Ovarian cancer occurs when cells in the ovaries mutate and multiply uncontrollably, forming a tumor. Some of the
risk factors for ovarian cancer include a family history of breast, ovarian and colorectal cancer, endometriosis,
early menstruation or late menopause. Having an ovarian cancer-causing genetic mutation, being overweight or obese,
not getting pregnant or having children later in life also increase your risk.
Symptoms
The early stage of ovarian cancer usually presents without symptoms. In the more advanced stages, the symptoms are
nonspecific and may include:
- Abdominal and pelvic pain or bloating
- Loss of appetite or feeling full quickly
- Increased frequency of urination
- Changes in bowel movements, such as diarrhea or constipation
- Fatigue
- Irregular periods or unusual vaginal bleeding
- Back pain
- Weight loss
Diagnosis
Once ovarian cancer is suspected, the following tests may be required to confirm the diagnosis:
Physical examination:
A thorough and complete physical and pelvic examination are the first steps taken to confirm a diagnosis.
Imaging tests:
Pelvic ultrasound, Computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography
(PET) tests may be used to better assess the local and distant extension of the disease.
Blood tests:
In addition to the routine complete blood count, liver and kidney tests, tumor markers may be taken that will
include tests for cancer antigen 125 (CA-125) and other tumor markers. However, these tests are not definitive for
ovarian cancer and may be elevated in other conditions.
Tissue biopsy:
When an ovarian mass is localized only to the ovaries, a tissue biopsy is not recommended due to the possibility of
it spreading to other areas. However, a biopsy may be necessary to confirm the diagnosis of cancer if it has spread
beyond the ovary to the abdomen or other organs before treatment. Aspiration may be necessary if there is fluid in
the abdomen (ascites).
Genetic analysis:
Upon confirmation of cancer, tissue from the cancer or blood from the patient is tested for genetic abnormalities,
which may aid in diagnosing and treating the patient and quantifying the risk to the rest of the family.
Treatment
Following the initial assessment, the treatment for ovarian cancer typically depends on the stage of the cancer, its
location, the overall health of the patient and other individual factors. Common treatment options for ovarian
cancer may include:
Surgery:
Cancer that affects only the ovaries is treated with surgery that includes removing the ovaries and the uterus,
along with multiple biopsies of the lymph nodes and adjacent tissues to determine the stage of the cancer.
In the more advanced cases, the treatment may involve taking a biopsy either by laparoscopy or guided by the
computerized tomography (CT) scan or by aspiration of the fluid in the abdomen, followed by chemotherapy and then
surgical excision of all the abdominal tumor tissues. Many times treatment starts with surgical excision of old
tumor tissues from the abdomen and pelvic cavities.
Chemotherapy:
Chemotherapy involves using powerful medications to kill cancer cells throughout the body. It may be used before
surgery, after surgery, or as the primary treatment for advanced cases.
Targeted therapy:
Medications like these identify and kill cancer cells based on their biological characteristics, such as those that
inhibit the growth of blood vessels necessary for tumor cells to grow and spread (anti-androgenic drugs), or those
that inhibit the repair of the deoxyribonucleic acid of cancer cells. (PARP inhibitors).
Immunotherapy:
This uses the body's immune system to fight cancer cells. Immunotherapy may be used alone or in combination with
other treatments.
Following the initial treatment, the patient may require maintenance therapy with anti-androgenic drugs and/or
PARP inhibitors. In the first two years, patients are closely followed up regularly with a clinical physical
examination, blood tests for tumor markers and periodic imaging such as computerized tomography scans of the
chest, abdomen and pelvis.
