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OVARIAN CANCER
ALL YOU SHOULD KNOW ABOUT OVARIAN CANCER
May 13, 2024
Ovarian cancer is one of the leading causes of cancer deaths among women and accounts for about 1% of all new cancer cases in the US. This translates to about 20,000 women getting a new diagnosis of ovarian cancer and about 13,000 women dying from ovarian cancer yearly. Fortunately, due to advances in diagnostic and treatment options, fewer women are dying from ovarian cancer. In fact, the mortality rate from ovarian cancer has decreased by 40% since 1975 and most of this progress was made within the past 20 years. So, what is ovarian cancer, how is it treated, and what we can do to protect ourselves from developing it?
What is Ovarian Cancer?
Ovarian cancer occurs when cells in the ovaries develop abnormally and grow too fast. These abnormal cells can invade healthy tissues and interfere with normal functions in the body.
The ovaries along with other organs like the uterus and fallopian tubes compose the female reproductive system. The uterus is the muscular organ responsible for carrying a fetus to term if an egg is fertilized and successfully implants in the uterine lining. If the egg is not fertilized, the nutrient-dense, blood-rich uterine lining is shed as a menstrual period.
The ovaries are small, almond-shaped organs that have two main roles in the body. They regulate important sex hormones like estrogen and progesterone, and they are also responsible for nurturing undeveloped eggs (oocytes) until they are ready for fertilization. Once an egg is mature it is released from an ovary and begins its journey towards the uterus.
Two fallopian tubes are attached on the top of the uterus, one on either side. The fallopian tubes are passageways that a mature egg will travel down every month towards the uterus. The fallopian tubes have finger-like projections, called fimbriae tubae, at their ends. Fimbriae are lined with hair-like structures and they guide the mature egg released by the ovary into the uterus to be fertilized or be shed as part of the menstrual process.
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Facts About Ovarian Cancer
According to the National Cancer Institute, ovarian cancer is the 18th most common form of cancer in the US, and the 11th most common in women. Most women who develop ovarian cancer are between the ages of 55 and 64, and white women are more likely to have it than women of other races.
Unfortunately, ovarian cancer is the deadliest of the gynecological cancers, with an average five-year relative survival rate of 50.8%. However, survival rate can differ from 50% to 92% based on the type of cancer and how far it has advanced. The advancement of treatment options has also drastically decreased mortality rates. In fact, ovarian cancer death rates have dropped by about 2.8% every year since 2011 and will, hopefully, continue to do so as advances in early detection and treatment continue to be made.
How Long Can Ovarian Cancer Go Undetected?
Unfortunately, ovarian cancer can go months and even years undetected. As the disease progresses and spreads, symptoms begin to appear. Diagnosis can be delayed since symptoms tend to be vague and non-specific to ovarian cancer. Since there are often no symptoms in the early stages, in about 70% of women with ovarian cancer, the disease is diagnosed at advanced stages when treatment is less likely to be effective. If ovarian cancer is caught in early stages, it has survival rates as high as 90%. Late-stage ovarian cancer is much more difficult to treat, and the survival rate drops to around 30%. Once symptoms are noticed, though, the median amount of time it takes for cancer treatment to begin is close to three months.
Signs and Symptoms of Ovarian Cancer
Some common symptoms that can occur with ovarian cancer are bloating, pelvic or abdominal discomfort, feeling full quickly or having difficulty eating, and urinary frequency and urgency. Some people experience fatigue, constipation, back pain, unintentional weight loss, or vaginal bleeding, as well. If you experience abnormal vaginal bleeding, especially if you’ve already been through menopause, see your doctor right away. If you notice any of the other symptoms and they last for two weeks or longer, it’s a good idea to talk to your doctor to rule out any possibility of ovarian cancer or other serious diseases that might mimic ovarian cancer, such as ovarian cysts, endometriosis, irritable bowel syndrome, pelvic inflammatory disease, and uterine fibroids.
