Ovarian Cancer: A Critical Female Syndrome

About 78% of women with ovarian cancer survive 1 year after diagnosis, and more than 50% survive longer than 5 years after diagnosis. If diagnosed and treated while the cancer has not spread outside the ovary, the 5-year survival rate is 90-95%. However, only 29% of all ovarian cancers are found at this early stage.

Types of ovarian cancer:

A malignant tumor that begins in the ovaries is called ovarian cancer. There are several types of ovarian cancer. Ovarian cancer that begins on the surface of the ovary [epithelial carcinoma] is the most common type. Ovarian cancer that begins in the egg-producing cells [germ cell tumors] and cancer that begins in the supportive tissue surrounding the ovaries [stromal tumors] are rare. The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells when the body needs them. This orderly process helps to keep the body healthy. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign or malignant.

1. Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back.
2. Malignant tumors are cancer. Cells in these tumors are abnormal and divide without control or order. They can invade and damage nearby tissues and organs

Ovarian cancer cells can break away from the ovary and spread to other tissues and organs in a process called shedding. When ovarian cancer sheds, it tends to form new tumor on the large membrane called peritoneum that lines the abdomen and on the diaphragm. This condition is known as ascites. It may make a woman feel bloated, or her abdomen may look swollen. Ovarian cancer cells can also enter the bloodstream. Once in the bloodstream or lymphatic system, the cancer cells can travel and form new tumors in other parts of the body.

Women with ovarian cancer in its early stages rarely have more than the most subtle symptoms. They may feel swollen or bloated - or suffer a generalized discomfort in the lower abdomen. But these are all symptoms that could easily be caused by something minor. There could be a loss of appetite or weight loss. It is only as a tumor grows and spreads that the symptoms become more pronounced. It may press on neighboring organs, such as the bowel or bladder, causing either constipation or frequent urination. There can also be a build-up of fluid in the abdominal cavity, and around the lungs, causing shortness of breath. It is uncommon that an obvious symptom such as bleeding from the vagina occurs. A doctor examining for the signs of ovarian cancer will carry out a full pelvic examination, feeling for the presence of a pronounced tumor.

Ovarian Cancer Tests and Diagnosis:

• Ultrasound.
• CT scan - it is carried out to look for signs of cancer.
• Barium enema - the patient is given a mildly radioactive enema then a series of x-rays. The barium helps the radiologist highlight the exact shape of the bowel and rectum, which may show up problems.

In addition, blood tests may show up the presence of a substance produced by ovarian cancer cells but not by healthy ones.

However, the only way to confirm the presence of ovarian cancer is by performing a biopsy operation to take a tissue sample. This is normally done by inserting a needle or tube into the abdominal cavity to take a tiny sample of tumor tissue. Scientists do not yet know what causes ovarian cancer, although there are some clues to its origin. If a woman has a close relative who has had the disease, the risk of her developing the disease increases. Some of these women may currently be offered screening tests, such as blood tests or ultrasound, to try to catch the disease early. Women who have never had a child also run an increased risk of ovarian cancer.

Most ovarian cancers happen in women over the age of 50 - the risk increases for older women. In addition, women who have previously suffered from breast cancer are twice as likely to get ovarian cancer in the future.

Treatment options

Surgery is almost always the first treatment a woman with ovarian cancer undergoes. This normally involves removal of the ovaries, the womb and the fallopian tubes, which link the two. Usually both ovaries are removed, unless the patient has only a slow growing cancer in one, and wants her fertility to be preserved.

The surgeon cannot always be sure that all the cancerous cells have been removed, so chemotherapy is almost always given as well, to kill any which remain in the body. The recommended type of chemotherapy involves drugs called taxanes, which are not available on the NHS in all parts of the country.

Radiotherapy is also occasionally used to kill cancer cells in the pelvic area.
Many factors increase or reduce the woman's chance of beating ovarian cancer.
The main one is the spread of the disease - if caught early, as with many cancers, it is much more treatable, particularly if only one part of one ovary is involved.
If the cancer involves a whole ovary, both ovaries, or has spread to involve other tissues, the chances of cure fall. The woman's age and general state of health can affect her ability to cope with surgery, chemotherapy and other treatments.

Also important is the type of ovarian cancer - some affect the cells which line the womb, whereas some affect the cells which produce eggs. Both have different cure rates.

Some questions to ask your Physician

As you cope with cancer and cancer treatment, you need to have honest, open discussions with your doctor. You should feel free to ask any question that's on your mind, no matter how small it might seem. Here are some questions you might want to ask. Be sure to add your own questions as you think of them. Nurses, social workers, and other members of the treatment team may also be able to answer many of your questions.

1. Would you please write down the exact kind of cancer I have?
2. Has my cancer spread beyond the ovaries?
3. What are the cell type, stage, and grade of my cancer, what does that mean in my case?
4. What treatment options are there? What do you recommend? Why?
5. What is the goal of this treatment?
6. What are the risks or side effects that I should expect?
7. Will I be able to have children after my treatment?
8. Will I lose my hair? If so, what can I do about it?
9. What are the chances my cancer will come back with the treatment we have discussed?
10. What should I do to be ready for treatment?
11. Should I follow a special diet?
12. What are my chances of survival, based on my cancer as you see it?

Can Ovarian Cancer Be Prevented

Most women have one or more risk factors for ovarian cancer. But risk factors only partly explain the disease, since most of them increase risk only slightly. So far, knowledge about risk factors has not led to ways to prevent the disease.

Some of the actions listed below may reduce the risk of the most common type of ovarian cancer only slightly, while others may decrease it much more.

Birth control pills: Birth control pills reduce the risk of ovarian cancer, especially among women who use them for several years.

Tubal ligation or hysterectomy: "Tying" the tubes as a method of birth control, when done after childbearing, may reduce the chance of ovarian cancer. Removing the uterus may also reduce the risk. But these surgeries should only be done for a valid medical reason and not just for their effect on ovarian cancer risk.

Pregnancy and breast-feeding: Having one or more children plus breast-feeding for a year or longer may decrease the risk of ovarian cancer. Although these measures slightly reduce the risk, they don't offer complete protection. Doctors do not suggest making these choices about when to have a child simply for the purpose of reducing ovarian cancer risk. Keep in mind that using the birth control pill has a greater impact on this risk.

Diet: A number of studies have shown a lower rate of this cancer in women who ate a diet high in vegetables. The American Cancer Society recommends eating a wide variety of healthful foods, with many from plant sources. Eat at least 5 servings of fruits and vegetables every day. And limit the amount of red meats, especially those that are high in fat.

Aspirin and acetaminophen: Some studies have shown that both aspirin and acetaminophen (Tylenol) reduce the risk of ovarian cancer. Women should not take these drugs simply to prevent this cancer. More research is needed.

Women with a family history of ovarian cancer might want to think about genetic counseling and perhaps genetic testing. Before asking for the test, a woman should discuss the benefits and possible drawbacks with her doctor. Genetic testing can tell if a woman carries certain gene changes that cause a higher risk of ovarian cancer. Learning that she does not have the gene change can be a great relief, while finding out that she does can be quite stressful. But the information can be helpful in looking at methods to prevent cancer.

Studies looking at whether the birth control pill could lower the risk of ovarian cancer have shown mixed results. For women at average risk, the pill does lower the risk. But for women at high risk because of gene changes, the results are mixed. More research is needed to make clear the pros and cons of the pill for women at high risk of ovarian or breast cancer.

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