Ovarian cancer develops when uncontrolled cell growth in the ovaries leads to the development of a malignant (cancerous) tumour. According to the NHS it affects 7,000 women in the UK each year and is the fourth most common cancer amongst women (following breast cancer, colon cancer and lung cancer). It can affect women of any age but it largely affects menopausal women (who are over 50 years old) and is very rare in women under 40.
To discuss ovarian cancer I will begin by further explaining the ovaries. There are two ovaries (left and right) which are part of the female reproductive system. When women reach childbearing age one of the ovaries releases an egg each month. This egg passes down the fallopian tube (which connects the ovaries to the womb) where it can be fertilised with sperm. If the egg is not fertilised it passes to the womb where it is lost during a woman’s monthly period. The ovaries are also responsible for the production of the female hormones oestrogen and progesterone. There are three main types of ovarian cancer:
1) EPITHELIAL OVARIAN CANCER:- Ovarian cancer which affects the layers of the ovary. This is by far the most common type of ovarian cancer accounting for 80% of all cases.
2) GERM CELL OVARIAN CANCER:- Ovarian cancer which originates from the egg making cells. This accounts for approximately 15% of ovarian cancers.
3) STROMAL OVARIAN CANCER:- Ovarian cancer which develops in the connective tissues of the ovaries. This represents an estimated 5% of ovarian cancers.
Like with many types of cancer no one knows exactly what causes ovarian cancer. However, there are multiple risk factors which include:
1) AGE:- As already discussed, your risk for ovarian cancer increases with age. Very few women under the age of 40 contract ovarian cancer and the majority of cases are diagnosed in women over 50 years old.
2) ENDOMETRIOSIS:- This is a condition when the cells that normally line a woman’s womb spread to other parts of the body such as the bladder, bowel and ovaries. Having endometriosis is believed to increase your risk of contracting ovarian cancer by a third.
3) FAMILY HISTORY:- The majority of ovarian cancers are not believed to run in families. However, inheriting the the BRCA 1 and BRCA 2 genes are believed to put you at an increased risk of both ovarian cancer and breast cancer. Having two or more close relatives (daughter, mother or sister) who developed ovarian cancer also increases your risk.
4) NUMBER OF EGGS RELEASED:- Every time a woman ovulates the surface of the ovary breaks in order to allow the egg to be released into the reproductive system. To repair this broken surface the cells of the ovary have to divide and multiply. If this happens too quickly a mass of malignant cells can form leading to the onset of ovarian cancer. Therefore, the number of eggs your ovaries release over your lifetime can be considered a risk factor e.g. if you start your periods early or enter the menopause late, you have in theory caused more damage to your ovaries, increasing the chances of ovarian cancer developing.
5) OBESITY:- It is believed that being obese can increase your risk of contracting ovarian cancer by up to one third.
People suffering from ovarian cancer do not exhibit symptoms in all cases, especially in the early stages. Even when symptoms do surface they are often very mild and go unnoticed or get mistaken for those of other less serious conditions such as irritable bowel syndrome (IBS) and pre-menstrual syndrome (PMS). However, doctors and medical professionals have become increasingly experienced at spotting the symptoms which can include:
– Bloating of the stomach.
– Constipation.
– Irregular periods.
– Loss of appetite.
– Pain during sex.
– Pain in your lower abdomen or sides.
– Urinating more frequently.
– Tiredness.
– Weight loss.
If you notice any of the above symptoms then you should consult your doctor immediately. Even if you have confused the symptoms with IBS or PMS, it is always better to be on the safe side. According to the NHS 95% of women will survive for five years or more if ovarian cancer is caught in the early stages, so following up on any symptoms could significantly improve your chances of overcoming this disease. Once you have explained your concerns to your doctor they will then be able to perform a number of tests for ovarian cancer. These include:
1) PHYSICAL EXAM:- The first test is likely to be a physical exam which will be performed by your doctor or a trained gynaecologist. This will allow any abnormalities (which could turn out to be to be ovarian tumours) to be felt. The main limitation of the physical exam is that normal sized ovaries are small and difficult to feel, meaning that it is not very effective in detecting early ovarian cancer.
2) BLOOD TEST:- A blood test will test for higher than normal levels of CA125, a chemical that is produced by cancer cells and released into the bloodstream. However, the blood test is not a fully reliable indicator of ovarian cancer. You can have raised levels of CA125 and not have ovarian cancer or have normal levels of CA125 and have ovarian cancer.
