Ovarian cancer treatment

Ovarian Cancer: Signs, Causes, Treatment.

Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries each about the size of an almond produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Surgery and chemotherapy are generally used to treat ovarian cancer.

Ovarian cancer symptoms.

• Locations of female reproductive organs
• Female reproductive system Open pop-up dialog box
• Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions.

Signs and symptoms of ovarian cancer may include.

• Abdominal bloating or swelling, pressure, and pain.
• Quickly feeling full when eating.
• Weight loss.
• Discomfort in the pelvis area.
• Changes in bowel habits, such as constipation.
• A frequent need to urinate.
• Abnormal fullness after eating.
  
• Difficulty eating.
• An increase in urination.
• An increased urge to urinate.

Ovarian cancer can also cause other symptoms, such as:

• Fatigue
• Indigestion
• Heartburn
• Constipation
• Back pain
• Menstrual irregularities
• Painful intercourse
• Dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles).

Again, cancers are best treated when detected early. Please consult with your doctor if you experience new and unusual symptoms.

The symptoms will persist if they’re due to ovarian cancer. Symptoms usually become more severe as the tumor grows. By this time, cancer has usually spread outside of the ovaries, making it much harder to treat effectively.

When to see a doctor.

Make an appointment with your doctor if you have any signs or symptoms that worry you.

• If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers.
• The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
• More than 22,000 women in the United States will receive an ovarian cancer diagnosis in 2017, and 14,000 women will die from it.
• Ovarian cancer often has warning signs, but the earliest symptoms are vague and easy to dismiss. Twenty percent of ovarian cancers are detected at an early stage.

In this article, you will find information on ovarian cancer including.

What are the early symptoms of ovarian cancer?

It’s easy to overlook the early symptoms of ovarian cancer because they’re similar to other common illnesses or they tend to come and go. The early symptoms include:

The ovaries are made up of three types of cells. Each cell can develop into a different type of tumor:

• Epithelial tumors form in the layer of tissue on the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors
• Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumors.
• Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare.
• Ovarian cysts
• Most ovarian cysts aren’t cancerous. These are called benign cysts. However, a very small number can be cancerous.

An ovarian cyst is a collection of fluid or air that develops in or around the ovary. Most ovarian cysts form a normal part of ovulation, which is when the ovary releases an egg. They usually only cause mild symptoms, like bloating and go away without treatment.

Cysts are more of a concern if you aren’t ovulating. Women stop ovulating after menopause. If an ovarian cyst forms after menopause, your doctor may want to do more tests to find out the cause of the cyst, especially if it’s large or doesn’t go away within a few months.

If the cyst doesn’t go away, your doctor may recommend surgery to remove it just in case. Your doctor can’t determine if it’s cancerous until they remove it surgically.

Risk factors for ovarian cancer.

The exact cause of ovarian cancer is unknown. These factors can increase your risk:

• A family history of ovarian cancer
• Genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
• A personal history of breast, uterine, or colon cancer
• Obesity
• The use of certain fertility drugs or hormone therapies
• No history of pregnancy
• Endometriosis
• Older age is another risk factor. Most cases of ovarian cancer develop after menopause.

It’s possible to have ovarian cancer without having any of these risk factors. Likewise, having any of these risk factors doesn’t necessarily mean you’ll get ovarian cancer.

How is ovarian cancer diagnosed?

It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect.

Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumor. There’s no routine diagnostic screening available for ovarian cancer. That’s why it’s so important for you to report unusual or persistent symptoms to your doctor.

If your doctor is concerned that you have ovarian cancer, they’ll likely recommend a pelvic exam. Performing a pelvic exam can help your doctor discover irregularities, but small ovarian tumors are very difficult to feel.

As the tumor grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.

Your doctor may also do the following tests.

• Transvaginal ultrasound (TVUS). This is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine whether tumors are cancerous.
• Abdominal and pelvic CT scan. If you’re allergic to dye, they may order a pelvic MRI scan.
• Blood test to measure cancer antigen 125 (CA-125) levels. This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
• Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.

What are the stages of ovarian cancer?

Your doctor determines the stage based on how far cancer has spread. There are four stages, and each stage has sub-stages:

Stage 1 ovarian cancer has three sub-stages:

Stage 1A: The cancer is limited, or localized, to one ovary.

Stage 1B: The cancer is in both ovaries.

Stage 1C: There are also cancer cells on the outside of the ovary.

In stage 2, the tumor has spread to other pelvic structures. It has two sub-stages:

Stage 2A: Cancer has spread to the uterus or fallopian tubes.

Stage 2B: Cancer spreads to the bladder or rectum.

