Ovarian Cancer

Introduction
The ovaries are one of the main parts of the female reproductive system, located on both sides of the uterus inside the pelvis. Each ovary is about the size of an almond. Their main functions are producing the female hormones estrogen and progesterone, as well as releasing eggs. The eggs travel from the ovaries into the fallopian tubes and then reach the uterus.
When women reach menopause, the ovaries stop releasing eggs, and hormone secretion decreases significantly.
Inside the ovaries, there are two important types of cells: germ cells, which produce eggs, and epithelial cells, which cover the surface of the ovaries. If germ cells undergo cancerous changes, germ cell tumors develop. Cancer arising from epithelial cells, called epithelial ovarian cancer, is more common than germ cell cancer.
Risk Factors
Factors that may increase the risk of ovarian cancer include:
Having a strong family history of ovarian, breast, uterine, or colorectal cancer
A personal history of breast, uterine, colon, or rectal cancer
Never having been pregnant, or becoming pregnant at an older age
Early onset of menstruation (at a young age) or late menopause
Women who believe they may be at risk should discuss this with their doctor for proper evaluation.
Symptoms
In its early stages, ovarian cancer usually does not cause obvious or specific symptoms, which is why it is often called the “silent killer.”
As the disease progresses and the tumor grows, symptoms may include:
Pain or pressure in the abdomen, pelvis, back, or legs
Nausea, indigestion, bloating, constipation, or diarrhea
Feeling full quickly or loss of appetite even after eating a small amount
Severe, persistent fatigue
Shortness of breath
Frequent need to urinate
Abnormal vaginal bleeding (such as heavy periods or bleeding after menopause)
Many of these symptoms can also be caused by other conditions, but a definitive diagnosis is only possible through medical evaluation and testing.
Diagnosis
If symptoms suggest ovarian cancer, the doctor will use physical exams, laboratory tests, and imaging studies for a detailed evaluation. Diagnostic methods include:
Physical examination – assessing overall health and palpating the abdomen for abnormal masses or swelling.
Pelvic exam – checking the ovaries and surrounding organs for changes in size or shape.
Blood tests – including measurement of CA-125 levels. This substance is found on the surface of ovarian cancer cells and some normal tissues. High levels may indicate cancer or other problems. This test is not used alone for diagnosis but is useful for monitoring treatment and detecting recurrence.
Ultrasound – using sound waves to create images of pelvic organs. Sometimes, a vaginal probe (transvaginal ultrasound) provides a more detailed view of the ovaries.
Biopsy – removing a sample of tissue or fluid for microscopic examination. For a definite diagnosis, laparotomy surgery is often performed to take samples and thoroughly examine the abdomen and pelvis.
Laparoscopy – inserting a thin, lighted tube through a small incision in the abdomen to examine or remove tissue. In early stages, this method can be used to remove benign cysts or early cancers, and also to check the spread of the disease.
Treatment
Ovarian cancer treatment usually involves surgery and chemotherapy.
1. Surgery (Laparotomy)
In this procedure, an incision is made in the abdominal wall. If cancer is diagnosed, the following may be performed:
Removal of both ovaries and fallopian tubes (salpingo-oophorectomy)
Removal of the uterus (hysterectomy)
Removal of the omentum (the fatty tissue covering the intestines)
Removal of nearby lymph nodes and sampling tissues from the pelvis and abdomen
If cancer has spread, the surgeon removes as much of the tumor as possible.
In very early stages, and for women wishing to have children, sometimes only one ovary, one fallopian tube, and the omentum are removed.
2. Chemotherapy
Anti-cancer drugs are given in cycles to destroy cancer cells. This treatment may be administered before or after surgery. Each cycle includes a rest period, and the number of cycles depends on the type of drugs used. Treatment can be done in a clinic or hospital, and in certain cases, hospitalization may be required.
Source: National University Cancer Institute, Singapore
Compiled by: Sara Khoshnoud

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