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Ovarian Cancer : Symptoms, Causes, Diagnosis and Treatment

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries ? each about the size of an almond ? produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Ovarian cancer refers to any cancerous growth that begins in the ovary. This is the part of the female body that produces eggs.

Ovarian cancer is now the fifth most common cause of cancer-related death among females in the United States. That said, deaths from ovarian cancer have been falling in the U.S. over the past 2 decades, according to the American Cancer Society (ACS).

The ACS estimate that in 2019, around 22,530 people may receive a diagnosis of ovarian cancer. Around 13,980 people are likely to die from this condition.

Ovarian Cancer belongs under the category of Sexual disease, Cancer. **Ovarian cancers** are now known to be several distinct diseases, which are named after the type of cell they come from: epithelial, germ cell, and stromal. These are the three main cell types that make up the ovary. Each cell type can develop into a different type of tumor, and each type differs in how it spreads, how it?s treated and its prognosis. - [**Epithelial ovarian cancer**](https://ocrahope.org/epithelial-ovarian-cancer/), which arise from the surface of the ovary (the epithelium), is the most common ovarian cancer. Fallopian Tube Cancer and Primary Peritoneal Cancer are also included within this designation. - [**Germ Cell ovarian cancer**](https://ocrahope.org/germ-cell-ovarian-cancer/) arises from the reproductive cells of the ovaries, and is rare. - **[Stromal cell ovarian cancer](https://ocrahope.org/stromal-cell-ovarian-cancer/),** which arises from connective tissue cells, is very rare. - [**Small cell carcinoma (SCCO)**](https://ocrahope.org/small-cell-carcinoma-of-the-ovary-scco/) of the ovary is an extremely rare ovarian cancer and it is not certain whether the cells in SCCO are from ovarian epithelial cells, sex-cord stromal cells or germ cells. are some common types of Ovarian Cancer. Generally Female are the victim of the Ovarian Cancer. Seriousness of this disease is Serious.

Symptoms of Ovarian Cancer are :

  • Pain during sex
  • Intercourse pain, or dyspareunia, can cause problems in a couple's sexual relationship. In addition to the physically painful sex occurs just before, during or after intercourse, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.

  • Irregular menstrual cycle or Irregular periods
  • On average, The normal length of a woman?s menstrual cycle is 24 to 38 days. A period usually lasts about 2 to 8 days. So this varies between individuals. When the length of the cycle is more than 35 days, or if the duration varies then it is called irregular menstruation or irregular periods.

  • Abdominal swelling
  • upset stomach
  • Frequent urination
  • constipation
  • Bone pain and Back pain
  • Weight loss
  • Sudden, noticeable weight loss can happen after a stressful event, although it can also be a sign of a serious illness.

    It's normal to lose a noticeable amount of weight after the stress of changing jobs, divorce, redundancy or bereavement.

    Weight often returns to normal when you start to feel happier, after you've had time to grieve or get used to the change. Counselling and support may be needed to help you get to this stage.

    Significant weight loss can also be the result of an eating disorder, such as anorexia or bulimia. If you think you have an eating disorder, talk to someone you trust and consider speaking to your GP. There are also several organisations that can provide you with information and advice, such as the eating disorders charity Beat.

    If your weight loss wasn't due to one of the causes mentioned, and you didn't lose weight through dieting or exercising, see your GP, as you may have an illness that needs treating.

  • abdominal pain
  • Abdominal pain has many potential causes. The most common causes ? such as gas pains, indigestion or a pulled muscle ? usually aren't serious. Other conditions may require more-urgent medical attention.

    While the location and pattern of abdominal pain can provide important clues, its time course is particularly useful when determining its cause.

    Acute abdominal pain develops, and often resolves, over a few hours to a few days. Chronic abdominal pain may be intermittent, or episodic, meaning it may come and go. This type of pain may be present for weeks to months, or even years. Some conditions cause progressive pain, which steadily gets worse over time.

  • Fatigue/weakness
  • Weakness

    Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.

    Fatigue

    Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.

