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Ovarian Carcinoma
What is Ovarian Carcinoma?
Ovarian carcinoma is a kind of cancer that starts in a woman’s
ovaries – these are the organs in the body that make egg cells for
reproduction. The ovaries are found one on either side next to the
womb in the pelvic area. A ‘carcinoma’ is any cancer that occurs in
a surface lining of the body and there are several different types
of ovarian carcinoma which are classified depending on the kind of
cell that causes the disease.
Types of Ovarian Carcinoma
One kind of ovarian carcinoma begins in the cells that make up the
surface of the ovaries – the ‘epithelial cells’. These are known as
epithelial ovarian carcinomas and are the most common form of
ovarian cancer. About 85-90% of ovarian cancers fall into this
category and there are several sub-types within this type.
If the tumor starts in the egg-forming cells of the ovary it is
called a germ cell carcinoma and accounts for about 5% of ovarian
cancers. It usually affects young women in their twenties but can
occur at any age. There are also many benign or ‘non-cancerous’ germ
cell tumors that affect the ovaries.
Stromal carcinomas are tumors that start in the connective tissue
cells that hold the ovary together and the cells that make female
hormones like estrogen and progesterone.
Tumors that start growing in the ovaries are able to spread to other
parts of the body i.e. they are invasive cancers.
What Causes Ovarian Carcinoma?
Scientists have determined that certain factors my lead to the
development of certain ovarian cancers namely the epithelial ovarian
carcinomas. If you have certain risk factors that contribute to the
disease then you have a higher risk of getting the disease but it
does not mean that you will definitely get ovarian cancer.
Ovarian cancer can and does occur mostly in women who have no known
risk factors while women who have several risk factors remain
unaffected.
The majority of ovarian cancers develop after a woman has undergone
the menopause or ‘change of life’. This is when the women’s
menstrual periods have stopped for at least one year. About 50% of
all ovarian cancers occur in women older than 63 years of age.
If you are very overweight your chances of getting ovarian carcinoma
are increased as obesity increases your risk. Very obese women have
a 50% greater risk of getting ovarian cancer.
If you began menstruating early (before age 12), and have no
children or had a child only after the age of 30, and/or experienced
menopause after age 50 you may have an increased risk of getting
ovarian cancer.
The use of fertility drugs called clomiphene citrates can increase
your risk for developing ovarian tumors called ‘tumors of low
malignant potential’ and infertility itself increases your risk.
If a member of your family had ovarian cancer, breast cancer, or
colorectal cancer, you have a higher risk of getting the disease. So
if your mother, sister, or daughter have (or have had) ovarian
carcinoma (especially at a young age) you are at greater risk.
The risk may be inherited from relatives on your mother's or
father's side of the family and approximately 10% of these cancers
arise from an inherited genetic tendency to develop the disease.
Breast cancer may be caused by an inherited mutation (alteration) of
the breast cancer gene BRCA1 or BRCA2 and if you or a relative has
this gene mutation you have a higher risk of ovarian cancer. The
same is true for a mutated gene that causes colorectal cancer.
Taking estrogen replacement therapy and hormone replacement therapy
may increase your risk of getting ovarian cancer, but some studies
suggest there is no link between ovarian cancer and HRT. Further
study is needed to determine the truth about the use of hormone
replacement therapy.
What are the Symptoms of Ovarian Carcinoma?
This kind of cancer tends to be ‘silent’ and only causes symptoms in
a very late stage when the tumor has grown and spread into the womb,
pelvis and abdomen. About 25% of tumors are found early and this
helps to be able to treat the cancer successfully because it is
still localized. In these cases about 90% of patients live for
longer than five years once diagnosed.
Because this kind of cancer can show no symptoms at all it is
important for women to have pelvic examinations on a regular basis
especially if she falls into a high risk category. This kind of
examination is one where the doctor feels the ovaries and uterus for
any abnormalities.
In many cases it is possible that the exam will not be able to
detect a growing ovarian carcinoma but it may detect several other
problems, including other types of cancer. Ultrasounds may be used
to check for problems.
