA, α-fetoprotein, hCG, LDH, (BRCA 2 gene for familial cases)

Biopsy for histological confirmation/diagnosis

Treatment options

Surgery remains the mainstay with
Chemotherapy:

­Total Abdominal Hysterectomy and
bilateral salpingo­oophorectomy with
omentectomy – TAH + BSO (Debulking
Surgery)
­
Chemotherapy – Carboplatin &
Paclitaxel­ usually for Epithelial malignancy
which remain the commonest variant.

Hormonal therapy

Targeted therapy

For women of reproductive age or if you want to get pregnant in future, your fertility may be preserved through egg freezing, embryo freezing and preservative ovarian surgeries.

Prevention

In the presence of positive family history &
BRCA2 and BRCA1 gene, there should be:

– ­Routine tumour markers assay ­ Ca 125, CEA

­- Routine and regular pelvic USS

References

1. [Guideline] American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses

2. Cramer DW, Vitonis AF, Terry KL, Welch WR, Titus LJ. The Association Between Talc Use and Ovarian Cancer: A Retrospective Case­Control Study in Two US States. Epidemiology. 2016 May. 27 (3):334­46.

3. Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, et al. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2007 Jan 15. 109(2):221­7

4. Stany MP, Maxwell GL, Rose GS. Clinical decision making using ovarian cancer risk assessment. AJR

5. Am J Roentgenol. 2010 Feb. 194(2):337­42
Surveillance, Epidemiology, and End Results
Program. Cancer Stat Facts: Ovary Cancer. National Cancer Institute.

6. Featured Image: Cellink

Written By:

Dr James Chukwuemeka

Dr Udomoh

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