Stages of Ovarian Cancer
Ovarian cancer is often categorized into four stages and several subcategories to help describe how much cancer is in the body and where it may have spread. As a rule, the lower the number, the less the cancer has spread from the ovaries to other parts of the body. A higher number will indicate that the cancer has spread beyond where it developed. Generally, lower numbers have better survival rates than higher numbers.
Stage I (A, B, and C): During stage 1, the cancer is confined to one or both ovaries or fallopian tubes and has not spread to other organs, lymph nodes, or distant sites in the body.
Stage II (A, B): In stage II, ovarian cancer has begun to infiltrate other organs, such as the uterus, bladder, fallopian tube, or rectum, but it has not spread to lymph nodes or distant sites in the body.
Stage III (AI, A2, B, and C): In stage III, ovarian cancer may have breached lymph nodes and spread to organs outside of the pelvis, such as the outside layer of the liver. Each sub-category in this stage outlines specific changes in the size and location of the cancer.
Stage IV (A,B): During stage IV, ovarian cancer has spread deeper into organs throughout the body, including the spleen, liver, and bones.
Types of Ovarian Cancer
There are three main varieties of ovarian cancer – epithelial, stromal, and germ cell – which correspond to three main types of cells in the ovary. A tumor can develop in any of these cells.
EPITHELIAL TUMORS
Around 90% of ovarian cancers are epithelial, and they are the most likely to be diagnosed in later stages due to minimal early symptoms. Epithelial ovarian cancer begins in the cells on the outer surface of the ovaries. Not every epithelial tumor is cancerous; however, the ones that are cancerous are called carcinomas. There are several subtypes of epithelial ovarian cancer including serous carcinomas (the most common and most aggressive subtype), endometrioid carcinomas, mucinous carcinomas, and clear cell carcinomas. These subtypes differ in their cancer-causing cell mutations, and treatment plans are typically based on which type is present.
OVARIAN STROMAL TUMORS
Stromal cell tumors account for only 1% of all ovarian cancers. They begin in the tissues that support the ovaries rather than the ovaries themselves. Vaginal bleeding is often an early symptom, and this kind of ovarian cancer is often diagnosed earlier than others.
GERM CELL TUMORS
Germ cell tumors account for only 2% of ovarian cancers. They form in the germ cells (immature eggs) inside the ovaries. This kind of ovarian cancer tends to occur mostly in teenagers and women in their twenties, and it has a 90% five-year survival rate.
OTHER FORMS
Another type of cancer, known as extraovarian primary peritoneal carcinoma (EOPPC), can mimic ovarian cancer except that it occurs in the lining of the abdomen and pelvis and may or may not involve the ovaries. Symptoms of EOPPC can include abdominal and pelvic discomfort, similar to ovarian cancer. Since EOPCC can occur outside of the ovaries, women who have had their ovaries removed may still develop EOPPC. Treatment options include surgery and chemotherapy, like ovarian cancer. A rare form of ovarian cancer is known as SCCO (small cell carcinoma of the ovary). It tends to occur in young women and can grow really fast.
OVARIAN TUMORS
The ovaries can also host several kinds of cysts and non-cancerous tumors. Usually, these kinds of growths are asymptomatic, but they can sometimes cause pelvic pain and menstrual irregularities. Most small ovarian growths less than two inches will resolve without treatment, while larger cysts might require surgical removal.
Role of Hormones in Ovarian Cancer
The sex hormones – estrogen and progesterone – seem to play a part in the development of cancerous cells in ovarian cancer. Although many studies are ongoing to fully understand the direct effect of the hormones on ovarian cancer, estrogen present in the intra-follicular fluid of ovulatory follicles can promote the development of cancer cells while progesterone has an inhibitory effect on the development of cancerous cells. Hormone replacement therapy (HRT) after menopause might slightly increase the risk of developing ovarian cancer, specifically endometrioid and serous types. The risk is slight, but your doctor can discuss the risks versus benefits of HRT based on your medical history.