A Pap test or ‘smear’ can detect cervical cancer early but this is
not the case for the majority of ovarian cancers – where they are
detected by a Pap test they are often already in an advanced stage.
Where symptoms do occur they may include:
Abdominal swelling (due to a mass or accumulation of fluid)
Unusual vaginal bleeding
Pelvic pressure
Back pain
Leg pain
Digestive problems like gas, bloating, indigestion, or long-term
stomach pain.
Of course all of these may be caused by minor problems but it is
wise to consult your physician if you are at all concerned,
especially if you fall into a high risk category. This is because by
the time any symptoms appear the cancer may already have spread to
other organs. However, the earlier the diagnosis, the better is the
outlook for the disease.
There are screening tests for ovarian cancer and if you are at
greater risk for any of the above reasons they are recommended.
Screening tests are done via transvaginal sonography which is an
ultrasound test performed with a small instrument placed in the
vagina as well as blood tests.
The transvaginal sonography test can detect a tumor in the ovary,
but it can’t tell your doctor if it is cancerous or non-cancerous
(benign).
A blood test can measure the amount of CA-125 (also known as OC-125)
in your blood. This is a protein that is found to be at high levels
in women with ovarian cancer. Bear in mind that non-cancerous
diseases of the ovaries may increase the blood levels of CA-125 and
also that ovarian cancers may not produce enough CA-125 to show up
in your blood test. X-rays may be taken to verify the results.
There are, at present no good tests to screen women for germ cell
tumors or stromal tumors bur a few germ cell cancers do give off
certain protein markers called human chorionic gonadotropin (HCG)
and alpha-fetoprotein (AFP) into the blood.
How is Ovarian Carcinoma Treated?
The way in which ovarian cancer can be treated may vary depending on
the type of cancer you have, your age, general health and whether
you want to have children in the future.
The main treatment programs for ovarian cancer are surgery,
chemotherapy and radiation treatments. One or all of these may be
used to fight the cancer.
Surgery
Depending on the kind of cancer you have part of the ovary or the
entire ovary may be removed. It may also be necessary to remove both
of the ovaries. The womb and fallopian tubes may also need to be
removed. If you still wish to have children your doctor will want to
do as little damage as possible to your reproductive system and
chemotherapy may be used rather than extensive surgery.
If both the ovaries and the uterus are removed you will no longer be
able to have children. For this reason it is important to find a
specialist that is skilled in treating ovarian carcinoma.
Chemotherapy
Chemotherapy involves taking anti-cancer medicines by mouth or
intravenously (injected into your veins) so that the drug can fight
the cancer inside your body. Once the drug is in the bloodstream it
can attack and destroy the cancer cells and try to shrink the tumor.
Chemotherapy will attack the cells in your body that are growing
quickly in an effort to kill the cancer but in so doing it may also
affect your normal, healthy cells. This can lead to side effects
like:
If the side effects are impacting negatively on your health your
doctor can give you medicines to take with the chemotherapy drugs to
minimize nausea and vomiting, increase your infection resistance or
keep your blood cells at normal levels.
During chemotherapy you will need to take extra safety precautions
to prevent illness from infection. Discuss your options with your
doctor.
Radiation Therapy
Radiation therapy involves using high-energy x-rays or radioactive
material to kill the cancer. This can be done from outside the body
or by placing the materials inside the body. Your doctor will tell
you if this is indicated for your type of ovarian cancer.
How to Cope with Ovarian Carcinoma
Talk to your doctor about your ovarian cancer and make sure you
learn as much about your disease as possible, including the goals of
treatment, the stage of your cancer and what drugs or surgery will
be used to try to fight the cancer.
If you are still in your childbearing years, this kind of cancer can
be very upsetting as you may fear losing your capacity to bear
children. It may help to talk to other woman with ovarian cancer or
those who have been successfully treated about your feelings and
possible options.
Take care of yourself during this time by eating balanced meals,
getting enough rest and exercise and talking to your doctor and your
family about your illness. A positive outlook and healthy habits
will give you the best chance of fighting your illness.
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