Ovarian cancer is not a single disease. There are over 30 types and sub-types of ovarian malignancies, each with their own histopathologic (diseased tissue) appearance and biological behavior.
Ovarian cancers can start in the different kind of tissues that compose the ovary, but they most often start in the most superficial layer. the tumors can form weak strands that can shed from the tumor and go into the abdominal cavity and thus form other tumors.
This cancer develops slowly and provokes few symptoms. There are no screening examinations that enable to detect this cancer precociously. Most of the times, the tumors that affect the ovary are benign. They look like cysts with liquid in them. But sometimes malignant tumors can occur.
Ovarian cancer is cancer that affects one or both ovaries. Ovarian cancer is not common. But because ovarian cancer often goes undetected until it is in an advanced stage, it is the number one cause of deaths from gynaecological cancers in the world.
Stage refers to the size of a tumor and whether cancer cells have spread to other parts of the body. Ovarian cancer has four stages:
Grade refers to how abnormal cancer cells look under a microscope. Ovarian tumors are graded as low-grade or high-grade. Low-grade tumors look the most like normal ovarian tissue. High-grade tumors look the least like normal ovarian tissue. The stage and grade of ovarian cancer help guide treatment decisions.
Risk factors are associated with epithelial ovarian cancer.
Another risk factor is a strong family history of ovarian and breast cancer. Hereditary breast and ovarian cancer (HBOC) syndrome is an inherited risk of breast cancer, ovarian cancer, and other types of cancer. HBOC syndrome is most commonly linked to mutations in two genes called BRCA1 and BRCA2. As many as 24 in 100 cases of ovarian cancer are due to mutations in BRCA1 and BRCA2.
Common Symptoms of Ovarian Cancer.If you have any of the following symptoms, especially if you have them for more than 12 days per month.
The treatment for ovarian cancer depends on:
There are three main forms ovarian cancer treatment that are offered:
There are also many combinations of these treatment methods. Treatment depends upon a number of factors (e.g., stage and grade of the disease, the histopathologic type, and the patient's age and overall health).
SurgeryYou will have either a laparoscopy (with 3–4 small cuts in your abdomen) or a laparotomy (with a vertical cut from around your bellybutton to your pubic line). A laparoscopy may be used to see if a suspicious mass is cancerous. If the cancer is advanced, you will usually have a laparotomy.
You may have a biopsy during surgery if you cannot have an image-guided biopsy, or to remove and check a suspicious tumour. The results will help decide if you need debulking surgery.
If cancer is found, the surgeon will remove as much cancer as possible. This is called debulking or cytoreductive surgery. You may also have chemotherapy before or after surgery.
Debulking usually means removing the ovaries, fallopian tubes, uterus and cervix. Depending on how far the cancer has spread, other organs or tissue may also be removed during the same operation.
HIPEC
Hyperthermic intraperitoneal chemotherapy (HIPEC)
HIPEC is a cancer treatment that involves circulating chemotherapy drugs inside your body at the time of cancer surgery. It may be a good treatment option for cancers that affect your abdominal or lung cavity. Some of these cancer types include ovarian cancer, colorectal cancer or gastric cancer. Before HIPEC, your surgeon removes as many visible tumors as possible. Then HIPEC can destroy cancer cells that are invisible to the naked eye
Hyperthermic intraperitoneal chemotherapy (HIPEC) surgery is a two-step procedure that treats certain cancers in the abdomen. Cancerous tumors are surgically removed, and then heated chemotherapy drugs are applied directly inside the abdomen to eliminate the remaining cancerous cells. The procedure generally involves.
The chemotherapy drugs circulate in your abdomen for about 1 to 1 1/2 hours. During treatment, the patient is physically rocked back and forth a few times to ensure that the drugs reach all areas of your abdominal cavity.
HIPEC offers some advantages over traditional chemotherapy. Benefits of HIPEC include:
For stage 3 or 4 ovarian cancer, chemotherapy is sometimes given before surgery (neoadjuvant chemotherapy). The aim is to shrink the tumours to make them easier to remove.
After three cycles of chemotherapy, you will have a scan to check how the tumour has responded and then decide about having an operation. If you have surgery, you will have another three cycles of chemotherapy afterward. If you do not have surgery, you will continue with a further three cycles of chemotherapy.
