Women at risk from deadly killer

In South Africa, one in 297 women will be diagnosed with 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 years.

That is because ovarian cancer symptoms can be vague and easily confused with a host of other and less serious conditions. For instance, the warning signs of ovarian cancer 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, or ova, as well as 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, it 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. 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, or a tumour. They can invade nearby tissues and break off from an initial tumour to spread elsewhere in the body (metastasize).

Experts recommend that women who have inherited a breast cancer gene change and have not had their ovaries removed, must 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, in 2015 there were an estimated 21 290 new cases of ovarian cancer and 14 180 deaths.

The vast majority of the cases are epithelial ovarian cancer and are found at stage three or later, meaning the cancer has spread beyond the pelvis. This is mostly due to the lack of definite symptoms at the early stages of cancer growth.

About 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, about 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 one will still be alive at five years.

However, the five-year survival for all women diagnosed with this 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.

Types Of Ovarian Cancer

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

• Epithelial tumours, which begin in the thin layer of tissue that covers 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 7% 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); and 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 an increased risk of ovarian cancer.The gene mutations that cause Lynch syndrome, 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.
• Fertility treatment.
• Use of an intrauterine device.
• Smoking.
• Polycystic 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. 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.

Test And Diagnosis

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

When a pelvic examination is done, your doctor will first fully inspect the outer part of your genitals. The doctor will then insert two gloved fingers into the vagina and press a hand on your abdomen to feel your uterus, 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 then also inserted into the vagina so that the doctor can visually check for abnormalities.

The following tests may also be recommended:

• Imaging tests, such as ultrasound or CT scans, of your abdomen and pelvis. These tests can help determine the size, shape and structure of your ovaries.
• Blood test, which can detect a protein (CA 125) found on the surface of ovarian cancer cells.
• A biopsy, which is the only way to know for sure if a woman has ovarian cancer. This usually is done with a laparotomy, through a cut (incision) in the belly.
• Surgery to remove a tissue sample and abdominal fluid to confirm a diagnosis of ovarian cancer. Minimally invasive or robotic surgery may be an option. If cancer is discovered, the surgeon may begin surgery to remove as much of the cancer as possible.

Doctors use the surgery results to help determine the extent – or stage – of your cancer. Your cancer’s stage helps determine your prognosis and your treatment.

Stages of ovarian cancer include: 

• Stage I Cancer is found in one or both ovaries.
• Stage II Cancer has spread to other parts of the pelvis.
• Stage III Cancer has spread to the abdomen.
• Stage IV Cancer is found outside abdomen.

Treatments And Drugs

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery

Treatment involves removing both ovaries, the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue where ovarian cancer often spreads. Your surgeon will also remove as much cancer as possible from your abdomen.

Less extensive surgery is possible if your cancer was diagnosed at an early stage.

For women with stage-one ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children.

Chemotherapy

After surgery, you will likely be treated with chemotherapy to kill any remaining cancer cells. Chemotherapy drugs can be injected into a vein or directly into the abdominal cavity or both. Chemotherapy may be used as the initial treatment in some women with advanced ovarian cancer.