Ovarian Cancer: Understanding the Silent Killer

Ovarian cancer, often referred to as the silent killer, poses a significant threat to women worldwide. The insidious nature of this disease lies in its ability to spread to different parts of the body without showing obvious symptoms until it reaches an advanced stage.

It is alarming to note that approximately 70-75 percent of ovarian cancer cases are diagnosed in the advanced stages, after the disease has already spread extensively.

The lifetime risk of developing ovarian cancer for every woman is about 1 in 78, with a risk of dying from the disease estimated at 1 in 108. These statistics highlight the importance of raising awareness and promoting early detection and treatment.

In support of this cause, Ovarian Cancer Day is celebrated globally on May 8, bringing attention to this silent killer and emphasizing the need for vigilance.

At What Age?

Ovarian cancer can affect women at various stages of life. While the risk of developing ovarian cancer does increase after menopause, it is essential to understand that women of any age can be affected by this disease. The different types of ovarian cancer that can occur are often associated with specific age groups.

Younger Women: In younger women, ovarian cancer is relatively rare. However, it can still occur, particularly in those with specific risk factors such as a family history of ovarian or breast cancer, or certain genetic mutations like BRCA1 and BRCA2.


Reproductive Age: Ovarian cancer can also develop during the reproductive years. Certain types, such as germ cell tumors or sex cord-stromal tumors, are more commonly found in this age group. These tumors can affect the ovaries and may require specialized treatment approaches.


Perimenopause and Menopause: The risk of ovarian cancer increases as women approach menopause and during the postmenopausal period. The majority of ovarian cancers occur in women aged 50 years or older. Epithelial ovarian cancer, the most common type, is frequently diagnosed in this age range.

Symptoms of Ovarian Cancer

Ovarian cancer is often referred to as the silent killer because it typically does not present with specific symptoms in its early stages. However, as the disease progresses, women may experience the following signs that warrant attention:

Flatulence or bloating: Persistent bloating or a feeling of fullness in the abdomen can be a symptom of ovarian cancer. It may be accompanied by increased gas, discomfort, or a swollen sensation.


Loss of appetite/fullness with little food: Women with ovarian cancer may experience a decreased appetite or feel full even after eating small amounts of food. This can lead to unintended weight loss.


Nausea/vomiting: Persistent nausea or vomiting that is not related to other digestive issues may be a symptom of ovarian cancer. It may occur in combination with other symptoms, such as bloating or abdominal pain.


Abdominal or back pain: Women with ovarian cancer may experience pain in the lower abdomen or pelvic area. This pain can be persistent or intermittent and may radiate to the lower back.


Feeling of stomach churning: Some women with ovarian cancer describe a sensation of their stomach “churning” or feeling unsettled, even without any obvious digestive issues.


Changes in urination habits: Ovarian cancer can sometimes affect the urinary system, leading to changes in urination patterns. This may include increased frequency, urgency, or difficulty in emptying the bladder.

Who is More Affected?

While ovarian cancer can affect women of all backgrounds, certain factors can increase an individual’s risk of developing the disease. Here are some additional details about groups that are more affected:

Infertility or low birth weight: Women who have a history of infertility or who have given birth to few or no children may have a slightly higher risk of ovarian cancer. Likewise, individuals who were born with a low birth weight may have an increased risk later in life.


Family history of BRCA one/two mutation: Women who have a family history of BRCA1 or BRCA2 gene mutations are at a higher risk of developing ovarian cancer. These genetic mutations are also associated with an increased risk of breast and other cancers. Genetic counseling and testing can help identify individuals who carry these mutations.


Family history of breast, uterine, or colon cancer: Women who have close relatives (such as a mother, sister, or daughter) diagnosed with breast, uterine (endometrial), or colon cancer may have an elevated risk of ovarian cancer. These cancers can sometimes be linked through inherited genetic mutations or shared environmental factors.


Hormone replacement therapy: Long-term use of hormone replacement therapy (HRT) after menopause, particularly estrogen-only HRT, has been associated with a slightly increased risk of ovarian cancer.

However, the absolute risk remains low, and the benefits of HRT for managing menopausal symptoms or preventing osteoporosis should be weighed against the potential risks.

Diagnosis

Diagnosing ovarian cancer involves a multi-step process that combines an assessment of symptoms, a thorough physical examination, and several diagnostic tests.

Detecting ovarian cancer at an early stage is challenging due to the lack of specific symptoms, which is why regular check-ups and awareness of potential warning signs are crucial.

Here are some additional details about the diagnostic methods used in the detection of ovarian cancer:

Medical History and Physical Examination: The initial step in diagnosing ovarian cancer involves discussing the patient’s medical history and conducting a physical examination. The doctor will inquire about any symptoms, risk factors, and family history of cancer. During the physical examination, the healthcare provider may check for any abnormal growths or tenderness in the pelvic area.


Imaging Tests: Ultrasonography or CT scan is commonly used to evaluate the ovaries and surrounding structures. Transvaginal ultrasound involves inserting a small probe into the vagina to obtain detailed images of the ovaries. CT scan utilizes X-ray technology to create cross-sectional images of the abdomen and pelvis, providing a more comprehensive view of the organs and potential tumors.