Chemotherapy after surgeryChemotherapy is usually given 2–4 weeks after the surgery (adjuvant chemotherapy) as there may be some cancer cells still in the body. For ovarian cancer, the drugs are usually given in repeating cycles spread over 4–5 months, but this can vary. Some people may have chemotherapy with a targeted therapy drug.
You will have blood tests before each chemotherapy cycle, to check your body’s healthy cells have had time to recover. If your blood count has not recovered, which can be common, there may be a delay before your next treatment.
In some cases, you may also have blood tests during treatment to check for the CA125 tumour marker.
Chemotherapy as the main treatmentChemotherapy may be recommended as the main treatment if you are not well enough for a major operation or when the cancer cannot be surgically removed.
Targeted therapy is used to treat ovarian cancer that has come back or advanced ovarian cancer. Whether you are offered targeted therapy drugs will depend on:
This targeted therapy drug blocks poly (ADP-ribose) polymerase (PARP), a protein that targets cancer cells that have a BRCA1 or BRCA2 gene fault.
You may be offered olaparib after chemotherapy to treat a high-grade epithelial ovarian cancer. This is known as maintenance therapy. Or you may have olaparib if the cancer has come back (recurred) after initial chemotherapy.
BEVACIZUMABThis targeted therapy drug is sometimes used to treat advanced epithelial tumours. It is given with chemotherapy every three weeks as a drip into a vein (intravenous infusion). Treatment will continue for 12 months for women first diagnosed with ovarian cancer, or for as long as it’s working if it is used for cancer that has come back.
Radiation therapyIt is occasionally used to treat ovarian cancer that has spread to the pelvis or to other parts of the body. It may be used after chemotherapy or surgery to help reduce the symptoms of advanced cancer, or on its own as a palliative treatment.
Number of radiation therapy sessions will depend on the type and size of the cancer and where it is located. You may have a few treatments or daily treatments for a number of weeks.
The side effects of radiation therapy vary. Most are temporary and disappear a few weeks or months after treatment. Radiation therapy for ovarian cancer is usually given over the abdominal area.
Palliative treatment helps to improve people’s quality of life by managing the symptoms of cancer without trying to cure the disease.
Many people think that palliative treatment is only for people at the end of their life, but it can help people at any stage of advanced ovarian cancer, even if they are still having active treatment for the cancer. As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms. It is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, cultural, social and spiritual needs.
ComplicationsOvarian cancer can cause other complications. This happens most often when the cancer spreads to the abdomen and lungs.
Many people have few, if any, of these complications. Still, it is important to be aware of the possibilities and seek medical attention if you have any symptoms.
Bowel ObstructionIt may occur when cancer spreads to the abdomen and pelvis. It may also happen because of scar tissue that forms after abdominal or pelvic surgery. This includes surgery for ovarian cancer.
Scar tissue can lead to kinks and twists in the bowel. This can cause an obstruction. Symptoms of a bowel obstruction include:
Surgery is often needed to remove the affected parts of the intestine. After surgery, feeding is often temporarily done through a tube. This gives the bowel time to recover.
Perforated ColonOvarian cancer tends to spread to the wall of the intestines. As it grows, tissue can weaken. This may set the stage for perforations in bowel.
When the bowel is perforated, bowel contents leak into the abdominal cavity. This causes an infection called peritonitis. Surgery is often needed to bypass the diseased area of the bowel.
Urinary Blockage or Urinary RetentionOvarian cancer can spread in the pelvis. It may block the tubes that travel from the kidneys to the bladder. These tubes are called ureters.
If both ureters are blocked, urine output drops. If only one ureter is blocked, there could be severe pain. There may also be no pain, depending on the location of the blockage.
small tube that holds the ureter open called as ureteric stents may be placed to resolve the blockage.
Pleural EffusionWhen the cancer spreads to the lungs or the chest region, fluid may build up between the membranes that line the lungs. These membranes are called pleura
Sometimes this fluid contains cancer cells. Pleura that contains cancer cells is called malignant pleural effusion
A procedure called thoracentesis can be used to drain the fluid. During this procedure, a needle is placed through the skin on the chest into the pleural cavity.
A stent can be placed to allow continual drainage. Pleurodesis is another option. During this procedure, a chemical is placed between the layers. This causes the membranes to scar together, preventing additional fluid build-up.
Bone PainWhen cancer spreads to the bones it can cause pain. This pain can be severe. Fortunately, there are treatments that can help, such as: