Understanding Ovarian Cancer

Ovarian cancer is a silent threat that affects thousands of individuals each year. In this article and guide, we aim to provide a clear and accessible overview of ovarian cancer, covering its causes, symptoms, diagnosis, treatments, and more. Whether you're looking for basic information or seeking to deepen your understanding, this article is tailored for everyone.  

What are the ovaries?

Ovaries are reproductive glands found only in females (women). The ovaries produce eggs (ova) for reproduction. The eggs travel from the ovaries through the fallopian tubes into the uterus where the fertilized egg settles in and develops into a fetus. The ovaries are also the main source of the female hormones estrogen and progesterone. One ovary is on each side of the uterus. 

What is Ovarian Cancer?

Ovarian cancer originates in the ovaries. When abnormal cells in the ovaries grow uncontrollably, they form tumors, leading to ovarian cancer. Ovarian cancers were previously believed to begin only in the ovaries, but recent evidence suggests that many ovarian cancers may actually start in the cells in the far (distal) end of the fallopian tubes. The ovaries are mainly made up of 3 kinds of cells. Each type of cell can develop into a different type of tumor:

• Epithelial tumors start from the cells that cover the outer surface of the ovary. The vast majority of ovarian tumors are epithelial cell tumors (80-85%).
• Germ cell tumors start from the cells that produce the eggs (ova).
• Stromal tumors start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone.

Who Gets It?

Ovarian cancer can affect women of all ages, but it is most common in postmenopausal women. While age is a risk factor, it's essential to be aware that ovarian cancer can occur at any stage of life.

Causes and Risk Factors:

A risk factor is anything that affects your chance of getting a disease such as cancer. The precise causes of ovarian cancer remain unclear, but certain risk factors may increase the likelihood. The factors that increase your risk of ovarian cancer include a family history of ovarian or breast cancer, inherited gene mutations (BRCA1 and BRCA2), age, obesity, reproductive history (never having been pregnant), and hormone therapy after menopause. Understanding these factors can aid in identifying individuals at higher risk.

The factors with unclear effects on ovarian cancer are androgens (male hormones), talcum powder, and diet. While pregnancy, tubal ligation (having the fallopian tubes tied) breastfeeding, birth control pills, and aspirin can all lower the risk of ovarian cancer. 

Symptoms:

Recognizing the symptoms of ovarian cancer is crucial for early detection. Common signs include abdominal bloating, pelvic pain, frequent urination, back pain, pain during sex, irregular heavy bleeding than normal (menstruation), and difficulty eating or feeling full quickly. If you have these symptoms more than 12 times a month, see your doctor as being mindful of these symptoms and their persistence is key to seeking prompt medical attention.

Can Ovarian Cancer be Found Early?

Only about 20% of ovarian cancers are found at an early stage. When ovarian cancer is found early, it infers very favorable survivability 5 years after diagnosis. There are ways to find ovarian cancer early such as regular women’s health exams, to see a doctor if you have symptoms, screening tests at regular intervals if you have an inherited gene mutation.

When to See a Doctor?

If you experience persistent or worsening symptoms, it's crucial to consult a healthcare professional. Ovarian cancer is often diagnosed at later stages due to its subtle symptoms, making early detection challenging. Regular check-ups and open communication with your healthcare provider are essential.

Diagnosis and Treatments:

Diagnosing ovarian cancer involves a combination of medical history and physical examination, imaging tests (such as ultrasound, computed tomography scans, barium enema x-ray, magnetic resonance imaging scans, chest x-ray, positron emission tomography scan), blood tests, lab tests for gene or protein changes such as CA-125 assay, colonoscopy, biopsy, and laparoscopy. Treatment options may include surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, hormone therapy, and supportive (palliative) care. Understanding the available treatments empowers you to make informed decisions in consultation with your healthcare team.

Access to Latest Treatments:

Staying informed about the latest advancements in ovarian cancer treatment is crucial. Clinical trials and emerging therapies offer hope and options for individuals facing this diagnosis. Open communication with healthcare providers about accessing cutting-edge treatments is always encouraged.

Recurrence and Survival:

Ovarian cancer recurrence is a possibility, but advances in treatment have improved survival rates. Regular follow-ups and monitoring are essential for survivors. The emotional and physical challenges of recurrence can be addressed with a supportive healthcare team and network.

Can Ovarian Cancer Be Prevented?

Most women have one or more risk factors for ovarian cancer. But most of the common factors only slightly increase your risk, so they only partly explain the frequency of the disease. So far, what is known about risk factors has not translated into practical ways to prevent most cases of ovarian cancer.

It is important to realize that some of these strategies lower your risk only slightly, while others lower it much more. Some strategies are easily followed, and others require surgery. If you are concerned about your risk of ovarian cancer, talk to your health care professionals. They can help you consider these ideas as they apply to your own situation.

Prevention strategies for women with a family history of ovarian cancer or BRCA mutation

If your family has a history of ovarian cancer, considering genetic counseling and testing is a good idea. Genetic counseling helps understand if there's a gene mutation linked to higher ovarian cancer risk. The results may not be straightforward, but a genetic counselor can guide you. Knowing you don't have the mutation can be a relief, while if you do, it helps in making decisions about prevention strategies for you and your family. It's like having a helpful guide to understand your family's health puzzle and make informed choices.

Prognosis:

Ovarian cancer prognosis varies based on the stage at diagnosis and individual factors. Ovarian cancer is staged I-IV with stage I having a survival rate of approximately 90-95% and stage IV about 1-5% survival rate. Understanding the prognosis can help you and your families prepare for the journey ahead, fostering a sense of control and empowerment.  

Questions to Ask Your Healthcare Provider:

1. What is my risk of ovarian cancer based on my family history?

2. What symptoms should I be aware of, and when should I seek medical attention?

3. Are there any screening tests recommended for me?

4. What are the available treatment options, and what side effects can I expect?

5. How can I access information about clinical trials or the latest treatments?

6. What are the chances the cancer will recur (come back) with these treatment plans?

Conclusion:

Empowering ourselves with knowledge about ovarian cancer is a crucial step in its prevention, early detection, and effective treatment. By understanding the basics in a language accessible to all, we hope to contribute to a more informed and aware community.

Written by Devangi Pethani

Edited by Adam Litwin, MD

References:

1. American Cancer Society. Ovarian Cancer 2022. https://www.cancer.org/cancer/types/ovarian-cancer/about.html

2. Mayo Clinic. Ovarian Cancer 2022. https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

3. PDQ Adult Treatment Editorial Board. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®): Patient Version. 2022 Dec 2. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK65718/

4. Cancer Research UK. Ovarian Cancer 2022. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/ovarian-cancer