How is Ovarian Cancer Diagnosed?
The only definitive way to diagnose ovarian cancer is with a biopsy, where your doctor removes a sample of ovarian tissue and looks at it under a microscope to see if cancerous cells are present. Biopsies are often performed after surgery to remove ovarian growths, although occasionally, a sample is retrieved through laparoscopy or even with a needle inserted into the ovary through the abdomen.
Imaging tests can be performed to determine the size and exact location of suspected ovarian cancers. Ultrasound, CT scans (computed tomography), MRIs (magnetic resonating imaging), and PET scans (positron emission tomography) might be performed before surgery or to help determine staging.
If ovarian cancer is suspected to have spread to the lungs, a chest x-ray might be ordered, while a colonoscopy or barium enema x-ray might be required if there is suspicion of colon involvement.
A blood test can be performed to check for CA-125. This is a cancer antigen protein that is often found in the blood when ovarian cancer is present. However, CA-125 alone cannot be used to diagnose ovarian cancer because other pelvic cancers, some non-cancerous ovarian growths, and even normal menstruation can cause an elevation in this protein. Testing for CA-125 can be useful in monitoring treatment efficacy or cancer recurrence; however, additional tests and imaging are typically needed for definitive diagnosis.
What is the Life Expectancy of Someone With Ovarian Cancer?
When caught early in stage 1, there is up to a 93% survival rate five years after diagnosis. Once ovarian cancer spreads to the lymph nodes, the survival rate drops to 75%, and if it has spread to distant organs like the liver or lungs the survival rate plummets to 31%. Survival rate, though, is based on factors such as stage, grade, and response to treatment; however, when all stages of ovarian cancer are considered, the average survival rate at five years is around 50%.
Treatment of Ovarian Cancer
Ovarian cancer is usually treated with a combination of surgery and chemotherapy. Surgery followed by six rounds of chemotherapy is a common treatment plan. For more advanced cases, treatment might start with chemo followed by surgery and then more chemotherapy.
Targeted therapies using medications that attack specific parts of cancer cells can be used if previous treatments have not been successful or if your cancer recurs. Genetic testing can help doctors determine which targeted therapy will work best for a specific type of ovarian cancer.
Radiation is not typically used to treat ovarian cancer; however, it might be beneficial when ovarian cancer has spread into other organs that are sensitive to radiation treatment. It can also be utilized in certain situations like palliative care or in combination with surgery for advanced or recurrent diseases involving specific sites.
Natural Ways to Reduce the Risk of Ovarian Cancer
Some lifestyle adjustments can minimize your risk of ovarian cancer. For instance, maintaining a healthy diet rich in quercetin-containing vegetables and fruits can lower the incidence of ovarian cancer. Quercetin is a powerful antioxidant found naturally in citrus fruits, apples, onions, broccoli, berries, and other foods.
Women who use birth control pills for five years or longer have up to a 50% lower chance of developing ovarian cancer. However, birth control can increase the risk of breast cancer and blood clots; thus, using birth control pills to reduce the risk of ovarian cancer is not feasible or appropriate for everyone.
If you have had a tubal ligation or a hysterectomy, your risk of ovarian cancer decreases. These types of surgeries, however, are not typically performed as prevention for ovarian cancer unless there is a valid medical reason. Most doctors do not remove the ovaries during a hysterectomy unless there is a medical reason such as a strong family history of ovarian cancer. If you do have a strong family history of ovarian cancer, you should consider getting genetic testing since genetic markers can help you and your physician come up with an effective prevention plan.
Maintaining a healthy diet and lifestyle can contribute to overall health and should be part of a comprehensive approach to prevent cancer. Ovarian cancer can be a tricky disease to diagnose; however, early diagnosis is crucial to treating it effectively. Even if you are not in a high-risk group, keep up with regular pelvic exams as recommended by your doctor and see your doctor if you have any concerning symptoms. When caught early, ovarian cancer is highly treatable and survivable.
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