Ovarian cancer: epidemiology, pathology, and treatment

Ovarian Cancer

What exactly is Cancer? Cancer is any type of malignant growth or a malignant tumor that is caused by an abnormal amount of cell division, or an uncontrolled amount of division. The disease once it sets in may spread to the rest of the body either through the lymphatic system or through the blood stream. Cancer is also a generalized term that is used to refer to the more than a hundred diseases that are related to abnormal cell division or growth. What happens is that the diseased cells that may be in the form of a tumor or a generalized mass, may spread on to the other unaffected pats of the body and end up destroying the normal unaffected cells within the body. (Define Cancer)

This in turn may end up causing new cancers in those unaffected parts of the body. It is most often a fatal disease unless it is detected in its very early stage and treated appropriately. Cancer is usually divided into about three broad categories for easy identification. These are: carcinomas, which are in essence those cancers that are derived from those cells that are found in the linings of the various different tissues of the body, sarcomas, which are those cancers that are derived from the underlying supporting tissues of the body, and the hematologic tumors, which are those cancers that are derived from the bloodstream and the lymphatic tissue systems. (Define Cancer)

Ovarian Cancer is the disease that is produced by the rapid growth and division of cancerous cells within one or both the ovaries of a woman. The ovary in other words is the reproductive organ of a woman where the woman produces the ova or the eggs, along with other female reproductive hormones. The ovaries when in a normal condition are capable of reproducing the cells within and this in turn maintains the normal healthy condition of the underlying tissues near and in the ovaries. When this normal growth pattern happens to be interrupted for whatever reason, then the cells start to multiply so fast and so without control that it results in the formation of a cellular mass or what is otherwise known as a tumor. The tumor may be confined to a few surface cell layers, like for example, where it has no chance of invading and affecting the underlying layers of tissues near the tumor. In this case, the tumor is said to be 'benign'. If, however, the dividing cells mange to affect the surrounding layers of tissues, then it is said that the cells are 'malignant' or cancerous. (Oncology Channel, Ovarian Cancer)

Sometimes it so happens that the cancerous cells break away from the original tumor and end up in another entirely different part of the body. This process is known as 'metastasis'. Many different kinds of tumors can be formed within the ovaries of a woman, in fact more than thirty known types. However, ovarian cancers are generally divided into three main categories, according to the type of cells that formed them, which are: epithelial cancers, that are the most common form o f ovarian cancers, and which are formed from the various cells that line or cover the ovaries. The second broad category of ovarian cancer is the germ cell cancer, which in other words means that this cancer starts from germ cells within the ovaries. Germ cells are those cells that have the capacity of becoming an egg. The third category of ovarian cancer is that of cancer of the sex cord, that is, the stromal cell cancers that are formed within the cells that are responsible for holding both the ovaries together and that produce female hormones. (Oncology Channel, Ovarian Cancer)

When the patient is suspected to be suffering from ovarian cancer, the attending physician generally conducts an exploratory laparotomy in order to assess whether the cancer has spread to other parts of the ovary and where it has actually spread. For this purpose, the physician who is usually a gynecologic oncologist, makes an incision in the patient's abdomen up to the ovaries, and ascertains the spread of the disease. If he finds that the ovary is indeed affected by the cancerous cells, then he removes as much of the tumor as is possible for him to remove. Sometimes, if the cancer is seen to have spread to a large area within the ovary, then it is necessary for him to remove one ovary, and this phenomenon is referred to as 'unilateral oophorectomy'. In most of such case, however, the physician removes not only one ovary but both, and also the uterus, the fallopian tubes, and the omentum, which is the fatty tissue that covers the bowels. In the case when one small part of the tumor is removed to ascertain the presence of cancer cells within the ovary, the part removed is sent for 'biopsy'. (Ovarian Cancer, Staging)

