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Ovarian Cancers

Ovarian cancers are excessive and abnormal growth of tissues arising from woman’s reproductive organs – ovaries and fallopian tubes. It may affect younger women to elderly women according to their types. They are often referred to as a "silent killer," since it has very vague symptoms which are difficult to identify by individual as well as it progresses rapidly which makes it one of the challenging cancers to detect and treat in its initial stages. Due to its late recognition in individuals, ovarian cancers are one of the deadliest cancers.

Types of Ovarian Cancers

According to the origin of ovarian cancer, they are classified into three categories. It is a group of diseases that differ in pathology, genetic origin, and response to treatment. The three main types of ovarian cancer are:

  • Epithelial tumors: These arise from the surface of the ovary/fallopian tubes and are the most common, accounting for about 90% of ovarian cancers.
  • Germ cell tumors: These start from the cells that produce eggs. They are rare and typically occur in younger women.
  • Stromal tumors: These develop from the structural tissue cells that hold the ovary together and produce hormones. Stromal tumors are also relatively rare.

Each type can behave differently, with varying levels of aggression, symptoms, and responses to treatment.

Risk Factors

Several factors can influence a woman's risk of developing ovarian cancer:

  • Age: The risk increases significantly with age, particularly after menopause.
  • Family history and Genetic predisposition: Women with close relatives who have had ovarian, breast, or colorectal cancer may be at higher risk, especially if linked to BRCA1 or BRCA2 gene mutations.
  • Reproductive history: Women who have never been pregnant may be at higher risk, while those who have had full-term pregnancies and breastfed may have a lower risk.
  • Endometriosis: This condition, in which tissue similar to the lining of the uterus grows outside it, has been linked to an increased risk of ovarian cancer.
  • Hormone replacement therapy (HRT): Long-term use of estrogen-only hormone replacement therapy, particularly after menopause, may increase the risk.

While these factors can increase the likelihood of developing ovarian cancer, many women diagnosed have no known risk factors.

Clinical Features

Ovarian cancer symptoms are often subtle and nonspecific, which contributes to its late diagnosis. Common symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Distension of abdomen / Feeling of mass per abdomen
  • Loss of appetite and/or significant loss of weight (≥10% of body weight)
  • Urinary urgency or frequency
  • Off and on diarrhoea, constipation
  • Fatigue, back pain, and menstrual changes
  • Some patients may also present with breathing difficulties

Since these symptoms are common in many other non-cancerous conditions, they are often overlooked until the disease has advanced.

Diagnosis

There is currently no effective screening test for ovarian cancer in the general population. Diagnosis typically begins with a physical and pelvic exam, followed by imaging tests such as:

  • Ultrasound pelvis: To visualise pelvic organs, mainly uterus and ovaries.
  • CT scan or MRI: To get detailed images of the abdomen and pelvis.
  • Tumor markers: Different ovarian cancers have different serum markers which get elevated with progression of disease.

Staging and Prognosis

Ovarian cancer is staged using a system that ranges from Stage I (confined to the ovaries) to Stage IV (spread to distant organs). The stage at diagnosis is a crucial factor in determining treatment and prognosis:

  • Stage I: Cancer is confined to one or both ovaries. The five-year survival rate is over 90%.
  • Stage II: Cancer has spread to other pelvic organs.
  • Stage III: Cancer has spread to the abdominal lining or lymph nodes.
  • Stage IV: Cancer has spread to distant parts of the body, such as the liver or lungs. The five-year survival rate drops significantly, often below 30%.

Early detection is key to improving outcomes, but unfortunately, about 70% of ovarian cancers are diagnosed at Stage III or IV.

Treatment

Treatment for ovarian cancer typically involves a combination of surgery and chemotherapy:

  • Surgery: The primary goal is to remove as much of the tumor as possible, a procedure called cytoreductive or debulking surgery. This may involve removing one or both ovaries, the uterus, fallopian tubes, and affected surrounding tissue.
  • Chemotherapy: Most women receive chemotherapy after surgery to kill any remaining cancer cells. Drugs like carboplatin and paclitaxel are commonly used.
  • Targeted therapy: Newer drugs, such as PARP inhibitors (e.g., olaparib, niraparib), are designed to interfere with specific pathways that cancer cells use to survive and replicate.
  • Radiation therapy: Less commonly used but may be employed in specific cases where cancer has localized recurrence.

In patients with advanced ovarian cancer, first-line chemotherapy may be required to reduce disease burden (Neoadjuvant Chemotherapy – NACT). Operable patients undergo staging or cytoreductive surgery followed by adjuvant chemotherapy.

Prevention & Risk Reduction

While ovarian cancer cannot always be prevented, there are strategies to reduce risk:

  • Oral contraceptives: Long-term use of birth control pills has been proven to reduce the risk of ovarian cancer.
  • Healthy lifestyle: A balanced diet, regular exercise, and maintaining a healthy weight may help lower risk.
  • Genetic testing: Women with a family history of ovarian or breast cancer may benefit from BRCA gene testing.
  • Prophylactic surgery: Women at high genetic risk (positive genetic testing) are advised to complete family planning early and may opt for preventive removal of the ovaries and fallopian tubes.
  • Routine health check-ups: Women with positive genetic testing should undergo yearly check-ups for prevention and early diagnosis if any ovarian mass has developed.

Role of Counselling and Emotional Support

A diagnosis of ovarian cancer is life-changing and often emotionally overwhelming. Many women face ongoing treatment, monitoring, and uncertainty about the future. Support networks, both personal and professional, are essential. Psychosocial support, nutritional counselling, and palliative care services can significantly enhance quality of life during and after treatment. Survivorship is possible, and outcomes are improving due to advances in early detection research, surgical techniques, and targeted therapies.

Conclusion

Ovarian cancer remains a formidable challenge in women’s health due to its often silent onset and high mortality rate. Awareness of symptoms, risk factors, and the importance of early diagnosis can lead to improved outcomes. Advances in medical research are offering new hope, and with continued education, advocacy, and innovation, the fight against ovarian cancer continues to move forward.