What is ovarian cancer?

Ovarian cancer is a type of cancer that affects the ovaries, which are two small organs located on each side of the uterus. It is the fifth most common type of gynecologic cancer in women and is often referred to as a “silent killer” because its symptoms can be difficult to detect. In this blog, we will explore ovarian cancer, how it develops and how it can be treated.

The female reproductive system

The female reproductive system is a complex and fascinating part of the human body. It is responsible for producing eggs, transporting them from the ovaries to the uterus and preparing the uterus to receive a fertilised egg for pregnancy.

Starting from puberty, menstrual cycles form an important part of life for most females, as these are tied to their fertility. The ovaries produce eggs that travel into the fallopian tubes, where they may be fertilised. The ovaries are also the main source of the female hormones estrogen and progesterone. For those going through menopause, the decrease in hormone production means no more monthly cycles or chances of becoming pregnant. These changes can be emotionally and physically difficult, but are an unfortunate natural part of ageing.

Introduction to ovarian cancer

Ovarian cancer occurs in one or both of the ovaries when abnormal cells within them begin to divide and grow uncontrollably. There are different types of ovarian cancer. The type depends on which type of cell the cancer begins in. The most common types of ovarian cancer include:

• Epithelial carcinoma, which starts on the surface of the ovary
• Germ cell tumours start in the cells inside an ovary that produce eggs. A germ cell tumour may initially be mistaken for a benign ovarian cyst
• Stromal tumours, which start in cells that hold together other parts of an ovary

Each of these major categories can further be divided into subtypes. Each subtype has its own characteristics when diagnosing and treating cancer. Additionally, ovarian cancers are classified into four stages based on how much they have spread throughout the body. The severity of cancer can range from Stage 1 (low grade) to Stage 4 (high grade).

Different stages of ovarian cancer

• Stage 1 ovarian cancer is typically limited to just one or both ovaries and affects only the area in the abdominal cavity near where the reproductive organs are located
• Stage 2 sees cancer spread to the uterus, fallopian tubes and other surrounding areas of the abdomen
• Stage 3 is considered advanced, cancer has begun to spread beyond the pelvic region up into the lymph nodes on either side of the body
• Stage 4 is classified as a metastatic stage in which cancer cells may have travelled to distant parts of the body organs such as the lungs, liver or even bones

This information helps guide treatment plans so that doctors in oncology can provide tailored care to the specific medical needs of patients.

How does ovarian cancer develop?

Ovarian cancer usually begins with a mutation in healthy cells inside one or both of your ovaries. This mutation causes those cells to grow and divide at an accelerated rate, until they form a mass of cancer cells. If this tumour is malignant (cancerous), it can spread to other parts of your body through your lymphatic system or bloodstream.

Epithelial ovarian cancer

Epithelial ovarian cancer is one of the most common types of ovarian cancer, as it accounts for approximately 90% of all cases. They can be benign or malignant. While benign cancers are typically non-harmful and rarely require treatment in mild patients, malignant cancers can cause devastating health problems.

Fallopian tube cancer

Fallopian tube cancer is a rare form of ovarian cancer confined to the fallopian tubes, with fewer than 1% of ovarian cancers originating in this area. It is tough to detect in its early stages and has symptoms similar to other conditions, such as endometriosis.

What causes ovarian cancer?

There are many potential causes of ovarian cancer, including genetic and lifestyle factors. Increased risk is associated with risk factors such as:

• Being a female over the age of 50 years
• A family history of ovarian cancer or breast cancer
• Carrying specific gene mutations, e.g. changes in the BRCA gene, specifically BRCA1 and BRCA2, Lynch syndrome
• Taking hormones such as estrogen for fertility issues or those who have used hormonal treatments or birth control pills
• Exposure to certain chemicals and pollutants

Studies have found that lifestyle choices can also be connected with an increased risk of ovarian cancer, such as smoking or consuming alcohol above recommended guidelines. Additionally, elevated levels of the hormone insulin in the body due to diet and lack of exercise are linked with increases in various forms of cancer, including ovarian cancer.

