Ovarian Cancer

Ovarian cancer tends to be found late after very few nonspecific symptoms or no symptoms at all. Early cancer has no symptoms, while advanced cancer has variable symptoms. Ovarian cancer is one of the deadliest of all cancers found in women, and is a leading cause of cancer-related deaths. Incidence is higher in developed countries and affects women nearing menopause and after menopause.

Symptoms of ovarian cancer
Early symptoms (stage I)

  • Usually asymptomatic

     Stage II and II ovarian cancer symptoms

  • Irregular periods
  • Vaginal bleeding after menopause
  • Lower abdominal pain
  • Polyuria (a lot of urine – over 2.5 litres a day)
  • Painful sex (dyspareunia)
  • Constipation
  • Swollen abdomen
  • Loss of appetite
  • Early satiety
  • Heartburn (dyspepsia)
  • Backache
  • Gas pains
  • Anaemia
  • Bloating

     Stage IV ovarian cancer symptoms

  • Loss of appetite
  • Early satiety
  • Feeling of fullness in the abdomen
  • Constipation
  • Fatigue
  • Shortness of breath
  • Muscle wasting (cachexia)
  • Abdominal swelling due to ovarian enlargement
  • Some women may have severe abdominal pain
  • Germs cell or stromal tumours may result in hyperthyroidism, feminisation, virilisation

     Types of ovarian cancer
Ovarian cancers have diverse roots, with 80 per cent developing from the epithelial cells in the ovary, with 75 per cent of those serous cystadenocarcinoma and around 10 per cent being invasive mucinous carcinoma. Almost 27 per cent of women with stage I epithelial ovarian cancer have some mucinous findings, but less than 10 per cent of those women with stages III or IV do.

Around 20 per cent of ovarian cancer originates in the primary ovarian germ cells or in sex cord and stromal cells, or can be cancer spread from another organ, often the breast or digestive tract. Germ cell cancers are typically found in women under the age of 30.

     Types of epithelial ovarian cancers
  • Brenner tumour
  • Clear cell carcinoma
  • Endometrioid carcinoma
  • Mucinous carcinoma
  • Serious cystadenocarcinomas (most common)
  • Transitional cell carcinoma
  • Unclassified carcinoma

     Types of primary germ cell ovarian cancers

  • Choriocarcinomas dysgerminomas
  • Embryonal carcinomas
  • Endodermal sinus tumors
  • Immature teratomas
  • Polyembryoma

    Types of sex cord and stromal cell ovarian cancers

  • Granulosa-theca cell tumours
  • Sertoli-Leydig cell tumours

     Diagnosis of ovarian cancer
Ovarian cancer is usually diagnosed via scans and analysis, with staging determined surgically, with markers detected in the blood. If a woman has unexplained masses, abdominal bloating, bowel habit changes, weight loss or abdominal pain, then ovarian cancer must be suspected.

     Treatment of ovarian cancer
Ovarian cancers are typically treated with a hysterectomy, with removal of both ovaries and the removal of as much tissue as possible. If cancer has spread to other organs, chemotherapy will likely be administered, but if the cancer remains localised to the ovary, just that ovary may be removed.

     Risk factors of ovarian cancer

  • Women who have not carried a pregnancy to term
  • Women who bear children later
  • Women who get their periods early (early menarche)
  • Delayed menopause
  • Family or personal history of endometrial, breast or colon cancer

Women who use oral contraceptives have a reduced incidence of ovarian cancers.

     Causes of ovarian cancer
While the cause of most cancers is not fully understood, up to 10 per cent of ovarian cancers are thought to be related to a gene mutation (autosomal dominant BRCA gene, BRCA1 and BRCA2), which is the gene responsible for gene-related breast cancer. Women with the BRCA mutation have a 50-85 per cent lifetime risk of developing breast cancer, while those with the BRCA1 mutation have a 20-40 per cent lifetime risk of developing ovarian cancer, while those with the BRCA2 mutations are less at risk. Ashkenazi Jews have a higher incidence of these mutations than anyone else. Other mutations that could be linked with hereditary breast and/or ovarian cancer include TP53, PTEN, STK11/LKB1, CDH1, CHEK2, ATM, MLH1, and MSH2.

XY gonadal dysgenesis predisposes one to ovarian germ cell cancer.

     Staging of ovarian cancer

  • Stage I – Tumour limited to the ovaries
  • Stage IA – Tumour limited to one ovary, with no tumour present on the external surface, and the capsule intact
  • Stage IB – Tumour in both ovaries, but no tumour on the external surface and capsules intact
  • Stage IC – Stage 1A or 1B, but with tumours on the surface of one or both ovaries, with capsule ruptured, or with malignant cells in ascites or peritoneal washings.
  • Stage II – Tumour involving one or both ovaries with pelvic extension or metastases
  • Stage IIA – Extension and/or metastases to the uterus, fallopian tubes, or both
  • Stage IIB – Extension to other pelvic tissues
  • Stage IIIC – Stage IIA or IIB, but with malignant cells in ascites or in peritoneal washings
  • Stage III – Tumour involving one or both ovaries with confirmed peritoneal metastases outside the pelvis
  • Stage IIIA – Microscopic peritoneal metastases outside the pelvis and negative lymph nodes
  • Stage IIIB – Macroscopic peritoneal metastases outside the pelvis that are two or less than two centimetres in diameter and negative lymph nodes
  • Stage IIIC – Abdominal peritoneal metastases extending beyond the pelvis and are over two centimetres in diameter and/or regional lymph node metastases
  • Stage IV – Distant metastases, including parenchymal liver metastases. If pleural effusion present, positive cytologic tests results must be obtained to signal stage IV.

     Outcomes and prognosis of ovarian cancers
The five-year survival rates with treatment are:

  • Stage I – 70-100 per cent
  • Stage II – 50-70 per cent
  • Stage III – 20-50 per cent
  • Stage IV – 10-20 per cent

Recurrence may occur in some people.