Stage 3 ovarian cancer has three sub-stages:

Stage 3A: Cancer has spread beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.

Stage 3B: The cancer cells are outside of the spleen or liver.

Stage 3C: Deposits of cancer at least 3/4 of an inch are seen on the abdomen or outside the spleen or liver. However, the cancer isn’t inside the spleen or liver.

In stage 4, the tumor has metastasized, or spread, beyond the pelvis, abdomen, and lymph nodes to the liver or lungs. There are two sub-stages in stage 4:

In stage 4A, the cancerous cells are in the fluid around the lungs.

In stage 4B, the most advanced stage, the cells have reached the inside of the spleen or liver or even other distant organs like the skin or brain.

How ovarian cancer is treated.

The treatment depends on how far cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:

• Chemotherapy
• Radiation
• Surgery to stage cancer and remove the tumor
• Targeted therapy
• Hormone therapy
• Surgery (Surgery is the main treatment for ovarian cancer.)

The goal of surgery is to remove the tumor, but a hysterectomy, or complete removal of the uterus, is often necessary. Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue.

Identifying all tumor locations is difficult. In one study, researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.

Targeted therapy :

Targeted therapies, such as chemotherapy and radiation treatments, attack the cancer cells while doing little damage to normal cells in the body.

Newer targeted therapies to treat advanced epithelial ovarian cancer include bevacizumab (Avastin) and olaparib (Lynparza). Doctors only use olaparib in people with mutations in the BRCA genes.

Fertility preservation :

Cancer treatments, including chemotherapy, radiation, and surgery, can damage your reproductive organs, making it difficult to become pregnant.

If you want to become pregnant in the future, talk to your doctor before starting treatment. They can discuss your options for possibly preserving your fertility. Possible fertility preservation options include:

• Embryo freezing. This involves freezing a fertilized egg.
• Oocyte freezing. This procedure involves freezing an unfertilized egg.
• Surgery to preserve fertility. In some cases, a surgery that only removes one ovary and keeps the healthy ovary can be done. This is usually only possible in early-stage ovarian cancer.
• Ovarian tissue preservation. This involves removing and freezing ovarian tissue for future use.
• Ovarian suppression. This involves taking hormones to suppress ovarian function temporarily.
• Ovarian cancer research and studies

New treatments for ovarian cancer are studied each year. Researchers are also exploring new ways to treat platinum-resistant ovarian cancer. When platinum resistance occurs, standard first-line chemotherapy drugs like carboplatin and cisplatin are ineffective.

Certain drugs are also studied for their potential benefits in ovarian cancer. A 2014 study examined targeted treatments for those with more advanced stages of this cancer.

Ovarian cancer treatment primarily focuses on surgery to remove the ovaries and uterus, and chemotherapy. As a result, some women will experience menopause symptoms.

A 2016 study examined how hormone therapy (HT) affects the quality of life after ovarian cancer treatment.

This study found that HT is safe for menopause treatments in women with ovarian cancer. People in the study maintained a high quality of life while receiving HT after being treated for ovarian cancer.

A 2015 article looked at intraperitoneal (IP) chemotherapy. This study found that those who received IP therapy had a median survival rate of 61.8 months. This was an improvement as compared to 51.4 months for those who received standard chemotherapy.

Can ovarian cancer be prevented?

There are no proven ways to totally eliminate your risk of developing ovarian cancer. However, there are steps you can take to lower your risk. Factors that have been shown to lower your risk of developing ovarian cancer include:

1. taking oral birth control pills
2. breastfeeding
3. pregnancy
4. surgical procedures on your reproductive organs (like a tubal ligation or hysterectomy)

What is the outlook?

Your outlook depends on a variety of factors, including the stage of cancer at diagnosis, your overall health, and how well you respond to treatment. Every cancer is unique, but the stage of the cancer is the most important indicator of outlook.

Survival rate.

The survival rate is the percentage of women who survive a certain number of years at a given stage of diagnosis.

For example, the five-year survival rate is the percentage of patients who received a diagnosis at a particular stage and live at least five years after their doctor diagnosed them. The relative survival rate also takes into account the expected rate of death for people without cancer.

Epithelial ovarian cancer is the most common type of ovarian cancer. The American Cancer Society estimates the relative survival rate for this type of ovarian cancer as:

Stage 1: 71 percent

1A: 93 percent

1B: 91 percent

1C: 84 percent

Stage 2: 61 percent

2A: 82 percent

2B: 72 percent

Stage 3: 28 percent

3A: 63 percent

3B: 53 percent

3C: 41 percent

Stage 4: 19 percent

The survival rate is higher than 90 percent when the cancer is found early in stages IA or IB and is treated right away. Doctors diagnose only 20 percent of ovarian cancers at the earliest stages.

