What is ovarian cancer?
Ovaries are the female reproductive organs that are responsible for the production of eggs for fertilisation and also secrete hormones like estrogen and progesterone.
Ovarian cancer is the second most common gynecological cancer in the United States. The lifetime risk of developing ovarian cancer is approximately 1 out of every 72 women. The median age of diagnosis is 63 years. More than 80% of all ovarian cancer patients get diagnosed after the age of 40. The risk of developing ovarian cancer increases with increasing age.
Ovarian cancer causes, risks, and risk mitigation
Reproductive and genetic factors are common risk factors for the development of ovarian cancer.
Reproductive factors include early onset of menstrual cycles or late onset of menopause. Women who have had multiple pregnancies are at lower risk of developing ovarian cancer. The use of oral contraceptive pills, undergoing tubal ligation (tubectomy) and breast feeding can offer some protection against ovarian cancer risk.
Family history or genetic factors plays an important role in the risk of developing ovarian cancer. Women with first degree relatives with ovarian cancer have about two-fold increased risk of developing ovarian cancer. Genetic mutations responsible for the development of ovarian cancer are BRCA1 and BRCA2. However, Only 10% of all ovarian cancer cases present with confirmed BRCA1 or BRCA2 genetic mutations. A confirmed inherited BRCA1 gene mutation appends up to 15-45% lifetime risk of developing ovarian cancer, whereas a confirmed inherited BRCA2 gene mutation can increase the risk of developing ovarian cancer by 10 to 20%.
Symptoms of ovarian cancer
Patients with ovarian cancer can present with either advanced stage acute symptoms (symptoms that arise suddenly) or early stage sub-acute symptoms, which get overlooked initially and then develop over time. One of the reasons why ovarian cancer is such a deadly disease, is that its early symptoms are often very subtle, and get mistaken for a common ailment.
Ovarian cancer may present with wide variety of symptoms which are vague and non-specific. These symptoms include bloating sensation, abdominal distension (fullness), abdominal pain and discomfort. Other symptoms include constipation, vaginal bleeding, indigestion, acid reflux, difficulty in breathing, tiredness, loss of appetite and loss of weight. Some patients may feel abdominal lumps of swelling.
Other symptoms of ovarian cancer can include postmenopausal bleeding, rectal bleeding and paraneoplastic symptoms such as dermatomyositis, anemia, or nephrotic syndrome.
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Diagnosis of ovarian cancer
Patients suspected to have ovarian cancer, should undergo a complete clinical assessment. An ultrasound of the abdominal and pelvic regions should be the first set of imaging tests. A CT scan is performed in ovarian cancer patients to understand the extent of the disease, and to plan surgery better. A chest X-ray can be done to look out for pleural effusion. An MRI scan is not routinely recommended in the diagnosis of ovarian cancer. CA-125 is the tumor marker which is routinely checked for in patients who are suspected to have ovarian cancer. In patients who present with intestinal symptoms, an upper and lower body endoscopy should be performed.
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Treatment of ovarian cancer
The treatment of ovarian cancer depends on the stage at which it gets diagnosed, and the general health condition of the patient.
Surgery is the initial treatment of choice when patient is fit and the disease is operable. Benefits of surgery include it removal of all the visible disease, confirms the diagnosis and disease extent. This surgery is generally called cytoreductive surgery. The surgery is generally followed by chemotherapy which is called Adjuvant chemotherapy.
Patients whose disease is not operable upfront, can be given neoadjuvant chemotherapy (before surgery) to decrease or downsize the tumour. This is then followed by surgery and further cycles of chemotherapy.
Patients who are not fit for surgery can be considered for Chemotherapy and surgery can be planned at a later stage or they can be treated with chemotherapy alone.
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Survival rates of ovarian cancer
The general prognosis of ovarian cancer patients continues to be poor, with an overall five year survival rate of 46%. The outcome for patients also closely depends on the stage of the disease. The five year survival rate for patients diagnosed at stage 1, is between 79 to 87%. For stage 2 patients, this rate goes down to 57 to 67%. The five year survival rate for stage 3 patients ranges between 23% to 41%, and it drops to 11% for patients who get diagnosed at stage 4.
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