Understanding Ovarian Cancer
and How to Manage It

Compassionate care focused on improving quality of life

“We acquire the strength we have overcome.”

Ralph Waldo Emerson

Early detection and diagnosis always increase your chances of receiving successful treatment and beating all forms of cancer – including ovarian cancer. Detecting ovarian cancer early will significantly boost your odds of survival. Hence, it is important to adhere to the recommended screening protocol for your age group so that you and your physician can detect and test any anomalies or changes.

You can read the section that details the various types of cancer before embarking on the journey
to understand ovarian cancer better. Read more

Let’s understand
the anatomy first

The ovaries are a pair of organs in the female reproductive system – there is one ovary on each side of the uterus. The ovaries produce eggs or ova and the hormones oestrogen and progesterone. 

There are two fallopian tubes, which are long and slender tubes on either side of the uterus. The eggs or ova pass from the ovaries through the fallopian tubes, to the uterus. 

The peritoneum is the tissue lining covering organs in the abdomen.

What is ovarian cancer?

Ovarian cancer is a type of gynaecological cancer that originates in the ovaries, the related areas of the fallopian tubes, and the peritoneum. It begins when healthy cells in the ovaries, fallopian tubes or the peritoneum start mutating or changing. Such mutations cause these cells to grow rapidly and prevent cell death. The accumulation of these abnormal cells forms a malignant mass or tumour. Often, the cancer cells invade nearby tissues and may break off from a tumour to spread or metastasize to other parts of the body. Ovarian cancer can often be cured.

Types of Ovarian Cancer

Ovarian cancer types are classified based on the types of cells where the cancer begins and how they look under a microscope; and include the following

Epithelial ovarian cancer

Epithelial ovarian cancer is the most common type and begins in the thin layer of tissue that covers the outer surface of the ovaries. Approximately 90 percent of all ovarian cancers are epithelial ovarian cancers.

Stromal ovarian cancer

Stromal ovarian cancer begins in the ovarian tissue, which has hormone-producing cells. About 7 percent of all ovarian cancers belong to this type.

Germ cell ovarian cancer

Germ cell ovarian cancer begins in the egg or ova producing cells and is a rare type of cancer. This type of cancer usually affects girls and young women.

What causes ovarian cancer?

While the exact causes of ovarian cancer are not known, it is found to be primarily due to changes or mutations in the DNA of the cells of the ovaries, fallopian tubes or peritoneum. These mutations give rise to abnormal cells, which grow uncontrollably and accumulate to form a mass or tumour. These cancer cells may also invade the nearby tissue and may spread or metastasize from the initial tumour to other parts of the body. You can read more about metastasis here. Read more

What are the Risk Factors?

While there is no way to ascertain your chances of developing ovarian cancer, there are several factors which may put you at higher risk

Your age – ovarian cancer often occurs in older women

A family history of ovarian cancer

Inherited gene mutation in genes – BRCA1 & BRCA2 puts you at higher risk.

Hormone therapy (especially treatments using oestrogen)

Starting to menstruate at an early age or starting menopause at a later age

Smoking has been known to increase the risk of developing a type of ovarian cancer called mucinous cancer

Having other medical conditions

  • Breast cancer – Women who have had breast cancer are more likely to develop ovarian cancer, since both cancer types share common risk factors
  • Endometriosis – A condition in which the lining of the uterus grows outside the uterus
  • Diabetes – A condition where the natural ability of the body to produce insulin is compromised
  • Lynch syndrome – A hereditary nonpolyposis colon cancer (HNPCC)

What Can be Done to Lower Your Risk of Getting Ovarian Cancer?

While there are no sure methods to prevent endometrial cancer, research has shown that certain factors may lower your risk

  • Maintaining an optimal body weight
  • Being physically active
  • Taking oral contraceptives (birth control pills)
  • Giving birth Breastfeeding for at least 8 to 10 months Discussing the pros and cons of hormone therapy with your doctor Talking to your doctor about ovarian cancer if you have breast cancer, endometriosis, diabetes or Lynch syndrome (HPNCC)
What are the Symptoms?

Ovarian cancers seldom cause any symptoms in the early stages and hence often go undetected. In advanced stages ovarian cancers may cause some nonspecific symptoms and could be often mistaken for more common health issues. Some signs and symptoms may include

Abdominal bloating or swelling

Difficulty eating, or feeling full too quickly

Unexplained weight loss

Pain or discomfort in the pelvic area

Changes in bowel habits

Unusual vaginal discharge

Vaginal bleeding after menopause

Experiencing these symptoms does not always mean that you have ovarian cancer. However, if you have any signs or symptoms which are out of the ordinary, it is recommended that you visit your doctor.Lynch syndrome – A hereditary nonpolyposis colon cancer (HNPCC)

Screening and Diagnosis

Ovarian cancer occurs only in women. If you experience any of the signs and symptoms listed abov, make an appointment with your doctor for prompt evaluation. Screening tests may be done when you have no cancer symptoms at all. The main objective of screening is to detect precancerous changes in the cells of the ovaries, fallopian tubes and peritoneum, which if untreated have a potential to develop into cancer. The secondary objective is to find ovarian cancer at an early stage, when treatment is usually more successful. 