Scientists are currently researching more improved and reliable ways to detect ovarian cancer early.

Type Of ovarian tumors.

Epithelial ovarian tumors :

Epithelial ovarian tumors start on the outer surface of the ovaries. These tumors can be benign (not cancer), borderline (low malignant potential), or malignant (cancer).

Benign epithelial ovarian tumors:

Epithelial ovarian tumors that are benign don’t spread and usually don’t lead to serious illness. There are several types of benign epithelial tumors including serous cystadenomas, mucinous cystadenomas, and Brenner tumors.

Borderline Epithelial Tumors.

When looked at in the lab, some ovarian epithelial tumors don’t clearly appear to be cancerous and are known as borderline epithelial ovarian cancer. The two most common types are atypical proliferative serous carcinoma and atypical proliferative mucinous carcinoma. These tumors were previously called tumors of low malignant potential (LMP tumors). These are different from typical ovarian cancers because they don’t grow into the supporting tissue of the ovary (called the ovarian stroma). If they do spread outside the ovary, for example, into the abdominal cavity (belly), they might grow on the lining of the abdomen but not into it.

Borderline tumors tend to affect younger women than typical ovarian cancers. These tumors grow slowly and are less life-threatening than most ovarian cancers.

Malignant epithelial ovarian tumors.

Cancerous epithelial tumors are called carcinomas. About 85% to 90% of malignant ovarian cancers are epithelial ovarian carcinomas. These tumor cells have several features (when looked at in the lab) that can be used to classify epithelial ovarian carcinomas into different types. The serous type is by far the most common and can include high-grade and low-grade tumors. The other main types include mucinous, endometrioid, and clear cells.

• Serous carcinomas (52%).
• Clear cell carcinoma (6%).
• Mucinous carcinoma (6%).
• Endometrioid carcinoma (10%).

Each ovarian cancer is given a grade, based on how much the tumor cells look like normal tissue:

Grade 1:- epithelial ovarian carcinomas look more like normal tissue and tend to have a better prognosis (outlook).

Grade 3:- epithelial ovarian carcinomas look less like normal tissue and usually have a worse outlook.

Other traits are also taken into account, such as how fast the cancer cells grow and how well they respond to chemotherapy, to come up with the tumor's type:

1. Type I tumors tend to grow slowly and cause fewer symptoms. These tumors also seem not to respond well to chemotherapy. Low grade (grade 1) serous carcinoma, clear cell carcinoma, mucinous carcinoma, and endometrioid carcinoma are examples of type I tumors.
2. Type II tumors grow fast and tend to spread sooner. These tumors tend to respond better to chemotherapy. High grade (grade 3) serous carcinoma is an example of a type II tumor.

Other cancers are similar to epithelial ovarian cancer.

• Primary peritoneal carcinoma.
• Primary peritoneal carcinoma (PPC) is rare cancer closely related to epithelial ovarian cancer. At surgery, it looks the same as an epithelial ovarian cancer that has spread through the abdomen. In the lab, PPC also looks just like epithelial ovarian cancer. Other names for this cancer include extra-ovarian (meaning outside the ovary) primary peritoneal carcinoma (EOPPC) and serous surface papillary carcinoma.
• PPC appears to start in the cells lining the inside of the fallopian tubes.
• Like ovarian cancer, PPC tends to spread along the surfaces of the pelvis and abdomen, so it is often difficult to tell exactly where cancer first started. This type of cancer can occur in women who still have their ovaries, but it is of more concern for women who have had their ovaries removed to prevent ovarian cancer. This cancer does rarely occurs in men.
• Symptoms of PPC are similar to those of ovarian cancer, including abdominal pain or bloating nausea, vomiting, indigestion, and a change in bowel habits. Also, like ovarian cancer, PPC may elevate the blood level of a tumor marker called CA-125.
• Women with PPC usually get the same treatment as those with widespread ovarian cancer. This could include surgery to remove as much cancer as possible (a process called debulking that is discussed in the section about surgery), followed by chemotherapy like that given for ovarian cancer. Its outlook is likely to be similar to widespread ovarian cancer.

Fallopian Tube Cancer.

This is another rare cancer that is similar to epithelial ovarian cancer. It begins in the tube that carries an egg from the ovary to the uterus (the fallopian tube). Like PPC, fallopian tube cancer and ovarian cancer have similar symptoms. The treatment for fallopian tube cancer is much like that for ovarian cancer, but the outlook (prognosis) is slightly better.

