Ovarian Cancer

Ovarian cancer is the third most common cancer amongst women. It usually occurs in women above 50 years of age. This form of cancer is often called the 'silent killer' because the symptoms manifest at a later stage of the disease. Since the ovaries are located deep inside the abdomen, they are not easily accessible for examination.

Causes:

• Have no children
• Have had breast or colon cancer
• Use fertility drugs regularly
• Are on or have undergone hormone replacement therapy

Symptoms:

• Stomach ache and abdominal discomfort accompanied by a feeling of bloating or fullness of the stomach
• Abnormal vaginal bleeding
• Sudden weight gain or weight loss without any apparent reason
• Loss of appetite, nausea, vomiting, constipation and frequent urination in some cases

Diagnosis:

Diagnosis of ovarian cancer starts with a physical examination, a blood test and ultrasound.

Ovarian cancer at its early stages is difficult to diagnose until it spreads and advances. This is because most symptoms are non-specific and thus of little use in diagnosis. The doctor may conduct vaginal or internal examination to investigate your ovaries and womb. They may also take a blood sample or refer you for an ultrasound scan.

The various methods used to diagnose ovarian cancer are:

Blood test (CA-125)

The doctor may conduct a blood test to look for a chemical called CA-125 in the blood. This chemical is produced by some ovarian cancer cells. A very high level of CA-125 in the blood may mean you have ovarian cancer.

However, this chemical is not specific to ovarian cancer and may also be raised in many benign conditions, so a raised level of CA-125 does not definitely mean you have ovarian cancer.

The National Institute for Health and Care Excellence (NICE), UK, has produced guidance that advises you to go for a test for CA-125 if you frequently experience:

• Bloating
• Feeling full quickly
• Loss of appetite
• Pelvic or abdominal pain

The CA-125 test is particularly important if you are 50 or over, or have these symptoms more than 12 times each month.

If in the test, the patient has a raised CA-125 level, then the doctor advices an ultrasound scan.

Ultrasound

An ultrasound uses high frequency sound waves to produce an image of the patient's ovaries. An internal ultrasound also known as a trans-vaginal ultrasound is where the ultrasound probe is inserted into the vagina, or it may be an external ultrasound, where the probe is put next to the stomach. The image produced can show the size and texture of the ovaries, as well as any cysts that may be present.

Further tests

If the patient has been diagnosed with ovarian cancer, she will have to undergo further tests which will determine how large the cancer is and whether it has spread. This is called staging.

Further tests may include:

• Chest X:ray: This shows if the ovarian cancer has spread to the lungs or caused a build-up of fluid around the lungs
• CT scan or MRI scan: These imaging techniques are used to look for signs of cancer elsewhere in the abdomen and pelvis
• Abdominal fluid aspiration: If there is a build-up of fluid in the abdomen and it looks swollen, it might mean that ovarian cancer has spread. To find out, a thin needle is passed into the abdomen to take a sample of fluid to be tested for cancer cells
• Laparoscopy: this small operation may be performed if the gynaecologist wants to take a better look at the ovaries. A thin tube with a camera on the end is inserted through a small cut in the lower abdomen in order to examine your ovaries. A small sample of tissue may be taken from your ovaries for testing.

Treatment:

Depending on the stage of the ovarian cancer, the doctor recommends one of the following approaches:

• Surgery
• Chemotherapy
• Radiotherapy

Surgical treatment may be sufficient for malignant tumours that are well-differentiated and confined to the ovary. In addition, chemotherapy may be required for more aggressive tumours that are confined to the ovary. For patients with advanced disease, a combination of surgical reduction with a combination chemotherapy regimen is standard.

Surgery

Surgery is the preferred treatment and is frequently necessary to obtain a tissue specimen for differential diagnosis via its histology.

The type of surgery depends upon how widespread the cancer is when diagnosed as well as the presumed type and grade of cancer. The surgeon may remove one or both ovaries, the Fallopian tubes, and the uterus.

 Chemotherapy

Chemotherapy has been a general standard of care for ovarian cancer for decades, although with highly variable protocols. Chemotherapy is used after surgery to treat any residual disease, if appropriate. This depends on the histology of the tumour; some kinds of tumours are not sensitive to chemotherapy. In some cases, there may be a reason to perform chemotherapy first, followed by surgery.

Radiation therapy

Radiation therapy is not effective for advanced stages because when vital organs are in the radiation field, a high dose cannot be safely delivered. Radiation therapy is then commonly avoided as the vital organs may not be able to withstand the problems associated.