It is important to remember that your physician does not necessarily think you have cancer if he or she suggests a screening test. They could just be following a normal screening protocol for your age group.

Screening tests for ovarian cancer
The Pelvic Exam

What to expect

A pelvic exam is a part of a woman’s routine medical check-up. Pelvic exams can help diagnose certain types of cancers, as well as reproductive problems. A Pap test can be done during a pelvic exam , but sometimes a pelvic exam is done without a Pap test. A Pap test is needed to find early cervical cancer or pre-cancers so ask your doctor if you need a Pap test along with your pelvic exam.

A pelvic exam is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up. 

During a pelvic exam: 

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will look at your pelvic area and feel your reproductive areas. It is normal for your doctor to insert his/her gloved fingers into your vagina as part of the test.
  • Your doctor may also do routine screening tests for sexually transmitted diseases by taking a swab of cells.
  • The collected samples are then examined in the lab for any abnormalities.
  • The pelvic exam itself should take around 5-10 minutes. If you experience any pain, be sure to inform your doctor.
Transvaginal ultrasound

What to expect

A transvaginal ultrasound is used to examine the female reproductive organs (including the ovaries, fallopian tubes and peritoneum) and detect any abnormalities.

The ultrasound is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up.

During this procedure:

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will start by applying a special gel to a small probe, called the transducer. The rounded end of this device is then gently inserted into the vagina.
  • Sound waves are used to create video images of your uterus.

Both these tests are screening tests. They cannot help you tell for certain if you have ovarian cancer. However, an abnormal result may indicate that more testing is required.

The CA 125 Blood Test

What to expect

The doctor may also test your blood for tumour markers that indicate ovarian cancer. The CA 125 test which measures the quantity of the protein CA 125 – also called cancer antigen 125 in your blood – can detect a protein that is often found in high levels in women with ovarian or fallopian tube cancer.

Diagnostic tests for VAGINAL cancer
Biopsy

What to expect

A biopsy is usually the best way to tell for certain if an abnormal area is cancerous or not. This procedure involves collecting a sample of tissue for further analysis in a lab. In most cases, a biopsy is needed before any treatment starts. While the screening tests for ovarian cancer are generally painless, a biopsy can cause discomfort, bleeding or even pain. There are generally two types of biopsies used to diagnose ovarian cancers

Image-guided biopsy
In this method, the doctor will pass a fine needle through the skin, using a CT or ultrasound scan to guide them to the right place. Your doctor will normally use local anaesthesia to complete this procedure. You may also be given a mild sedative to help you relax. You will usually be kept under observation for a few hours after this test, or sometimes overnight.

Laparoscopy
This is a surgical procedure used to take biopsies. You will be given a general anaesthetic (i.e. you will be asleep) during the operation. The doctor will make a few small cuts in the abdomen. Then he or she will pump gas into the abdominal wall, to gain better visibility of the internal organs. Next, your doctor will pass a thin tube with a small camera at one end into the abdomen. This instrument is called a laparoscope. The doctor will then examine the area carefully and take biopsies. You may experience some pain or discomfort after the procedure, but this will usually subside after a day or two. You will usually be kept under observation for a few hours after this test, or sometimes overnight.

Staging Ovarian Cancer

If your physician detects or confirms ovarian cancer, you may be referred to a specialist in female reproductive cancers – called a gynecological oncologist. A gynecological oncologist is an obstetrician-gynecologist or OB-GYN, who has additional training in the diagnosis and treatment of ovarian and other gynecological cancers. Once your cancer is diagnosed, other tests may be used to determine

If the disease has spread beyond the ovaries (i.e. determine the stage of cancer)

How quickly the cancer will grow

How likely it is to spread through the body

What sort of treatments might work

The likelihood of the cancer to recur (come back)

The stage of your cancer is a key aspect in determining your treatment. Refer to this section to understand your cancer diagnosis and for more information about how ovarian cancer is staged. Read more

Treatment options
for ovarian cancer

The decision about the best course of treatment is based on these test results and the type, stage, grade and size of your tumour. Treatments like surgery, chemotherapy and radiation therapy are some of the options used for ovarian cancer. Refer to this section to understand the types of cancer treatments for ovarian cancer and possible side effects. Read more

Your cancer journey
Everyone deals with a cancer diagnosis and treatment in a different way. Refer to this section, to understand various aspects of your cancer journey and the road to recovery. Read more
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