While it can be frightening to consider these risk factors, they can help inform treatment decisions and possibly prevent the occurrence of the disease in cases where those risks are present. Individuals at risk need to talk to their doctor about steps to reduce their chances of developing this serious form of cancer.

What are the symptoms of ovarian cancer?

Ovarian cancer symptoms can be tricky to spot, as it often doesn’t present with any symptoms in its earliest stages. However, some of the most common signs and indicators of ovarian cancer can include:

• Bloating
• An urgent need to urinate
• Pelvic and abdominal pain
• Feeling tired all the time
• Changes in bowel movements such as constipation or diarrhoea
• Unexplained weight loss or gain
• Unexplained changes in appetite

If you spot something unusual, reach out to your healthcare provider immediately so they can investigate further. Early diagnosis is key in ovarian cancer, so don’t wait until the symptoms worsen.

How to diagnose ovarian cancer

Most early stages of an ovarian cancer diagnosis do not produce symptoms, making it difficult to diagnose accurately. However, women diagnosed in an early stage have a higher survival rate. Diagnosing ovarian cancer is a complex process that usually begins with a physical examination and a medical history review. Common tests used to diagnose the disease include:

• Pelvic exams
• Transvaginal ultrasound
• Biopsies
• CT scans
• Blood tests such as the CA-125 test

During the pelvic exam, your doctor looks for abnormalities in the size or shape of the ovaries. At the same time, an ultrasound imaging test may reveal tumours that cannot be felt during a physical exam. The biopsy helps determine if any ovarian tissue contains cancerous cells, while imaging scans provide detailed images of the structure inside your body. Finally, the CA-125 test detects elevated levels of a protein in your blood that can indicate ovarian cancer. Though diagnostic testing for ovarian cancer can be intimidating and daunting due to its complexity, accurate diagnosis is key to successful treatment plans.

Genetic testing

Genetic testing for ovarian cancer can be a powerful tool in diagnosing and treating the condition. This type of testing looks at specific genetic mutations linked to this disease’s development and progression. The results of this testing can provide valuable insight into how the disease will progress, helping doctors create an appropriate treatment plan tailored to each patient’s needs. It may also help those at risk for serious illness identify genes associated with the condition and take preventative measures before symptoms become serious. In any case, genetic testing for ovarian cancer is an important step in diagnosing and treating this potentially life-threatening condition.

How is it treated?

Ovarian cancer treatment options depend on several factors, including age, overall health status, stage of the disease (how far it has spread) and whether you have had surgery before for ovarian cancer. Common treatments include:

• Surgery to remove as much tumour as possible (debulking surgery)
• Hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes)
• Chemotherapy. Medications such as cisplatin, carboplatin, doxorubicin and topotecan may be prescribed
• Radiation therapy. Using high-energy rays (similar to x-rays) to kill cancer cells
• Targeted therapy. Medications such as bevacizumab, rucaparib, niraparib and olaparib may be prescribed
• Hormone therapy. Medications such as aromatase inhibitors, e.g. letrozole and tamoxifen and luteinizing hormone-releasing hormone (LHRH) agonists, e.g. leuprolide acetate
• Clinical trials using experimental treatments such as gene therapy or cryosurgery

Is ovarian cancer curable?

Ovarian cancer is a difficult disease to treat, with many feeling hopeless about its diagnosis. However, this is not always the case. Multiple treatment levels are available depending on severity and stage, that can make ovarian cancer curable. Early detection through awareness and screening is critical for the best outcome and immediate access to qualified medical support.

With early intervention and high-quality cancer care, patients can often overcome ovarian cancer completely or at least, keep it from worsening. There is hope in these difficult times, advances in healthcare give cause for optimism about a better prognosis for people with ovarian cancer.

Talk to your doctor

If you have any concerns about possible signs or symptoms of ovarian cancer or want more information, talk to your doctor as soon as possible. They can answer any questions you have and provide guidance on the next steps for diagnosis and treatment if needed.

Sources

• Ovarian Cancer – The Eve Appeal
• Ovarian Cancer – Cancer Research UK 
• Overview Ovarian cancer – NHS