This step not only helps the physician ascertain the presence of cancer but would also help him to discuss the various treatment methods that are available for the treatment of cancer with the patient. This is called the 'staging system' and it helps the physician to a great extent in discovering the spread of the caner within the ovaries, whether it is in stage one which means that only one ovary has been affected, or whether it is in stage two where the cancer has spread to the pelvic organs but not to the abdomen, or whether it is in stage three where the abdominal organs are also involved, or in stage four, where the cancer has spread to distant sites, like as far as the neck, or stage five, where the cancer is in its recurrent form, that is, it has come back after the patient has successfully completed his course of treatment. Once the particular stage is ascertained, then the treatment methodology can be adapted to that particular stage, and the patient would have more chances of recovery. (Ovarian Cancer, Staging)

What are the 'risk factors' for ovarian cancer? A risk factor can be explained as anything that may increase the chances of a person getting the disease, and the different cancers have different risk factors too. For example, increased exposure to sunlight when unprotected may increase the risk factor for skin cancer, while smoking may increase the risk factor for lung cancer, and so on. Scientists and researchers have discovered several different risk factors for ovarian cancer, and the surprising fact is that there is no known risk factor for ovarian cancer, though the risk may increase due to certain specific reasons, and this too dose not necessarily mean that all women who show one or the other of the risk factors may develop ovarian cancer. One high risk factor for ovarian cancer is the age of the woman, wherein the woman after menopause is more prone to ovarian cancer than younger women; more than half of all ovarian cancer cases are found in women who are above the age of 65. (What are the risk factors of ovarian cancer?)

Obesity is also a major contributing factor for risk in ovarian cancer, and the heavier the woman, the more prone she is to ovarian cancer. The woman's reproductive history, that includes facts such as when did the woman start to menstruate; if it was before the age of 12, then she is at risk, when did the woman have her first child; if it was after the age of 30 then she is at risk, did she in fact have a child, when did she enter the phase of menopause, where the menstruation stops, and so on. In cases where the woman opts for certain types of drugs to increase her chances of being able to bear her own child, like 'clomiphene citrate', the chances of developing hard tumor like growths within the ovaries are more, and these growths may increase the risk factor for cancer. These tumors are also known as LMP tumors, or 'tumors of low malignant potential'. However, even if the woman has not had any drugs for the purpose of infertility treatment, if she is indeed infertile, then she is at risk from ovarian cancer.

The family history of the woman is also very important and is one of the major risk factors in ovarian cancer, and if the mother or the sister or the daughter of the woman has suffered from ovarian cancer, and this had been developed at a very young age, then the woman is at high risk from suffering the same disease at some stage in her life. The increased risk factor for cancer can in fact be inherited form the mother's side and the father's side of the family, and about 10% of ovarian cancers is formed because of this inherited tendency to develop the cancer, and if the inherited disease is that of change or mutation of the breast cancer causing gene 'BRCA1' or BRCA2', then the risk for ovarian cancer becomes very high. A mutation of the gene causing colorectal cancer or epithelial ovarian cancer are major risk factors for ovarian cancer, and genetic testing within the laboratory can identify most of these. However, the women who possess these inherited genes are at less risk than those women who do not have any family history of ovarian cancer, and while the former group can be treated with advanced planning and genetic counseling, the latter group cannot be prepared in this manner. (What are the risk factors of ovarian cancer?)

Some women who have already suffered from breast cancer at an earlier stage in their lives may be at increased risk for ovarian cancer because the reproductive organs are somehow connected with each other, and the inherited breast cancer gene, that is the BRCA1 or the BRCA2, drastically increases the risk factor for ovarian cancer. Some studies have indicated that those women, who use talcum powder on their genital area directly, or on their sanitary napkins, are at risk from ovarian cancer. However, these studies are inconclusive, and the presence of asbestos in talcum powder in the days gone by may have caused such investigations, and the talcum powders today that have absolutely no asbestos content do not add to the risk for ovarian cancer in the woman. Sometimes the estrogen replacement therapy that some women use after they have passed the period of menopause are linked to ovarian cancer, and with the more prolonged use, the more the risk is. (What are the risk factors of ovarian cancer?)

