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Ovarian Cancer
By peace | July 12, 2006
Ovarian cancer is a disease of older women, with 48% over the age of 65 at diagnosis. It is also the most deadly of gynecologic malignancies, accounting for more deaths than cervical and endometrial carcinoma combined in the US. An estimated 23,400 new cases of ovarian cancer will be diagnosed in 2001 with 13,900 deaths in the US. As our population ages, the number of women affected by ovarian cancer will increase.
Cancer is a group of many related diseases that begin in cells, the body’s basic unit of life. To understand cancer, it is helpful to know about normal cells and what happens when they become cancerous.
The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells when the body needs them. This orderly process helps to keep the body healthy. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
Malignant tumors are cancer. Cells in these tumors are abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Cancer cells can also spread(metastasize) from their original site to other parts of the body.
Ovarian cysts are a different type of growth. They are fluid-filled sacs that form on the surface of an ovary. They are not cancer. Cysts often go away without treatment. If a cyst does not go away, the doctor may suggest removing it, especially if it seems to be growing.
A malignant tumor that begins in the ovaries is called ovarian cancer. There are several types of ovarian cancer. Ovarian cancer that begins on the surface of the ovary (epithelial carcinoma) is the most common type. Ovarian cancer that begins in the egg-producing cells (germ cell tumors) and cancer that begins in the supportive tissue surrounding the ovaries (stromal tumors) are rare.
Ovarian cancer cells can break away from the ovary and spread to other tissues and organs in a process called shedding. When ovarian cancer sheds, it tends to seed (form new tumors) on the peritoneum (the large membrane that lines the abdomen) and on the diaphragm (the thin muscle that separates the chest from the abdomen). Fluid may collect in the abdomen. This condition is known as ascites. It may make a woman feel bloated, or her abdomen may look swollen.
Ovarian cancer cells can also enter the bloodstream or lymphatic system (the tissues and organs that produce and store cells that fight infection and disease). Once in the bloodstream or lymphatic system, the cancer cells can travel and form new tumors in other parts of the body.
The exact cause of ovarian cancer is unknown. It is the fifth leading cause of cancer deaths in women and is also the leading cause of death from gynecological malignancies. This is because malignant tumours of the ovaries develop quickly. Often, they affect both ovaries and they shed malignant cells relatively early in the disease. These cells, which frequently land on the uterus, bladder, and bowel, can begin forming new tumour growths before the cancer is detected.
In addition to the rapid rate of development, there is not a screening test for ovarian cancer and symptoms of early disease are minimal. Hence 50 per cent of women with ovarian cancer are in the advanced stage of the disease by the time the disease gets diagnosed.
The incidence of ovarian cancer is higher in older women. Over half the deaths from ovarian cancer occur in women between 55 and 74 years of age, and 25 per cent between 35 and 54 years.
Risk factors
The risk factors include poor reproductive history such as infertility, repeated spontaneous abortions and delayed child bearing beyond age 30. Past medical history of breast cancer is known to double the risk of ovarian cancer.
Exposure to asbestos or high levels of radiation, high dietary fat, the use of talcum powder in the genital area and hormonal replacement therapies for post-menopausal women are some of the other risk factors associated with ovarian cancer.
Prevention
No complete prevention is known. However, having regular pelvic examination and avoiding the above-listed risk factors may decrease the overall risk. Studies have shown that there may be a lower risk of ovarian cancer in patients who have used oral contraceptive pills. There was a 60 per cent reduction in the risk of ovarian cancer following five years or more use of oral contraceptives.
Symptoms
The following are the symptoms of ovarian cancer:
- vaginal bleeding
- sense of pelvic heaviness
- vague lower abdominal discomfort
- abnormal menstrual cycles
- weight gain or loss
- indigestion, increased gas, nausea and vomiting, bloating
Cancer limited to an ovary is typically silent and discovered incidentally on exam or at surgical exploration for other reasons. Patients with disease that has spread beyond the ovaries may present with vague gastrointestinal symptoms, bloating, diarrhea, pain and changes in bowel or bladder habits. On physical exam, patients will have a pelvic mass and often ascites. Due to the absence of symptoms until the malignancy has spread beyond the ovaries, and the lack of good screening tests, approximately 70% of patients present with advanced disease and overall survival is poor.
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