Ovarian Cancer

Understanding Ovarian Cancer Patient Information

Ovarian Cancer: An Overview

Cancer occurs when cells in an area of the body grow abnormally.

Ovarian cancer is the seventh most common cancer among women.

There are three types of ovarian cancer:

(1) epithelial ovarian cancer

(2) germ cell cancer and

(3) stromal cell cancer.

  • Epithelial ovarian cancer is the most common and accounts for 85 percent to 89 percent of ovarian cancers. It forms on the surface of the ovary in the epithelial cells.
  • On the other hand, germ cell cancer is an uncommon form of ovarian cancer, accounting for only about five percent of ovarian cancers.Germ cell cancers start in the cells that form the eggs in the ovaries. This cancer is usually found in adolescent girls and young women, and usually affects only one ovary. Please visit the Women’s Cancer Network
  • Stromal cell cancer starts in the cells that produce female hormones and hold the ovarian tissues together. Familial breast-ovarian cancer syndrome is a common inherited condition that causes 10 percent of all ovarian cancers and 5–10 percent

of all breast cancers. Research confirms that there is a link between breast and ovarian cancer. Any woman who has had one of these cancers is at a higher risk for developing the other.

Epithelial Ovarian Cancer:

  1. 1. Risk increases with age, especially around the time of menopause.
  2. A family history of epithelial ovarian cancer, fallopian tube cancer, peritoneal cancer, premenopausal breast cancer and/or male breast cancer is a very important risk factor.
  3. A personal history of premenopausal breast cancer is also an important risk factor, and some families affected by both colon and endometrial cancer will also have an increased risk.

4.Infertility and not bearing children are also risk factors.

Epithelial Ovarian Cancer:

These symptoms include:

➤ Bloating

➤ Pelvic or abdominal pain

➤ Difficulty eating or feeling full quickly

➤ Urinary symptoms (urgency or frequency).

Women who have these symptoms almost daily for more than a few weeks should see their doctor, Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

It is important to understand that symptoms associated with ovarian cancer are common and often due to other causes. And therefore are not specific. We all have these symptoms from time-to-time, but it does not mean that we have ovarian cancer. Again, if you have these symptoms, and they are new and occur almost daily for more than a few weeks, this could be a sign of ovarian cancer. Seek prompt medical attention.

When a woman experiences concerning symptoms, a pelvic exam, including a rectovaginal exam, and a general physical exam should be performed. If the exam is abnormal, women should undergo a transvaginal or pelvic ultrasound to evaluate the ovaries. If an abnormality of the ovaries is found,additional radiographic studies, such as a CT scan, or MRI and a blood

test for CA 125, may be performed. CA 125 is elevated in approximately 80 percent of women with advanced stage epithelial ovarian cancer, but elevations can occur for reasons other than ovarian cancer.

When ovarian cancer is diagnosed, it is important  to determine if the cancer has spread beyond the ovaries. Your treatment team may do more tests to determine if the cancer has spread. In addition, during surgery, certain additional steps should be performed to determine the extent of the disease. This process is called staging. Staging helps to determine the exact extent of your cancer and what treatment plan is best for you. It is important that your surgery be performed by a Surgical oncologist(Cancer Surgeon)

Following surgery, your cancer will be categorized into one of the following stages:

 

Stage I: The cancer is found in one or  both ovaries. Cancer cells also may be found on the surface of the ovaries or in fluid collected from the abdomen.

 

Stage II: The cancer has spread from one or both ovaries to other tissues in the pelvis, such as the fallopian tubes or uterus. Cancer cells may also be found in fluid collected from the abdomen.

 

Stage III: The cancer has spread outside the pelvis or nearby lymph nodes. Most commonly the cancer spreads to the omentum (an apron of fatty tissue that hangs down from the colon and stomach), diaphragm, intestine and the outside (surface) of the liver.

 

Stage IV: The cancer has spread to tissues outside the abdomen and pelvis. Most commonly to the space around the lungs. If the cancer spreads inside the liver or spleen, it is considered stage IV.

T REATMENT

Ovarian cancer is most often treated with surgery and chemotherapy.Only rarely is radiation therapy used. It is important to distinguish between early stage ovarian cancer and advanced disease because the

treatment approaches are different. Your specific treatment plan will depend on several factors, including:

➤ The stage and grade of your cancer

➤ The size and location of your cancer

➤ Your age and general health

Surgery is usually the first step in treating ovarian cancer. Most surgery is performed

using a procedure called a laparotomy during which the surgeon makes a long cut in the wall of the abdomen. If ovarian cancer is found, the following procedures are performed:

Salpingo-ooophorectomy: both ovaries and fallopian tubes are

removed.

Hysterectomy: the uterus is removed.

In addition, the omentum, a fatty pad of tissue that covers the intestines, is removed along with nearby lymph nodes, and multiple tiny samples of tissues from the pelvis and abdomen.

If the cancer has spread, the gynecologic oncologist removes as much cancer as possible. This is called “debulking” surgery. Often this will involve extensive surgery, including removal of portions of the small or large intestine and removal of tumor from the liver, diaphragm and pelvis. Removal of as much tumor as possible is one of the most important factors affecting cure rates.

If you have early Stage I cancer, and still hope to get pregnant, it may be possible to only remove one ovary and fallopian tube. Your future pregnancy wishes should be discussed with your oncologist

before surgery.

Side effects of surgery

Some discomfort is common after surgery. It often can be controlled with medicine. Tell your treatment team if you are experiencing pain.

Other possible side effects are:

➤ Nausea and Vomiting

➤ Infection, fever

➤ Wound problem

➤ Fullness due to fluid in the abdomen

➤ Shortness of breath due to fluid around the lungs

➤ Anemia

➤ Swelling caused by lymphedema, usually in the legs or arms

➤ Blood clots

➤ Difficulty urinating or constipation

Talk with your doctor if you are experiencing any of the problems listed.

  • Occasionally, cancers will be advanced at initial diagnosis and your surgical oncologist may feel that surgery is unlikely to be as effective as desired, or that immediate surgery will be too difficult for you to tolerate.
  • In this situation, chemotherapy treatments can be given to shrink the tumor. Once there has been shrinkage and your physical condition is improving, surgery is performed usually followed by more chemotherapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for ovarian cancer is usually given intravenously (injected into a vein).  Chemotherapy is usually given in cycles. Periods of chemotherapy treatment are alternated with rest periods when no chemotherapy is given. Most women with ovarian cancer receive chemotherapy for about 6 months following their surgery.

 

Side Effects:

Each person responds to chemotherapy differently. Some people may have very few side effects while others experience several. Most side effects are temporary. They include:

➤ Nausea

➤ Loss of appetite

➤ Mouth sores

➤ Increased chance of infection

➤ Bleeding or bruising easily

➤ Vomiting

➤ Hair loss

➤ Fatigue

A few types of ovarian cancer need hormones to grow. In these cases, hormone therapy may be a treatment option. Hormone therapy removes female hormones or blocks their action as a way of preventing ovarian cancer cells from getting or using the hormones they may need to grow.

Hormone therapy is usually taken as a pill, but can be given as a shot.

Side effects:

  • The side effects depend on the type of hormones being used.
  • Some women retain fluid and have a change in appetite or have hot flashes.

After treatment completion you may require to visit your oncologist at frequent intervals usually every 3 months. Some investigations like an USG abdomen and pelvis and Ca 125, maybe advised to you at follow up.

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