What are the Symptoms of ovarian cancer? The truth is that Ovarian Cancer has been named the 'Silent Killer' because of the fact that by the time the cancer is discovered, it has spread to other areas of the body, especially into the abdomen, and by then it is too late to hope for a complete recovery. This happens more than 70 to 75% of the times. However, research on the subject has revealed that there are in fact some small warning symptoms, and when people are more aware of the symptoms, and then the chances of early discovery and therefore early recovery are increased. The activists for ovarian cancer have this to say: "It whispers, so listen!." Why is ovarian cancer so very difficult to detect when it is still in the early stages? This is because it is not generally known at what stage ovarian cancer produces any types of symptoms, and by the time the woman recognizes the symptoms and she visits the Doctor, the cancer would have spread to the abdomen or to other parts of the body, and it would be difficult to control at this stage. (The whisperings of ovarian cancer)

However, the most tragic part is that most of the women who are diagnosed with ovarian cancer had in fact visited the doctor earlier for the treatment of certain symptoms related to ovarian cancer, but since the symptoms are not very obvious and it can take months before ovarian cancer is accurately diagnosed, these women have to suffer needlessly. Therefore, it is better to make a comprehensive list of the symptoms of the disease, and if there is any small indication, then the doctor must be informed immediately. The problem here is that most of these symptoms may be related to other ailments in the body that are totally unrelated to ovarian cancer, but as it is definitely better to be safe than to be sorry, the woman must be made aware of the symptoms of ovarian cancer so that she may seek treatment immediately. (The whisperings of ovarian cancer)

Abdominal swelling is one of the symptoms of ovarian cancer, but the fact is that even in ovarian cancer cases, this may not be one of the primary symptoms. Therefore, the woman must educate herself of the entire gamut of symptoms, and see the doctor if any of them persist for an extended period of time, maybe about two weeks or so. In addition to abdominal swelling, if there is abdominal or pelvic pain or a feeling of fullness, or if there is a feeling of bloated ness, then this may be one of the symptoms. If there are any gastrointestinal symptoms such as gas or indigestion or a feeling of nausea or a change in bowel movements, then these must be considered as symptoms. In addition, the following symptoms must also be taken note of as symptoms for ovarian cancer: any vaginal bleeding or discharge, any types of urinary problems such as a burning sensation, or spasming, or urgency, a feeling of fatigue with or without fever, pain during intercourse, back pain, and a difficulty n breathing.

These symptoms may not at all be related to ovarian cancer, but when taken as an entire group of symptoms, then these may indicate ovarian cancer, and the woman must take herself to the doctor before it is too late. The doctor would perform a pelvic examination, and also a recto-vaginal examination, and order some blood tests like CA125, and also order for a transvaginal ultrasound examination. A combination of all these tests will indicate to the doctor if the patient is in fact suffering from ovarian cancer or not. (The whisperings of ovarian cancer)

What are the treatment methods for ovarian cancer? The treatment for various types of ovarian cancer depends on the type that the cancer is, and the treatment generally varies for ovarian epithelial cancer, for ovarian germ cell tumor treatment, and for ovarian low malignant potential tumor treatment. In the treatment of ovarian epithelial cancer, and its prognosis or the chances for complete recovery generally depend on the stage that the cancer is in at the time of discovery. The shape as well as the size of the tumor is also very important, as are the patient's general age and health conditions. The fact of whether the cancer has juts been diagnosed or if it has recurred or come back in the patient is also a major factor in choosing the method of treatment, and in some cases the only option may be the removal of the entire reproductive system organs of the woman, including both the ovaries, the fallopian tubes, and the uterus and cervix etc. This type of treatment is called 'hysterectomy'.

Another surgery is the 'oophorectomy' wherein the ovaries or one ovary, and/or the fallopian tubes are removed. 'Omentectomy' is a surgery that removes the 'omentum', which is the piece of tissue that lines the abdominal wall. A 'lymph node' biopsy can also be undertaken, and in this procedure, a part of the tumor is removed, and it is examined under a microscope for the presence of cancer cells. If they are found to be present, then the treatment will continue accordingly. Radiation therapy is another method of treatment for ovarian cancer. This involves the use of high-energy radiation form x-rays and gamma rays and neutrons that would either shrink the tumor or kill it completely. There are two different types of radiation: one is that of 'external radiation therapy' where the treatment is done from an external source of x-rays like a machine and sent into the body, while the second method is through 'internal radiation therapy', which uses a radioactive coated substance like a needle or a catheter or a wire for treatment of the cancer.