Ovarian Cancer

In this section, you or a loved one can find out more about medical treatments, research studies and practical information about ovarian cancer. Read on to find answers to some of your questions as well as links to other information. Being informed is an important first step towards becoming an active decision-maker in your care plan. 

Ovarian cancer makes up 3% of cancer in women, but it causes more deaths than breast cancer. Ovarian cancer is the growth of abnormal, malignant cells that start in a woman's ovaries. Ovaries are the part of the reproductive system that produces eggs and are mainly made up of three types of cells, each of which can develop into a different type of tumour. 

Epithelial tumours grow in the layer of tissue that covers the surface of the ovary. While most are benign (non-cancerous), cancerous epithelial tumours account for about 90% of ovarian cancers. Additionally, some ovarian epithelial tumours are described as having low malignant (cancerous) potential, and they tend to affect younger women. They grow slowly and are less life-threatening.

Germ cell tumours, which can be benign or cancerous, grow in the cells that form eggs, accounting for about 1 in 20 ovarian cancers. Germ cell tumours include teratomas (which can contain substances including hair, teeth and bone); dysgerminomas (the most common ovarian germ cell cancer); and endodermal sinus tumours and choriocarcinomas.

Stromal tumours develop in the tissues that hold the ovary together and produce the hormones oestrogen and progesterone. 

Additionally, a very small number of ovarian cancers are small cell carcinomas, mainly affecting young women with a median age at diagnosis of 24 years old.

Though the cause of ovarian cancer is unknown, some theorise that increased hormone levels before and during ovulation may cause abnormal cells to grow. There are several risk factors: 

• Age is a risk factor with about half the women diagnosed with ovarian cancer being 63 years of age or older. 
• The age at which a woman starts or finishes menstruation is also a factor, with a higher risk for women who started menstruating before age 12 or who underwent menopause after age 52. 
• Additionally, a woman who had a full-term pregnancy before age 26 has a lower risk of ovarian cancer and the risk decreases with each full-term pregnancy. 
• Women with a first full-term pregnancy after age 35 or those who never carried a pregnancy to term have higher risks of ovarian cancer. Obese women (those with a body mass index of at least 30) may have a higher risk of ovarian cancer. 
• Other risk factors include long-term or large-dose oestrogen hormone replacement therapy, having never been pregnant, having undergone fertility treatment, smoking, use of an intrauterine device, and polycystic ovary syndrome. 
• Additionally, some women with certain gene mutations may have a higher risk of ovarian cancer. These gene mutations include breast cancer gene 1 (BRCA1), breast cancer gene 2 (BRCA2) and the gene that causes Lynch syndrome, which is most commonly associated with colon cancer.

In addition to affecting the reproductive system, ovarian cancer cells can invade nearby tissues and travel to other parts of the body through the blood or lymph system where they may grow and replace normal tissue in a process called metastasis. 

Ovarian cancer first affects the ovaries, but as it spreads, it can affect the entire reproductive system, nearby organs such as the colon and liver, and more distant organs and tissues through the process of metastasis. 

Unfortunately, early ovarian cancer is difficult to detect. The symptoms of ovarian cancer are shared by other diseases but occur more frequently and are more severe in the case of ovarian cancer. Common symptoms include: 

• Bloating 
• Pelvic or abdominal pain 
• Trouble eating or feeling full quickly 
• A need to urinate urgently or often 
• Back pain 
• Constipation 
• Fatigue 
• Menstrual changes 
• Pain during sex 
• Upset stomach 
• Abdominal swelling 
• Weight loss 

The course of ovarian cancer can vary widely, depending on the type and stage of tumour, as well as age at diagnosis, general health and other factors. 

Reproductive System Complications

Most women have surgery to remove their ovaries and uterus as part of their treatment for ovarian cancer and are therefore no longer able to become pregnant. The removal of a woman's ovaries also causes a woman to enter menopause if she has not already done so. Sexual side effects can be common, including decreased libido, vaginal dryness, a shortened vagina, diminished response and self-consciousness. 

Digestive System Complications

During surgery, it may be necessary to remove a piece of colon to help decrease the size of a tumour. In some cases, the colon can be sewn back together. Sometimes, though, the ends can't be joined right away and the top of the colon is attached to a stoma, or opening, in the abdomen to allow the exit of waste. This is a colostomy, and it can usually be reversed. 