    Causes

    Ovarian Cancer can be caused due to:

    While the causes of ovarian cancer are still unknown, scientists have some theories:

    • Genetic errors may occur during one?s life known as acquired (somatic) gene mutations;
    • A person can be born with gene mutations (hereditary gene mutations also known as germline mutations);
    • Because being pregnant and taking birth control pills can lower risk of ovarian cancer, ovarian cancer may be related to ovulation;
    • Though thought of as male hormones, androgens are found in women at lower levels, and may play a role in ovarian cancer;
    • And because tubal litigation and hysterectomy seem to lower risk, others have hypothesized that external substances that can cause cancer may enter the body through the vagina and pass through the uterus and fallopian tubes to the ovaries.

    Additionally, based on research, it is believed that many if not almost all high-grade serous ovarian cancers (the most common subtype) previously thought to originate in the ovaries actually arise from precursor lesions that begin in the fallopian tubes. Primary Peritoneal Carcinoma (PPC) is thought to develop from cells in the lining of the abdomen and pelvis, called the peritoneum. These cells are very similar to cells on the surface of the ovaries?some researchers believe PPC may also begin in the cells lining the fallopian tubes. Other subtypes diagnosed as PPC share molecular similarities, as well, and therefore high-grade serous carcinomas that originate from the fallopian tube and elsewhere in the peritoneal cavity, together with most epithelial cancers, are staged and treated similarly. Since 2000, FTC and PPC have generally been included in ovarian cancer clinical trials. Regardless of the site of origin, the hallmark of these cancers is their early peritoneal spread or metastases.

    It's not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease.

    In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).

    What kind of precaution should be taken in Ovarian Cancer?

    There's no sure way to prevent ovarian cancer. But there may be ways to reduce your risk:

    • Consider taking birth control pills. Ask your doctor whether birth control pills may be right for you. Women who use oral contraceptives may have a reduced risk of ovarian cancer. But oral contraceptives do have risks, so discuss whether the benefits outweigh those risks based on your situation.
    • Discuss your risk factors with your doctor. If you have a family history of breast and ovarian cancers, bring this up with your doctor. Your doctor can determine what this may mean for your own risk of cancer. In some cases, your doctor may refer you to a genetic counselor who can help you decide whether genetic testing may be right for you. If you're found to have a gene mutation that increases your risk of ovarian cancer, you may consider surgery to remove your ovaries to prevent cancer.

    How it can be spread?

    Early symptoms of ovarian cancer may include persistent bloating, abdominal discomfort, trouble eating and urinary urgency. However, not all women with ovarian cancer will experience symptoms in its early stages. Additionally, these symptoms are also associated with many other, more common conditions, so the presence of one or more of these symptoms does not necessarily mean you have ovarian cancer.

    Treatment for the Ovarian Cancer

    Diagnosis:

    Diagnosing ovarian cancer starts with a medical history and physical exam. The physical exam should include a pelvic and rectal examination. One or more blood tests may also be used to diagnose this condition.

    An annual pap smear test does not detect ovarian cancer. Tests that may be used to diagnose ovarian cancer include:

    • a complete blood count
    • a test for cancer antigen 125 levels, which may be elevated if you have ovarian cancer
    • a test for HCG levels, which may be elevated if you have a germ cell tumor
    • a test for alpha-fetoprotein, which may be produced by germ cell tumors
    • a test for lactate dehydrogenase levels, which may be elevated if you have a germ cell tumor
    • a test for inhibin, estrogen, and testosterone levels, which may be elevated if you have a stromal cell tumor
    • liver function tests to determine if the cancer has spread
    • kidney function tests to determine if the cancer has obstructed your urine flow or spread to the bladder and kidneys

    Other diagnostic studies can also be used to check for signs of ovarian cancer:

    Biopsy

    A biopsy is essential for determining if cancer is present. During the procedure, a small tissue sample is taken from the ovaries to look for cancer cells.

    This can be done with a needle that?s guided by a CT scan or by an ultrasound. It can also be done through a laparoscope. If fluid in the abdomen is present, a sample can be examined for cancer cells.

    Imaging tests

    There are several types of imaging tests that can look for changes in the ovaries and other organs that are caused by cancer. These include a CT scan, MRI, and PET scan.

