Ovarian Cancer - Symptoms, Causes, Diagnosis and Treatment

The female reproductive system is fairly complex. Not only is it responsible for giving birth, but it is also responsible for hormonal balance. And according to what we have already known about cancer, is, if a body part is of any use, cancer will find a way to ruin it. Ovarian cancer (OC) is the third most common gynaecological cancer in India.

It is also one of the most lethal cancers for women in the country. There are 47,333 new cases of ovarian cancer per year, placing India as the second-highest country in terms of new ovarian cancer cases globally, based on 2022 statistics. But what is ovarian cancer to begin with?

Ovarian cancer happens when abnormal cells in the ovaries start to multiply and quickly grow out of control. Not only ovaries but cells in the fallopian tubes as well. The cells in question multiply pretty quickly and start to invade and destroy healthy body tissue.

The female reproductive system has two ovaries, one on either side of the uterus. These round, almond-sized organs are responsible for producing eggs and the hormones progesterone and estrogen. When cells in these two organs start growing and multiplying out of control, ovarian cancer happens.

This disease can be divided into four stages—the more serious the condition, the higher the number.

Stage I

We can divide this stage into three sub-stages (Stage 1A, Stage 1B and Stage 1C). In Stage 1A, the cancer is localised in just one ovary or fallopian tube. By the time Stage 1B happens, the cancer has spread to both ovaries or fallopian tubes.

Stage 1C sees the cancer in both ovaries, fallopian tubes and on the outside of the ovary, on the outside itself or in the space surrounding the ovary also known as the peritoneal cavity.

Stage II

This stage is also subdivided into a couple of stages. In Stage IIA, the cancer has spread from the ovary to the uterus. In Stage IIB, the cancer has invaded other structures in your pelvis.

Stage III

There are three sub-stages in this stage. In Stage IIIA, the cancer has spread beyond the pelvis and the abdomen or within the lymph nodes. In the second sub-stage, Stage IIIB, the tumour, which is around two centimetres long in this case, might be within the lymph nodes. Now, it can harm other organs, like the spleen or the liver.

Stage IV

At this stage, the cancer is most severe. It has spread to the inside of organs like the liver and spleen. It is found near the lungs in Stage IVA, in the lymph nodes of the groin, or the chest in Stage IVB.

Doctors are not very clear on what exactly causes ovarian cancer. They have, however, identified factors that magnify the risk of this disease.

According to doctors, ovarian cancer occurs when cells in or near the ovaries start exhibiting mutations in their DNA. Within the cell's DNA, are instructions that dictate to the cell what to do. These changes tell cells to grow and multiply quickly, creating a tumour of cancerous cells.

Age: These cancerous cells continue living after the death of healthy cells. They invade tissues in close proximity and break off from the initial tumour to metastasise to other body parts. You are at risk of developing ovarian cancer if you are over the age of 60 and are obese.

Genetics: If people in your family have had the disease, or if you have inherited a gene mutation (BRCA1 or BRCA2) or Lynch syndrome, you are at higher risk. Also at risk are women who have never been pregnant. And finally, there’s endometriosis - a severe condition in which tissue similar to the uterus’s lining grows outside the uterus.

Endometriosis: Having endometriosis can increase the risk of ovarian cancer. Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of the uterus.

Obesity: Being overweight can increase the risk of ovarian cancer. Obesity is quite prevalent in India, which is why there are many women at risk of getting ovarian cancer.

Menstrual history: Starting periods before age 12 or going through menopause after age 55 can increase the risk of ovarian cancer. Having an irregular menstrual cycle can also put you at risk.

Pregnancy history: Never being pregnant or having children later in life, can increase the risk. Pregnancy naturally suppresses ovulation, which means the ovaries are not repeatedly going through the process of releasing eggs.

Hormone replacement therapy: Using hormone replacement therapy, especially estrogen-only therapy, can increase the risk, especially with long-term use.

Radiotherapy: Having radiotherapy treatment for a previous cancer can increase the risk. Receiving radiotherapy treatment for a previous cancer, particularly in the pelvic area, can increase the risk of developing ovarian cancer later in life.

Smoking: Smoking tobacco can increase the risk of ovarian cancer. Smoking tobacco puts you at risk of many different kinds of ailments, like lung cancer, oral cancer and ovarian cancer.

The Symptoms

Ovarian cancer is a sneaky ailment. It might not exhibit any initial symptoms. When symptoms of ovarian cancer do occur, they are attributed to other, more common healthcare problems.

This means that the disease can develop and spread through the abdomen fairly quickly before causing any apparent symptoms, making early detection extremely difficult. Symptoms include -

• Bloating or swelling in the abdominal area or pelvic area.

• Feeling full after eating just a little bit, losing your appetite

• Inexplicable weight loss.

• The problem of feeling uncomfortable in the pelvic area.

• Inexplicable fatigue makes you feel very tired.

• Back pain, which prevents you from doing anything.

• Constipation - or changes in your bowel habits.

• A constant urge to pass urine.

• Discharge or bleeding from the vagina that isn’t connected to your periods.

• A marked increase in abdominal size.

A lot of research has gone into ovarian cancer, yet experts have been unable to come up with a decent cancer screening test for it. This is why this condition is quite tricky to diagnose, especially in the early stages.

If your doctor suspects ovarian cancer, they’ll enquire about your symptoms or perform a pelvic exam, during which they’ll check for any untoward growths or enlarged organs. Additional tests might be recommended, like

Imaging tests -

• Pelvic ultrasound

• MRI (Magnetic Resonance Imaging)

• CT Scan (Computed Tomography)

• PET Scan (Positron emission tomography)

Blood Tests

A doctor might test your blood for Cancer Antigen 125 (CA-125). If there are elevated levels of CA-125 in your blood, it is a sign of cancer. Please note that CA-125 levels might show normal even with the presence of cancer, and it might be higher in conditions that are not even cancerous. This is why providers depend on blood tests together with other tests to pinpoint ovarian cancer.

