Ovarian Cancer in Young Females

Overview

Ovarian cancer is a condition in which some cells of the ovaries grow uncontrollably and destroy surrounding healthy tissue. The ovaries are a pair of small glands one on each side of the uterus. They produce an ovum (egg) each month and make the hormones oestrogen and progesterone. Ovarian cancer is treated with surgery and chemotherapy.

What is Ovarian Cancer? Who is Affected?

Ovarian cancer encompasses a group of conditions that has its origins in the ovaries or the fallopian tubes or the peritoneum (tissue lining that covers organs of the abdomen). When malignant or cancerous cells form in these organs, it is defined as ovarian cancer. 

Anyone who is born with ovaries can get ovarian cancer, but it typically affects women after the age of 50. It is often seen to have a familial tendency. Gene mutations are more common among races like Ashkenazi Jews, making them susceptible to ovarian cancer.

Since the symptoms of ovarian cancer are not always obvious, the condition is diagnosed at a late stage in most cases.

Symptoms of Ovarian Cancer

In the initial stages, there are no noticeable symptoms of ovarian cancer, or they may be mistaken for some other condition. The common symptoms are:

• swelling of the abdominal region or bloating
• pain and pressure in the abdomen or between the hips (pelvic area)
• loss of appetite or a feeling of fullness while eating
• frequent and sudden urges to urinate. 
• vaginal discharge
• indigestion, diarrhea or constipation.

Causes of Ovarian Cancer

Though it’s not clear what exactly causes ovarian cancer, certain factors increase the risk of developing the condition. These include:

• middle-age and older women are more likely to develop ovarian cancer
• having a close family member on either parent’s side who has had ovarian cancer
• mutation associated with BRCA1 (BReast CAncer1) or BRCA2 genes
• a history of breast or colon cancer
• being affected by a condition called endometriosis (tissue from the uterine lining grows in other places in the body)
• women who have never given birth or have trouble getting pregnant.
• Not all women who have one or more of these factors develop ovarian cancer, but the risks should be understood. 

How Does Ovarian Cancer Spread?

Ovarian cancer spreads in 3 ways -  

• Tissue - The abnormal cell growth can affect nearby tissues or organs like the uterus or abdomen.
• Lymph - Cancerous cells can travel through the lymphatic system to distant organs
• Blood - Cells can also travel through the circulatory system to different organs.
• When ovarian cancer cells break away and form a tumor in a distant part like the lung, it is called metastasis. It is referred to as metastatic ovarian cancer and not lung cancer. 

Diagnosis of Ovarian Cancer 

Ovarian cancer is difficult to diagnose in the early stages because of the lack of an appropriate screening test (performed before any symptom arises). Current tests are diagnostic and performed after the onset of symptoms. A thorough medical history is elicited first. When there is a risk or suspicion of ovarian cancer, a pelvic exam is done to check for any abnormal growth or enlargement. There are additional tests that are usually recommended:

Blood tests 

• A CBC (Complete Blood Count), as well as liver and kidney health assessments, will be done. 
• CA-125 (Cancer Antigen-125) is a tumor marker and its presence in the blood may indicate cancer.

Imaging

• Ultrasound scan of the pelvic region
• MRI (Magnetic Resonance Imaging)
• CT (Computed Tomography) scan, PET (Positron Emission Tomography) scan

Biopsy

• Laparoscopy is a procedure by which a thin flexible tube with a light and a camera can be used through a small incision. It can be used to take tissue samples for a biopsy and it can also be used to remove the entire tumor if possible.

Stages of Ovarian Cancer

Ovarian cancer is graded in 4 stages starting from 1 and progressing higher as the condition becomes more serious. Staging is important to develop a treatment plan.

Ovarian Cancer Stage I

• Stage IA - Cancer has affected only one ovary or one fallopian tube.
• Stage IB - cancer is present in both ovaries or both fallopian tubes
• Stage IC - cancer is in both ovaries or fallopian tubes and is present outside the ovary, in the peritoneal cavity.

Ovarian Cancer Stage II

• Stage IIA - It has invaded the uterus or fallopian tubes
• Stage IIB - It is present on the outer surface or invaded nearby pelvic organs like the bladder or colon.

Ovarian Cancer Stage III

• Stage IIIA - growth is in one or both ovaries or fallopian tubes or there is peritoneal cancer. It has spread to local lymph nodes.
• Stage IIIB - there is cancer in one or both ovaries or fallopian tubes or it has spread to organs outside the pelvis. The tumor has grown to 2 centimeters and may or may not be involving retroperitoneal lymph nodes.
• Stage IIIC - previous stage plus the growth of tumor has exceeded more than 2 centimeters.

Ovarian Cancer Stage IV 

• The most severe stage. The liver and spleen are affected.
• Stage IVA - lungs are affected
• Stage IVB - cancer cells spread and are present inside the spleen or liver, and to lymph nodes outside the peritoneum.

Treatment for Ovarian Cancer 

Ovarian cancer treatment aims to remove or destroy cancerous cells and tissue by:

• Surgery - Early-stage cancer can be managed by removing only the affected ovary and its fallopian tube. Sometimes, both ovaries and their fallopian tubes may need removal. In case of an extensive spread of cancer, even the uterus and a little of the surrounding tissue may need to be removed. Surgery can be a minimally invasive procedure or an open surgery.
• Chemotherapy - Drugs can be given orally or intravenously. 
• Targeted therapy focuses on specific weaknesses within the cancerous cells.
• Hormone therapy is used for ovarian cancer cells that grow and spread using hormones. 
• Immunotherapy increases the capacity of the immune system 

Ovarian Cancer Prevention

Ovarian cancer causes are unknown, so it cannot be prevented and no screening test is currently available for it. 

• Genetic testing can provide information about the genes BRCA1 (BReast CAncer 1) and BRCA2. These genes protect women from certain cancers but any mutation prevents them from functioning properly. If a woman inherits such a mutated gene from either parent, she is at increased risk of breast or ovarian cancer. 
• An otherwise healthy woman with a known risk can opt to have the ovaries removed surgically as a preventive measure. This procedure is known as bilateral oophorectomy.

When to Consult a Doctor

Women may observe the following symptoms at various stages and they are not a cause for concern in most situations. They should consult a cancer specialist when any of these symptoms are present for more than a couple of weeks:

• abdominal or back pain
• losing weight without the intention
• vaginal bleeding after menopause
• presence of unusual lumps