Ovarian Germ Cell Tumors.

Germ cells usually form the ova or eggs in females and the sperm in males. Most ovarian germ cell tumors are benign, but some are cancerous and may be life-threatening. Less than 2% of ovarian cancers are germ cell tumors. Overall, they have a good outlook, with more than 9 out of 10 patients surviving at least 5 years after diagnosis. There are several subtypes of germ cell tumors. The most common germ cell tumors are teratomas, dysgerminomas, endodermal sinus tumors, and choriocarcinomas. Germ cell tumors can also be a mix of more than a single subtype.

Teratoma.

Teratomas are germ cell tumors with areas that, when seen under the microscope, look like each of the 3 layers of a developing embryo: the endoderm (innermost layer), mesoderm (middle layer), and ectoderm (outer layer). This germ cell tumor has a benign form called mature teratoma and a cancerous form called an immature teratoma.

The mature teratoma is by far the most common ovarian germ cell tumor. It is a benign tumor that usually affects women of reproductive age (teens through forties). It is often called a dermoid cyst because its lining is made up of tissue similar to the skin (dermis). These tumors or cysts can contain different kinds of benign tissues including, bone, hair, and teeth. The patient is cured by surgical removal of the cyst, but sometimes a new cyst develops later in the other ovary.

Immature teratomas are a type of cancer. They occur in girls and young women, usually younger than 18. These are rare cancers that contain cells that look like those from embryonic or fetal tissues such as connective tissue, respiratory passages, and the brain. Tumors that are relatively more mature (called grade 1 immature teratoma) and haven’t spread beyond the ovary are treated by surgical removal of the ovary. When they have spread beyond the ovary and/or much of the tumor has a very immature appearance (grade 2 or 3 immature teratomas), chemotherapy is recommended in addition to surgery.

Dysgerminoma.

This type of cancer is rare, but it is the most common ovarian germ cell cancer. It usually affects women in their teens and twenties. Dysgerminomas are considered malignant (cancerous), but most don’t grow or spread very rapidly. When they are limited to the ovary, more than 75% of patients are cured by surgically removing the ovary, without any further treatment. Even when the tumor has spread further (or if it comes back later), surgery, radiation therapy, and/or chemotherapy are effective in controlling or curing the disease in about 90% of patients.

Endodermal sinus tumor (yolk sac tumor) and choriocarcinoma.

These very rare tumors typically affect girls and young women. They tend to grow and spread rapidly but are usually very sensitive to chemotherapy. Choriocarcinoma that starts in the placenta (during pregnancy) is more common than the kind that starts in the ovary. Placental choriocarcinomas usually respond better to chemotherapy than ovarian choriocarcinomas do.

Ovarian stromal tumors.

About 1% of ovarian cancers are ovarian stromal cell tumors. More than half of stromal tumors are found in women older than 50, but about 5% of stromal tumors occur in young girls.

The most common symptom of these tumors is abnormal vaginal bleeding. This happens because many of these tumors produce female hormones (estrogen). These hormones can cause vaginal bleeding (like a period) to start again after menopause. In young girls, these tumors can also cause menstrual periods and breast development to occur before puberty.

Less often, stromal tumors make male hormones (like testosterone). If male hormones are produced, the tumors can cause normal menstrual periods to stop. They can also make facial and body hair grow. If the stromal tumor starts to bleed, it can cause sudden, severe abdominal pain.

Types of malignant (cancerous) stromal tumors include granulosa cell tumors (the most common type), granulosa-theca tumors, and Sertoli-Leydig cell tumors, which are usually considered low-grade cancers. Thecomas and fibromas are benign stromal tumors. Cancerous stromal tumors are often found at an early stage and have a good outlook, with more than 75% of patients surviving long-term.

Ovarian Cysts.

An ovarian cyst is a collection of fluid inside an ovary. Most ovarian cysts occur as a normal part of the process of ovulation (egg release) these are called functional cysts. These cysts usually go away within a few months without any treatment. If you develop a cyst, your doctor may want to check it again after your next menstrual cycle (period) to see if it has gotten smaller.

An ovarian cyst can be more concerning in a female who isn't ovulating (like a woman after menopause or a girl who hasn't started her periods), and the doctor may want to do more tests. The doctor may also order other tests if the cyst is large or if it does not go away in a few months. Even though most of these cysts are benign (not cancer), a small number of them could be cancer. Sometimes the only way to know for sure if the cyst is cancer is to take it out with surgery. Cysts that appear to be benign (based on how they look on imaging tests) can be observed (with repeated physical exams and imaging tests), or removed with surgery.