The ovaries are female reproductive organs that produce eggs for fertilization. They secrete hormones like estrogen and progesterone. Ovarian cancer is the second most common gynecological cancer in the US. The lifetime risk 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.
Causes, risks, and risk mitigation
Reproductive and genetic factors are common risk factors.
Reproductive factors include early onset of menstrual cycles or late onset of menopause. Women who have had multiple pregnancies are at a lower risk. The use of oral contraceptive pills, undergoing tubal ligation (tubectomy) and breastfeeding can offer some protection against ovarian cancer risk.
Family history or genetic factors play an essential role in the risk of developing ovarian cancer. Women with first degree relatives with the condition have about two-fold increased risk. 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 and signs of ovarian cancer
Ovarian cancer patients can present with either advanced stage acute symptoms (signs that arise suddenly) or early-stage sub-acute symptoms. The signs are hard to spot and the tumor may 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 are difficult to detect.
Ovarian cancer may present with a 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 when they develop the tumor.
Other symptoms of ovarian cancer include postmenopausal bleeding, rectal bleeding, and paraneoplastic symptoms such as dermatomyositis, anemia, or nephrotic syndrome.
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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. Also, a CT scan in ovarian cancer patients helps understand the extent of the disease, and to plan surgery better. A chest X-ray helps spot pleural effusion. An MRI scan is not the usual recommendation. CA-125 is the tumor marker that is routinely checked for in patients who are suspected. Furthermore, 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 of diagnosis, and the general health condition of the patient.
Surgery is the initial treatment of choice when the patient is fit, and if the tumor is in the early stages. The benefits of surgery include its removal of all the visible conditions, confirms the diagnosis and disease extent. Adjuvant chemotherapy usually follows cytoreductive surgery.
Doctors recommend neoadjuvant chemotherapy (before surgery) to decrease or downsize the tumor for patients whose disease is not operable upfront. Patients may then have surgery and further cycles of chemotherapy.
For patients who are healthy enough for surgery, doctors recommend chemotherapy. Also, doctors may operate at a later stage or may opt for chemotherapy alone.
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Survival rates for ovarian cancer
The general prognosis of ovarian cancer patients continues to be weak, with an overall five-year survival rate of 46%. The outcome for patients also strictly depends on the stage of the disease. Furthermore, 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% when the diagnosis is at stage 4.
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