Surgical evaluation

A healthcare provider might diagnose ovarian cancer during surgery- if abnormal growths are found in the uterus, they’ll get rid of them during the same procedure.

Laparoscopy

When a laparoscopic surgery occurs, a surgeon passes a thin camera called a laparoscope through a tiny incision in your abdomen. Using the device as a guide, as well as other ports to hold instruments, the surgeon can study cancer and, if required, perform staging biopsies or, in some instances, get rid of ovarian tumours.

Ovarian Cancer Treatment Options

The main objective of your doctor would be to remove as much cancer from your body as possible. Some methods of treating ovarian cancer include -

Surgery

A doctor will typically remove your reproductive organs, as well as any organ that has cancer on it. For this purpose, the surgeon might use a laparoscopy or a laparotomy.

Chemotherapy

A doctor might ask you to go for chemotherapy either before or after the surgery. Chemotherapy drugs are powerful and are designed to target and kill cancerous cells. The doctor might administer chemotherapy intravenously or orally.

Targeted Therapy

In this form of cancer treatment, drugs are used to pick and attack cancer cells. Targeted therapy completely alters the way cancer cells grow and divide.

Hormone Therapy

Sometimes, ovarian cancers depend on hormones to grow. This kind of therapy blocks hormones, thereby slowing or halting cancer growth.

Radiation therapy

Radiation therapy is rarely used in the treatment of ovarian cancer. However, if other treatment methods don’t work, they are implemented.

After going through treatment for ovarian cancer, your doctor might want to see you regularly for observation. You might need routine appointments to check and ensure that the cancer hasn’t returned over time.

During these appointments, your doctor might go through possible symptoms and carry out an exam. If you have any symptoms, do let your doctor know.

While preventing ovarian cancer is a long shot, there are certain steps you can take to bring down your risk of getting this disease. They are:

Birth Control Pills

Ingesting birth control pills that have oestrogen and progesterone for five or more years might bring down your risk of getting ovarian cancer. However, taking birth control pills can increase your risk of contracting breast cancer.

Tubal ligation

This is a surgical procedure in which the surgeon will tie or block the fallopian tubes to stop eggs from reaching the uterus. This brings down your risk of ovarian cancer, even if you might have an average risk of developing it.

Breastfeeding

Breastfeeding is one of the most natural ways to prevent ovarian cancer. Doing it for at least one year dramatically reduces your risk of developing ovarian cancer.

Giving Birth

Giving birth, especially multiple times, might bring down your risk of getting ovarian cancer. This is because pregnancy reduces the frequency of ovulation.

Quit Smoking

Smoking tobacco drastically increases your risk of getting ovarian cancer. The longer you smoke, the greater the risk.

Weight Matters

Ensure that your body weight remains at a healthy level. Increasing your body weight or obesity can increase your risk of getting ovarian cancer.

Regular Medical Check-Ups

Always be sure to get regular gynaecological exams so that you can catch abnormalities early. Regular exams can nip cancer in the bud.

Genetic Counselling

If your family has someone who has been diagnosed with ovarian or breast cancer, you are automatically at more risk. Speak to a doctor as to how to bring down this risk over time.

If you have been diagnosed with ovarian cancer, there are certain questions that you must ask your healthcare provider.

Where is the tumour?

Finding out the exact tumour location is instrumental in getting treatment. You need to find out where in your body this tumour is present. Only then can you start treatment.

Has this cancer spread? How far?

Knowing whether the cancer is localised to one body part or has spread to neighbouring body parts is vital for treatment. Your doctor should be able to tell you exactly where this cancer has spread.

What treatments should I take?

Whether your doctor wants to go ahead with surgery, or chemotherapy, and radiation therapy, is their guess. Ask your doctor about the course of treatment you require.

What is my treatment duration?

Ask your doctor how long this treatment will take. Cancer treatment takes a fair bit of time, so knowing how much time in advance, can help.

Can I work while getting treated?

Ask your doctor whether it is possible for you to work while being treated for cancer. Usually, they shouldn’t have a problem.

To sum up, ovarian cancer is a serious health challenge. However, research has made some amazing progress. Early detection and treatment options have increased hope for many.

There’s no definite way to prevent this disease; however, knowing your risk factors, symptoms, and causes and going for regular check-ups can lead to early diagnosis and better outcomes.

Support from doctors and the community is important for those affected, assisting them in navigating their journey with strength and resilience. By raising awareness and investing in research, we can improve survival rates and, one day, maybe, find a cure for this deadly disease.

FAQs

I have a growth in my ovary. Do I have ovarian cancer?

Having a growth in your ovary puts you at risk for many ailments, ovarian cancer included. What you can do is get that growth examined so you know for sure whether it is cancer or not.

I am a 50 year old childless female. Am I at greater risk of getting ovarian cancer?

If you have not had children all your life, your risk of ovarian cancer might increase.

I don’t smoke or drink. Is it possible to contract ovarian cancer?

Even if you don’t smoke or drink, you might be at risk of ovarian cancer. Speak to a doctor about this risk today.

What are the early signs of ovarian cancer?

Ovarian cancer can be difficult to detect early, as symptoms often mimic other conditions. Common signs include bloating, abdominal pain, changes in appetite, frequent urination, and feeling full quickly.

Who is at risk for ovarian cancer?

While ovarian cancer can affect anyone, certain factors can increase risk, including age (more common in women over 50), family history of ovarian or breast cancer, genetic mutations (such as BRCA1 and BRCA2), and a personal history of endometriosis.