    Checking for metastasis

    If your doctor suspects ovarian cancer, they may order other tests to see if the cancer has spread to other organs. These tests may include the following:

    • A urinalysis can be done to look for signs of infection or blood in the urine. These can occur if cancer spreads to the bladder and kidneys.
    • A chest X-ray can be done to detect when tumors have spread to the lungs.
    • A barium enema can be done to see if the tumor has spread to the colon or rectum.

    Regular ovarian cancer screenings are not recommended. Right now, medical experts believe they return too many false results. However, if you have a family history of breast, ovarian, fallopian tube, or peritoneal cancer, you may want to be tested for certain gene mutations and be screening regularly. Decide if ovarian cancer screenings are right for you. Other diagnostic test:

    • Abdominal exploration
    • Alpha Fetoprotein (AFP) Tumor Marker Test
    • BRCA Test
    • CA 125 Blood Test (Ovarian Cancer)
    • CEA Test
    • Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Screening
    • Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women
    • Screening for Ovarian Cancer
    • Stages of Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer
    • Stages of Ovarian Low Malignant Potential Tumors
    • Tumor Marker Tests]

    Treatment:

    Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

    Surgery

    Operations to remove ovarian cancer include:

    • Surgery to remove one ovary. For very early stage cancer that hasn't spread beyond one ovary, surgery may involve removing the affected ovary and its fallopian tube. This procedure may preserve your ability to have children.
    • Surgery to remove both ovaries. If cancer is present in both your ovaries, but there are no signs of additional cancer, your surgeon may remove both ovaries and both fallopian tubes. This procedure leaves your uterus intact, so you may still be able to become pregnant using your own frozen embryos or eggs or with eggs from a donor.
    • Surgery to remove both ovaries and the uterus. If your cancer is more extensive or if you don't wish to preserve your ability to have children, your surgeon will remove the ovaries, the fallopian tubes, the uterus, nearby lymph nodes and a fold of fatty abdominal tissue (omentum).
    • Surgery for advanced cancer. If your cancer is advanced, your doctor may recommend chemotherapy followed by surgery to remove as much of the cancer as possible.

    Chemotherapy

    Chemotherapy is a drug treatment that uses chemicals to kill fast-growing cells in the body, including cancer cells. Chemotherapy drugs can be injected into a vein or taken by mouth. Sometimes the drugs are injected directly into the abdomen (intraperitoneal chemotherapy).

    Chemotherapy is often used after surgery to kill any cancer cells that might remain. It can also be used before surgery.

    Targeted therapy

    Targeted therapy uses medications that target the specific vulnerabilities present within your cancer cells. Targeted therapy drugs are usually reserved for treating ovarian cancer that returns after initial treatment or cancer that resists other treatments. Your doctor may test your cancer cells to determine which targeted therapy is most likely to have an effect on your cancer.

    Targeted therapy is an active area of cancer research. Many clinical trials are testing new targeted therapies.

    Supportive (palliative) care

    Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery and chemotherapy.

    When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

    Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

    Possible complication with Ovarian Cancer

    Complications From Surgery

    • Infection You have a higher risk of developing an infection after surgery. Symptoms may include fever, chills, sweats, cough, shivering, or swelling or redness around the incision.
    • Vaginal bleeding After your procedure, you might experience some vaginal bleeding, similar to a light period, typically for a few days to a few weeks.
    • Blood clots You may be at risk for developing a blood clot in your pelvis or legs. To help prevent this, your medical team will encourage you to get up and walk around as soon as possible after your operation. You may also be given injections to thin your blood or be asked to wear special stockings.
    • Bleeding in the abdomen or pelvis You?ll likely lose some blood during surgery, and there?s a small chance you could bleed internally afterward.
    • Leg swelling If your surgeon removes your lymph nodes, you may experience fluid buildup in your legs or, rarely, in your genital area. Tell your doctor if this occurs.
    • Bladder or bowel issues When surgeons operate on the pelvis or abdominal area, there?s a risk of damaging the bladder or bowel.
    • Colostomy bag or catheter During an ovarian cancer debulking surgery (a technique to remove as much of the tumor as possible), your surgeon may remove part of the colon or bladder. Afterward, you may need to wear a colostomy bag to collect stool or a catheter to remove urine. These fixes are usually temporary. (3)
    • Infertility If you have surgery to remove both your ovaries, you won?t be able to get pregnant. Your doctor can tell you about possible ways to preserve your fertility or other options.
    • Early menopause Having your ovaries removed during surgery results in menopause if you haven?t already gone through it.