3) ULTRASOUND SCAN:- This involves using sound waves to build a picture of your ovaries. This picture can then be used to identify any abnormalities and determine whether they are fluid or solid. If the abnormalities are solid or complex (a mixture of solid and fluid) they may be cancerous and a sample will need to be taken.
4) COMPUTERISED TOMOGRAPHY (CT) SCAN:- The CT scan uses multiple x-rays to build a 3D image of your ovaries. This will then allow any tumours to be measured and also reveal whether the tumours have spread to other areas of the body.
5) LAPAROSCOPY:- This is a small operation performed under general anaesthetic which allows your doctor to look at your ovaries and the surrounding areas. Your doctor will make a small incision into your lower abdomen and insert a laparascope (a thin fibre optic tube) which can then be used to look at the ovaries.
6) BIOPSY:- The laparascope can also be used to take a sample of tissues from the ovary for further examination. This procedure is referred to as a biopsy.
7) ABDOMINAL FLUID ASPIRATION:- If your stomach has become swollen with fluid this may be a sign that ovarian cancer has spread to other areas of your body. In this instance your doctor or gynaecologist will give you a local anaesthetic and drain this fluid using a long thin needle. This fluid will then be tested for the presence of cancer cells.
If any of the above tests reveal that you have ovarian cancer your doctor will then stage the cancer. Stageing will show you how far the cancer has spread and also allow your doctor to determine the best course of treatment. The stages range from 1 to 4 and are discussed below:
1) STAGE 1:- This is when the cancer is contained within the ovaries. It can be further broken down into stage 1a (the cancer is inside just one ovary), 1b (the cancer is inside both ovaries) and 1c (the cancer is inside one or both ovaries and there are some cancer cells found on the surface of one or both ovaries).
2) STAGE 2:- This is when the cancer has grown outside the ovaries and is in the lower stomach area (pelvis). It can be further broken down into stage 2a (the cancer is inside the fallopian tubes or womb), 2b (the cancer has grown into other tissues in the pelvis e.g. the bladder) and 2c (the cancer is inside the fallopian tubes, womb or other tissues and there are some cancer cells found on the surface of one or both ovaries).
3) STAGE 3:- This is when the cancer has grown outside the pelvis into the abdominal cavity. It can be further broken down into stage 3a (cancer can be seen under the microscope in tissues taken from the lining of the abdomen or intestines), stage 3b (there are tumour growths of 2cm or less on the abdominal lining) and 3c (there are tumour growths larger than 2cm on the abdominal lining).
4) STAGE 4:- This is when the cancer has spread to other organs such as the lungs.
Based upon the stageing of your ovarian cancer your doctor will then recommend a course of treatment. The possible treatments for ovarian cancer include:
1) SURGERY:- Almost all cases of ovarian cancer require surgery. If your ovarian cancer is stage 1 and contained within a single ovary you may only need that ovary and the adjoining fallopian tube removed, meaning that you may still be able to conceive. However, in most other cases you will require a hysterectomy (removal of the ovaries and the womb) which will mean you begin the menopause following surgery and will not be able to conceive.
2) CHEMOTHERAPY:- This involves using anti-cancer medications to kill off any cancer cells. Chemotherapy will generally be used to kill off any cancer cells that remain after surgery.
3) RADIOTHERAPY:- This involves using high levels of radiation to kill off any cancer cells. Like with chemotherapy, radiotherapy is normally used to kill off any remaining cancer cells after surgery.
Prevention of ovarian cancer is possible with anything that reduces or stops ovulation appearing to reduce your chances of contracting the disease. Some factors that may help prevent ovarian cancer include:
– Early menopause.
– Oral contraceptives.
– Pregnancy.
– Starting periods later in life.
– Tubal litigation (having the fallopian tubes tied).
Ovarian cancer is not as common as lung cancer or breast cancer and because of this it does not receive as much coverage. However, it is still important that you are aware of the symptoms and the various treatments. Whilst there are no sure fire ways to prevent ovarian cancer I hope this article has given you the information you need to deal with this condition.
Whilst every intention has been made to make this article accurate and informative, it is intended for general information only. Ovarian cancer is a very serious, life threatening condition and you should discuss any concerns, treatments or lifestyle changes fully with your doctor.
Sources:
Irritable Bowel Syndrome (Wikipedia)
Ovarian Cancer Information (BUPA)
Ovarian Cancer Information (Cancer Backup)
Ovarian Cancer Information (Cancer Research UK)
Ovarian Cancer Information (eMedicineHealth)
Ovarian Cancer Information (Net Doctor)
Ovarian Cancer Information (NHS Direct)
Ovarian Cancer Information (Wikipedia)
Pre-Menstrual Syndrome Information (Wikipedia)