Ongoing pain or cramps in your belly or back could be a sign of ovarian cancer

In South Africa, one in 297 women have ovarian cancer. It is not as common as breast cancer but has similar risk factors and is deadlier. It is estimated that only 45% of women with ovarian cancer are likely to survive for more than five years while about 89% of breast cancer patients survive for five or more.

That is because ovarian cancer symptoms can be vague and easily confused with a host of other, less serious conditions.

For instance, ovarian cancer warning signs include ongoing pain or cramps in the belly or back, abnormal vaginal bleeding, nausea, and bloating.

If you have a genetic predisposition to ovarian cancer, or any of these symptoms, see your doctor who may recommend regular pelvic imaging and blood tests to screen for the disease.

Ovarian cancer is a type of cancer that begins in the ovaries.

Women have two ovaries, one on each side of the uterus.

The function of ovaries is to produce eggs (ova) as well as the hormones oestrogen and progesterone.

The danger with ovarian cancer is that it often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Surgery and chemotherapy are generally used to treat ovarian cancer.

If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. It is not clear what causes ovarian cancer.

In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Cancer cells quickly multiply, forming a mass (tumour). They can invade nearby tissues and break off from an initial tumour to spread elsewhere in the body (metastasize).

Some experts recommend that women who have inherited a BRCA (breast cancer) gene change and have not had their ovaries removed have a transvaginal ultrasound and a CA-125 blood test at least once a year, starting at age 35.

According to the National Cancer Institute (NCI), in 2015 there were an estimated 21 290 new cases of ovarian cancer and 14 180 deaths from the disease.

The vast majority of the cases are EOC (epithelial ovarian cancer) and are found at stage 3 or later, meaning the cancer has spread beyond the pelvis or to the lymph nodes.

This is mostly due to the lack of definite symptoms at the early stages of cancer growth. Around 1.3% of women will be diagnosed with cancer of the ovary at some point in life, thus it is relatively rare.

The median age of diagnosis is 63. However, approximately 25% of cases are diagnosed between ages 35 and 54. Caucasian women have the highest rate of diagnosis.

Like many other cancers, when ovarian cancer is found at an early stage (for example, localised to the ovary or fallopian tube) the survival at five years is very good (about 92%); most women at stage 1 will still be alive five years later.

However, the five-year survival for all women diagnosed with ovarian cancer is only 45%. This is because it is often found at an advanced stage in which the disease has already spread within the abdomen.

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Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types are:

• Epithelial tumours, which begin in the thin layer of tissue thatcovers the outside of the ovaries.  About 90 % of ovarian cancers are epithelial tumours.
• Stromal tumours, which begin in the ovarian tissue that contains hormone-producing cells.  These tumours are usually diagnosed at an earlier stage than other ovarian tumours. About seven percent of ovarian tumours are stromal.
• Germ cell tumours, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.

Risk factors

Certain factors may increase your risk of ovarian cancer:

• Age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.
• Family history. A small percentage of ovarian cancers are caused by an inherited gene mutation. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2).

These genes were originally identified in families with multiple cases of breast cancer, which is how they got their names, but women with these mutations also have a significantly increased risk of ovarian cancer. The gene mutations that cause Lynch syndrome, which is associated with colon cancer, also increase a woman’s risk of ovarian cancer.

• Oestrogen hormone replacement therapy. Especially with long-term use and in large doses.
• Age when menstruation started and ended. If you began menstruating before age 12 or underwent menopause after age 52, or both, your risk of ovarian cancer may be higher.
• Never being pregnant.
• Had fertility treatment.
• Smoke.
• Use of an intrauterine device.
• Phad plycystic ovary syndrome

Symptoms

Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions, such as constipation or irritable bowel syndrome. These symptoms are common for some women.

They may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a pattern:

• They start suddenly.
• They feel different than your normal digestive or menstrual problems.
• They happen almost every day and don’t go away.

Signs and symptoms of ovarian cancer may include:

• Abdominal bloating or swelling;
• Quickly feeling full when eating;
• Weight loss;
• Discomfort in the pelvis area;
• Changes in bowel habits, such as constipation;
• A frequent need to urinate;
• Fatigue;
• Indigestion;
• Back pain;
• Pain with intercourse;
• Menstrual cycle changes.

Tests and diagnosis

The best way to diagnose ovarian cancer is through your doctor taking a full history, full general examination, including the pelvic examination.

Your doctor will inspect the outer part of your genitals carefully. The doctor will then insert two gloved fingers into the vagina and simultaneously press a hand on your abdomen to feel your uterus and ovaries.

An ovarian lump may be felt during a pelvic exam. A rectovaginal exam may also be done to feel the pelvic organs. A device (speculum) is inserted into the vagina so that the doctor can visually check for abnormalities.

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