Analysis of Cancer Markers: Blood tests can be performed to measure the levels of certain substances called cancer markers. In the case of ovarian cancer, the most commonly used marker is CA-125. Elevated levels of CA-125 may indicate the presence of ovarian cancer, although it is important to note that this marker can also be elevated in other conditions or diseases.


Biopsy: If the imaging tests and cancer marker analysis suggest the presence of ovarian cancer, a biopsy may be performed to confirm the diagnosis. In most cases, this involves the surgical removal of a tissue sample from the ovary or any suspicious masses. The sample is then sent to a laboratory for examination by a pathologist who specializes in analyzing tissue samples.


Abdominal or Lung Fluid Testing: In some cases, if there is fluid accumulation in the abdomen (ascites) or lungs (pleural effusion), a sample of this fluid may be collected and examined for cancer cells. This can help determine the spread of cancer and guide treatment decisions.

Treatment

The treatment of ovarian cancer is determined based on various factors, including the stage of the disease, the type of ovarian cancer, the patient’s overall health, and individual preferences.

A multidisciplinary team of healthcare professionals, including gynecologic oncologists, medical oncologists, and radiation oncologists, collaborate to develop a personalized treatment plan. Here are some additional details about the common treatment options for ovarian cancer:

Surgery: Surgery is typically the primary treatment for ovarian cancer and aims to remove as much of the tumor as possible. The extent of surgery depends on the stage of the cancer and may involve removing the ovaries, fallopian tubes, uterus, nearby lymph nodes, and other affected tissues. In advanced cases, surgery may also involve removing tumors from other organs in the abdomen or pelvis. Surgical procedures can be performed through open surgery or minimally invasive techniques, such as laparoscopy.


Chemotherapy: Chemotherapy is often recommended after surgery to destroy any remaining cancer cells and reduce the risk of recurrence. It involves the use of powerful drugs that kill cancer cells or inhibit their growth. Chemotherapy may be administered intravenously or directly into the abdominal cavity (intraperitoneal chemotherapy). It can be given in cycles, with periods of treatment followed by rest to allow the body to recover.


Targeted Therapy: Targeted therapy uses drugs that specifically target certain molecular abnormalities in cancer cells. For example, some ovarian cancers may have mutations in the BRCA genes or overexpression of a protein called HER2. Targeted therapy drugs can inhibit these specific molecular targets, helping to slow down the growth of cancer cells. Targeted therapies are often used in combination with chemotherapy.


Hormone Therapy: Hormone therapy may be considered for certain types of ovarian cancers, such as those that are hormone receptor-positive. Hormone therapy involves the use of medications that interfere with the hormone receptors on cancer cells, preventing them from receiving the signals that promote their growth.


Other treatment modalities that may be used in specific cases include radiation therapy, which uses high-energy X-rays or other radiation sources to kill cancer cells, and immunotherapy, which stimulates the immune system to recognize and attack cancer cells.

It is important to note that the treatment plan for ovarian cancer is individualized to each patient’s specific situation. The healthcare team will consider the stage and type of cancer, the patient’s overall health, and their preferences when determining the most appropriate treatment approach.

It is recommended that patients and their families have open and thorough discussions with their healthcare providers to fully understand the treatment options, potential side effects, and expected outcomes. Supportive care, including psychological support, nutritional counseling, and pain management, is also an integral part of the treatment process.


Dr. Farhana Tarannum Khan is a renowned specialist in Gynecology and Gynecological Oncology at the National Cancer Research Institute and Hospital in Dhaka. With extensive experience and expertise in the field, Dr. Khan is dedicated to raising awareness about ovarian cancer and providing exceptional care to her patients.

Ovarian cancer is a malignancy that develops in the ovaries, the female reproductive organs responsible for producing eggs and hormones.

Risk factors include a family history of ovarian or breast cancer, certain genetic mutations (BRCA1 and BRCA2), increasing age, infertility or low birth weight, and hormone replacement therapy.

Symptoms may include bloating, abdominal or pelvic pain, loss of appetite, changes in bowel or bladder habits, fatigue, and unexplained weight loss. However, these symptoms are not exclusive to ovarian cancer and can be caused by other conditions.

Diagnosis involves a combination of medical history evaluation, physical examination, imaging tests (ultrasonography or CT scan), analysis of cancer markers (such as CA-125), and sometimes a biopsy.

Ovarian cancer is staged from I to IV, with stage I being localized to the ovaries and stage IV indicating spread to distant organs. Staging helps determine the appropriate treatment approach.

Treatment may include surgery to remove tumors, chemotherapy to kill cancer cells, targeted therapy to inhibit specific molecular targets, hormone therapy for hormone receptor-positive tumors, radiation therapy, and immunotherapy in certain cases.

There is no guaranteed way to prevent ovarian cancer, but some preventive measures include maintaining a healthy lifestyle, having regular check-ups, discussing family history with healthcare providers, and considering risk-reducing surgeries for high-risk individuals.

Early detection significantly improves treatment outcomes. However, due to the lack of specific symptoms, ovarian cancer is often diagnosed at advanced stages. Awareness of symptoms and regular check-ups are vital for early detection.

Prognosis varies depending on the stage at diagnosis, the type of ovarian cancer, and individual factors. Early-stage diagnosis and prompt treatment offer better chances of successful outcomes.

Yes, research continues to develop new treatment strategies, including targeted therapies and immunotherapies. Clinical trials are conducted to evaluate the effectiveness of novel approaches.

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