    Complications From Chemotherapy

    Chemo can also lead to short-term or long-term complications, such as:

    • Anemia This condition is characterized by low red blood cell counts and can cause tiredness and fatigue.
    • Leukopenia Resulting from low white blood cell counts, this complication can raise your risk of infection.
    • Thrombocytopenia The low platelet counts that lead to this condition can lead to easy bruising or bleeding.
    • Kidney damage The chemo drug cisplatin can affect your kidneys. Your doctor will give you lots of IV fluids to counteract it.
    • Neuropathy Cisplatin, Taxol (paclitaxel), and Taxotere (docetaxel) can lead to nerve damage, which may trigger numbness, tingling, or pain in the hands and feet.
    • Hearing loss Cisplatin can damage nerves to the ear, which can affect hearing.
    • Early menopause You might experience menopause sooner than you would have without chemo.
    • Infertility Some women aren?t able to become pregnant after receiving chemo treatments.
    • Bone marrow damage This side effect is rare, but it can happen. If the damage is permanent, it can lead to a bone marrow cancer, such as myelodysplastic syndrome or acute myeloid leukemia.
    • Bladder problems The medication ifosfamide may cause irritation and bleeding in the lining of the bladder.

    Complications From Radiation Therapy

    Radiation uses high energy beams to kill cancer cells. It?s not typically used for ovarian cancer, but it could help treat areas where cancer has spread.

    Side effects are usually temporary and improve after treatment stops. They may include skin changes, fatigue, nausea, vomiting, diarrhea, or vaginal irritation

    Complications From Targeted Therapy

    Some women with ovarian cancer benefit from targeted therapy, a treatment that homes in on specific targets on cancer cells.

    The therapy can cause side effects such as nausea, diarrhea, vomiting, dizziness, fatigue, loss of appetite, weight gain, taste changes, confusion, or pain affecting the muscles, joints, or belly.

    Anemia, heart problems, and abnormal liver tests are some possible complications associated with targeted drugs. Rarely, some of these medicines can lead to a blood cancer, such as myelodysplastic syndrome or acute myeloid leukemia.

    Common Complications From Ovarian Cancer

    • Fatigue or weakness In one study, 75 percent of women reported this symptom. (9)
    • Nausea, vomiting, or constipation These are common gastrointestinal side effects.
    • Edema Excess fluid buildup in body tissues can cause swelling in the legs or pelvic area.
    • Anemia Low blood cell counts can be caused by the cancer itself.
    • Ascites These are collections of fluid in the abdominal cavity that are caused by the cancer. Symptoms of ascites may include swelling, bloating, shortness of breath, indigestion, loss of appetite, or worsened fatigue.
    • Bowel or bladder obstruction Large tumors may block the intestines or bladder. This can lead to pain and discomfort, and may require corrective procedures.
    • Pleural effusion Pleural effusion is a buildup of fluid between the thin membranes that line the lungs and the inside of the chest cavity. It can cause breathing difficulties and other symptoms.
    • Nutrition issues If you can?t eat on your own because of the side effects of cancer or you?re malnourished, you may receive parenteral nutrition, which involves getting your requirements intravenously

    References:

    1 https://medlineplus.gov/ovariancancer.html#cat_78 2 https://www.plusmedical.ro/en/articole/comunicat-de-presa-ce-este-cancerul-ovarian-si-cum-poate-fi-tratat/ 3 https://www.healthline.com/health/cancer/ovarian-cancer-facts-statistics-infographic#1 4 https://www.medicalnewstoday.com/articles/159675#stages 5 https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941 6 https://ocrahope.org/patients/about-ovarian-cancer/ 7 https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging.html 8 https://www.verywellhealth.com/ovarian-cancer-symptoms-514265 9 https://www.healthline.com/health/ovarian-cancer/advanced-ovarian-cancer-treatment-complications#1

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