The ovary is a ductless reproductive gland about the shape and size of an almond in which the female reproductive cells are produced. Females have a pair of ovaries, held by a membrane beside the uterus on each side of the lower abdomen. The ovaries are located on opposite sides of the uterus in the pelvic cavity and are attached to the uterus by the ovarian ligament
The ovaries play two central roles in the female reproductive system by acting as both glands and gonads.
Our body is made up of zillions of cells, and there is a continuous process where the cells of our body gets worn out after certain duration and gets replaced by new cells.
Cells in our body divide by a process called mitosis, where they replicate their DNA and divide into two halves. However, normal cells don’t divide infinitely, they stop dividing generally after 50 or 60 generations and commit apoptosis. This process is called senescence. Cancer cells don’t obey senescence, they are immortal and they keep dividing over and over again, giving rise to a tumor.
The National Cancer Institute defines cancer as “ a term used for diseases in which abnormal cells divide without control and invade nearby tissues”. Cancer is a collective term used for a number of diseases. There are multiple different types of cancer that show up in different parts of the body and every type of cancer works difffernetly, caused by different factors and demands unique prognosis.
There are many different types of ovarian tumors classified by the types of cells and tissue they originate from.
Ovarian cancer is among top three killers among adults in both rural and urban India. Though cancer incidence rates in India is lower as compared to western countries, but the rates are changing rapidly over recent decades. During the year 2002, it ranked third in frequency (4.1%) among all cancers in women.
In India, during the period 2004-2005, proportion of ovarian cancer varied from 1.7% to 8.7% of all female cancers in various urban and rural populations.
Ovarian cancer may not produce symptoms, particularly in the early stages. Some of the symptoms are mentioned below. However, they can be very subtle and vague, as well as very common.
These symptoms, of course, occur with many different conditions and are not specific to cancer. Consulting the doctor and discussing the symptoms is important, especially if they occur frequently and persist for more than a few weeks.
The risk of developing Ovarian Cancer in the course of their lifetime for the general population of women is 2 %. However, some women have an increased risk of developing Ovarian Cancer. All women should be aware of the risk factors and of the symptoms of Ovarian Cancer.
“When you know the risk, you’re empowered to make choices to reduce that risk. It’s not about scaring people; it’s about giving them the chance to be realistic.”
There are a number of possible causes of Ovarian Cancer but these are not yet fully understood. The most important risk factors are age and a family history of ovarian or breast Cancer.
The risk of developing Ovarian Cancer increases with increasing age. Women over the age of 50 have a higher risk, and most cases of Ovarian Cancer occur in women who have already gone through the menopause. Although it is not common for younger women to get Ovarian Cancer, there are instances of Ovarian Cancer in pre-menopausal women. This is especially important if women have a family history of ovarian or breast Cancer.
There is a slight increased risk of developing Ovarian Cancer for an obese person.
Women who’ve been diagnosed with one of these Cancers have a higher risk of developing Ovarian Cancer.
Smoking can increase the risk of certain types of Ovarian Cancer. 3% of Ovarian Cancer seems to be linked to exposure to tobacco smoke.
About 85 % of Ovarian Cancer cases are ‘sporadic’. This means they are one-offs, not inherited and close female relatives face no significant increase in their risk of developing the disease themselves.
The remaining 15 – 20 % of cases are believed to be caused by an inherited faulty gene, which is often the BRCA1 or BRCA2 gene.
Taking HRT increases a woman’s risk of developing Ovarian Cancer by 40 % compared to a woman who has never taken HRT. The lifetime risk of developing Ovarian Cancer is 2 %.
Research has shown that diabetics have an increased risk of up to 25 % compared with non-diabetics of developing Ovarian Cancer. Additionally the risk may be slightly higher in diabetics who use insulin as opposed to diet or tablet controlled diabetics.
The risk of Ovarian Cancer may also be linked to various activities, foods or physical traits, though these theories have no evident proofs to be backed by. Some such factors are cited below:
There is evidence to suggest that women with endometriosis have an increased risk of developing Ovarian Cancer.
Women who have delivered at least one child, especially before age 30, are at a lower risk for developing the disease. The more children a woman has, the more her Ovarian Cancer risk declines. Women who breastfeed further reduce their risk.
Some of the risk factors that might lead to ovarian cancer can be controlled by taking preventive measures. Some of the precautions are mentioned below:
Ovarian cancer can be staged using TNM system.
T – The size of the tumor.
N – The spread to the lymph glands/lymph nodes (N).
M – The tumor has spread anywhere else in the body.
Survival depends on many different factors. It depends on your individual condition, type of cancer subtype, treatment and level of fitness.
Epithelial Ovarian Cancer is the most deadly of the gynecologic cancers. Approximately 80% of patients will eventually die of the disease. However, survival in the short term is quite good. With the addition of IP chemotherapy, the survival of ovarian cancer has been significantly extended. According to recent studies, if a patient undergoes optimal debulking, followed by IP chemotherapy, then they have a greater than 50% chance to still be alive in six years. This is quite good compared to other advanced stage cancers. Even in the recurrent setting, epithelial Ovarian Cancer is often very sensitive to chemotherapy. The disease can often go in to complete remission (no detectable disease) many times. However, once it recurs, it is not curable and will continue to come back.
Germ cell and stromal tumors have a much better prognosis. They are often cured because they are more often detected at early stages
The survival rate is higher than 90 percent when the cancer is found early and treated right away. Doctors diagnose 15 percent of Ovarian Cancers at the earliest stages. Scientists are currently researching more improved and reliable ways to detect ovarian cancer early.
It’s much easier to treat ovarian cancer when diagnosed at an early stage. However, it’s not easy to detect. Ovaries are situated deep within the abdominal cavity, so it is unlikely to feel a tumor. There’s no routine diagnostic screening available for Ovarian Cancer. That’s why it’s so important to report unusual or persistent symptoms to your doctor.
If a woman has Ovarian Cancer symptoms, a strong family history, or a genetic predisposition such as a BRCA mutation, following tests are suggested:
Often vague symptoms eventually lead to a clinical diagnosis, or one based on suspicion generated by exams, laboratory tests, and imaging. However, an accurate diagnosis requires some of the tumor to be removed, either by biopsy (less often), or preferably, surgery to verify the diagnosis.
Various types of imaging studies can be used to diagnose this disease and lead to tissue sampling. Ultrasound and CT scans are the most commonly done studies. These often can give images that show masses in the abdomen and pelvis, fluid in the abdominal cavity (ascites), obstructions of the bowels or kidneys, or disease in the chest or liver. PET scans can be used, but often are not necessary if a CT scan is able to be performed.
The treatment depends on how far the 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:
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. It is often recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue. Identifying all tumor locations is difficult.
New therapies for Ovarian Cancer may be directed at blocking tumor growth by interfering with the formation of blood vessels to supply the tumor. The process of blood vessel formation is known as angiogenesis. The drug Avastin works by blocking angiogenesis, causing tumors to shrink or stop growing.
Chemotherapy is typically given after surgery for all stages of Ovarian Cancer. Chemotherapy drugs are usually given intravenously, or administered directly into the abdominal cavity (intraperitoneal chemotherapy).
Having a symptoms associated with Ovarian Cancer may not necessarily indicate the presence of the disease. However, expert advice to rule out the possibility is prudent, making curative treatment possible. So, regular self examination and a physical examination at least once a year is recommended to facilitate early diagnosis of the disease.
Being aware of the symptoms, and any health issue that might indicate the presence of the disease needs to be examined thoroughly. Also, a few lab tests and regular tests can also sometime unveil the presence of the hideous disease.