Urinary Tract Complications

Ovarian cancer surgery may sometimes require the removal of a part of the bladder. As the bladder heals, a catheter may be necessary. When the bladder heals, the catheter can be removed.

Other Complications

Surgery may also require removing all or parts of the spleen, gallbladder, stomach, liver or pancreas.

While treatment plans should be tailored to each individual's unique circumstances, most women with ovarian cancer undergo surgery. Surgery is usually followed-up by chemotherapy or another therapy, although sometimes chemotherapy may be given before surgery. 

Surgery 

Surgery, ideally performed by a qualified gynaecological oncologist, is generally used to both diagnose and treat ovarian cancer. Women who have some types of early-stage ovarian cancer may be able to retain one ovary and remain fertile, but usually both ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum are removed. If the cervix is removed as well, it is referred to as a total hysterectomy. The surgeon may also go beyond the uterus in the process, which is called "debulking". The goal is to leave no tumours larger than a centimetre behind, and this may mean examining and removing parts of organs near the ovaries and uterus including the colon, stomach, liver, bladder, spleen and pancreas. 

Chemotherapy 

Usually used following surgery, chemotherapy for ovarian cancer involves the infusion of chemicals into the bloodstream or abdomen to destroy cancer cells or to stop them from growing in and beyond the ovaries. Chemotherapy can have side effects such as nausea, hair loss, poor appetite, fatigue, infection and increased bleeding, but most effects are temporary. 

Radiation

Less often used for ovarian cancer, radiation therapy involves high-energy X-rays that target cancer cells and shrink tumours.

Targeted therapy

Treatment may include targeted therapy, which is designed to attack specific cancer cells without harming normal cells. Targeted therapy includes monoclonal antibody therapy and treatment with PARP inhibitors.

Some patients may seek to relieve some of their cancer symptoms and side effects with complementary care. Complementary therapies should not be confused with alternative therapies, which by definition, replace conventional therapy. Acupuncture, massage, aromatherapy, vitamin supplements, special diets and meditation are among the more common complementary therapies. Patients should discuss these treatments with their doctor to avoid compromising their traditional medical care.

For most people, regardless of having cancer or not, exercise, healthy eating and good sleeping habits are recommended. A healthy lifestyle can lead to an enhanced quality of life for most people. Talk to your doctor before making any lifestyle changes. 

Diet

For women with ovarian cancer, it is important to maintain a nutritious diet and to drink lots of fluids to maintain energy, stay as healthy as possible, and to help avoid constipation and diarrhoea, both of which are common during cancer treatment.

Exercise

If appropriate, regular exercise can help to regulate mood and provide cardiovascular benefits.

Prevent infection

Wash hands often, avoid crowds and people who are ill, trim nails carefully, and take measures to avoid cuts, scrapes and situations that may introduce an increased risk of infection during cancer treatment.

Managing depression, anxiety and stress

Enlisting the support of those closest to you is crucial. Women may also want to consider psychotherapy, relaxation exercises and similar measures to help deal with stress, fear and anxiety.

Please note that the information on this website is intended for informational purposes only and should not be used as a substitute for seeking medical advice or treatment from a healthcare professional. You should not use this information to diagnose or treat a medical condition or health problem. Speak to a healthcare professional if you have any questions about your health, medical condition, symptoms or treatment options.

http://www.cancerresearchuk.org

Leading UK cancer charity

http://ovarian.org

National Ovarian Cancer Coalition

The National Ovarian Cancer Coalition works to increase early diagnosis of ovarian cancer by raising awareness and offering national programmes and information for patients and their caregivers.

http://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq#section/_156

National Cancer Institute

Part of the National Institutes of Health, the National Cancer Institute is the US federal government’s principal agency for cancer research and training.

http://www.cancer.org/cancer/ovariancancer/index

American Cancer Society

A 501(c)(3) non-profit organisation, the American Cancer Society is a nationwide, voluntary health organisation dedicated to eliminating cancer as a major health problem, funding research, and offering information and programmes to help people through every step of their cancer experience.