Ovarian cancer: a guide
The ovaries are an integral part of the gynaecological organs. In this article, a consultant gynaecological surgeon and gynaecological oncologist, Mr Mohamed Mehasseb, explains ovarian cancer, from symptoms, to diagnosis, to treatment.
What is ovarian cancer?
The ovaries are the female gonads which produce the hormones needed for sexual reproduction, namely oestrogen and progesterone. These hormones are utilised to mature egg follicles in the ovaries, which when ready, will be transported along the fallopian tubes to be implanted in the womb, ready for insemination. The hormones also help prepare the womb to house an embryo by thickening the uterine tissue walls. Without these processes, a natural conception is not possible.
Ovarian cancer is when there is abnormal cell behaviour in or on the surface of the ovaries, causing growths which are tumours and can spread (metastasise) to other organs of the pelvis and possibly beyond without intervention. There are cases where the growths are benign and do not spread, which are called ovarian cysts.
Ovarian cancer can affect anyone with gynaecological organs, but those who are most at risk include women over the age of 50 or who have undergone menopause, those who have a family history of gynaecological, breast, or colorectal cancers, those undergoing hormone replacement therapy, those who had their first menstrual period earlier than 12 years old, those who have endometriosis or polycystic ovary syndrome (PCOS), or those with particular genetic mutations such as BRCA1 and BRCA2.
There are several types of ovarian cancer, including:
- Epithelial, which is the most common and encompasses subtypes such as serous carcinoma, endometrioid, and mucinous carcinoma. This originates on the surface tissue of the ovaries.
- Germ cell, which is quite rare, and originates in the cells that become eggs (germs).
- Stromal, which tends to be discovered at an early stage and originates in the stroma, the structural connective tissue cells which produce the sexual hormones.
What are the symptoms of ovarian cancer?
Ovarian cancers, in their earliest stages, do not have many noticeable symptoms. However, as they progress, symptoms will start to manifest such as:
- Abdominal bloating or swelling
- Pain and pressure in the pelvic region and back
- Lack of hunger or a sensation of fullness
- Increase in urination
- Changes in bowel habits
- Unexplained weight loss
How is ovarian cancer diagnosed?
The diagnostic process for ovarian involves several tests and scans. A doctor will conduct a pelvic exam to look for any swelling or lumps. They will ask the patient about their family history, lifestyle and any symptoms exhibited thus far. The patient will likely be recommended to undergo further, more detailed testing and scans, such as:
- Imaging tests, to map the structure of the ovaries and discover growths and masses. Techniques can include MRIs, CT scans, and ultrasounds conducted abdominally or internally (transvaginal).
- Blood tests, to look for genetic mutations or a protein called CA-125, which is commonly in higher quantities in patients with ovarian cancer.
- A biopsy, where a sample of tissue from the area of concern is extracted and examined under a microscope to analyse cell behaviour.
How is ovarian cancer treated?
There is no one treatment plan as it depends on which ovarian cancer the patient has, and what stage it is at. The most common forms of treatment are chemotherapy, targeted therapy, and surgery. Chemotherapy works by using drugs to kill cancer cells and shrink growths; targeted therapy is similar, but the drugs that are utilised are designed to kill specific cells to avoid damaging normal healthy cells Radiotherapy is also sometimes used, but only in rare cases where the cancer is particularly resistant to other forms of therapy and can be quite effective for pain. Surgical approaches aim to remove all of the diseased tissue to prevent the further spread, and typically involve removing one or both of the ovaries and often the fallopian tubes – in some cases, it may be necessary to also remove the womb (a hysterectomy).