Ovarian Cancer

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones (chemicals that control the way certain cells or organs work).

Risk Factors

• Family history of ovarian cancer in a first-degree relative (mother, daughter, or sister)
• Inherited changes in the BRCA1 or BRCA2 genes
• Hereditary nonpolyposis colorectal cancer (HNPCC also called Lynch syndrome)
• Endometriosis
• Postmenopausal hormone therapy
• Obesity
• Tall height

 

Symptoms

• Pain, swelling, or a feeling of pressure in the abdomen or pelvis
• Vaginal bleeding that is heavy or irregular, especially after menopause
• Vaginal discharge that is clear, white, or colored with blood
• Lump in the pelvic area
• Gastrointestinal problems, such as gas, bloating, or constipation

Investigations

• Physical exam and history
• CA-125 blood assay
• Ultrasound scan
• CT scan
• PET scan (positron emission tomography)
• MRI scan (magnetic resonance imaging)
• Chest x-ray
• Biopsy

Prognosis

The prognosis (chance of recovery) depends on the following:

• Type and extent of ovarian cancer
• Stage and grade of the cancer
• If there is extra fluid in the abdomen causing swelling
• If all of the tumor can be removed by surgery
• If there are changes in BRCA1 or BRCA2 genes
• Age and general health of patient
• If the cancer has just been diagnosed or has recurred

Ovarian cancer tends to spread to the gastrointestinal tract. Complete surgical removal of ovarian cancer often requires removal of the involved portions of the gastrointestinal tract.

Staging

Stages of ovarian cancer are Stage I, II, III and IV. Stage I ovarian cancer is treated as early cancer. Stages II, III, and IV ovarian are treated as advanced cancers.

Treatment

Three kinds of standard treatment are used–

Surgery

Most patients have surgery to remove as much of the tumor as possible. Different types of surgery include:

• Hysterectomy: Surgery to remove the uterus
• Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube
• Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes
• Omentectomy: A surgical procedure to remove the omentum
• Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.
• Removal of other organs: Surgical procedure to remove other organs such as colon, rectum or bowel involved by cancer.

Chemotherapy

Chemotherapy maybe systemic or regional depending on the type and stage of the cancer being treated. A type of regional chemotherapy used to treat ovarian cancer is intraperitoneal chemotherapy in which the anticancer drugs are delivered directly into the peritoneal cavity through a thin tube. In hyperthermic intraperitoneal chemotherapy (HIPEC) warmed chemotherapy is sent directly into the peritoneal cavity.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays to kill cancer cells. Some women receive a treatment called intraperitoneal radiation therapy in which radioactive liquid is put directly in the abdomen through a catheter.