What is Ovarian Cancer

Ovarian cancer is a disease in which malignant or cancerous cells are found in the ovaries. An ovary is one of two small, almond-shaped organs located on each side of the uterus that store eggs or germ cells and produce female hormones estrogen and progesterone.

 

Cancer Basics

Cancer develops when cells in a part of the body (in this case the ovary) begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells.

 

Normally, cells in your body divide, and form new cells to replace worn out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to create new abnormal cells forming a tumor. Tumors can put pressure on other organs lying near the ovaries.

Cancer cells sometimes can travel to other parts of the body where they begin to grow and replace normal tissue. This process, called metastasis, occurs as the cancer cells move into the bloodstream or lymph vessels of our body. Cancer cells that spread from other organ sites (such as breast or colon) to the ovary are not considered ovarian cancer

There are many types of tumors that can start in the ovaries. Some are benign, or noncancerous, and the patient can be cured by surgically removing one ovary or the part of the ovary containing the tumor. Some are malignant or cancerous. The treatment options and the outcome for the patient depend on the type of ovarian cancer and how far it has spread before it is diagnosed.

 

What is the general outlook for women diagnosed with ovarian cancer?

In women age 35-74, ovarian cancer is the fifth leading cause of cancer-related deaths. An estimated one woman in 71 will develop ovarian cancer during her lifetime. The American Cancer Society estimates that there will be over 22,000 new cases of ovarian cancer diagnosed this year and that more than 15,000 women will die from ovarian cancer this year.

 

When one is diagnosed and treated in the earliest stages, the 5-year survival rate is over 90%. Due to ovarian cancer's non-specific symptoms and lack of early detection tests, only 19% of all cases are found at this early stage. If caught in stage III or higher, the survival rate can be as low as 30.6%. Due to the nature of the disease, each woman diagnosed with ovarian cancer has a different profile and it is impossible to provide a general prognosis.

 

Symptoms of Ovarian Cancer

 

Ovarian cancer is difficult to detect, especially, in the early stages. This is partly due to the fact that these two small, almond shaped organs are deep within the abdominal cavity, one on each side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:

• Bloating

• Pelvic or abdominal pain

• Trouble eating or feeling full quickly

• Feeling the need to urinate urgently or often

Other symptoms of ovarian cancer can include:

• Fatigue

• Upset stomach or heartburn

• Back pain

• Pain during sex

• Constipation or menstrual changes

If symptoms persist for more than two weeks, see your physician.

 

Persistence of Symptoms

When the symptoms are persistent, when they do not resolve with normal interventions (like diet change, exercise, laxatives, rest) it is imperative for a woman to see her doctor. Persistence of symptoms is key. Because these signs and symptoms of ovarian cancer have been described as vague or silent, only around 19% of ovarian cancer is found in the early stages. Symptoms typically occur in advanced stages when tumor growth creates pressure on the bladder and rectum, and fluid begins to form.

 

• A rectovaginal pelvic examination is when the doctor simultaneously inserts one finger in the rectum and one in the vagina.

• It is helpful to take a mild laxative or enema before the pelvic exam.

• Have a comprehensive family history taken by a physician knowledgeable in the risks associated with ovarian cancer. 5% to 10% of ovarian cancer has a familial link.

Every woman should undergo a regular rectal and vaginal pelvic examination. If an irregularity of the ovary is found, alternatives to evaluation include transvaginal sonography and/or tumor markers. The most common tumor marker is a blood test called the CA-125.

 

Types & Stages of Ovarian Cancer

Types of Ovarian Cancer

There are more than 30 different types of ovarian cancer which are classified according to the type of cell from which they start. Cancerous ovarian tumors can start from three common cell types:

• Surface Epithelium - cells covering the lining of the ovaries

• Germ Cells - cells that are destined to form eggs

• Stromal Cells - Cells that release hormones and connect the different structures of the ovaries

Common Epithelial Tumors - Epithelial ovarian tumors develop from the cells that cover the outer surface of the ovary. Most epithelial ovarian tumors are benign (noncancerous). There are several types of benign epithelial tumors, including serous adenomas, mucinous adenomas, and Brenner tumors. Cancerous epithelial tumors are carcinomas - meaning they begin in the tissue that lines the ovaries. These are the most common and most dangerous of all types of ovarian cancers. Unfortunately, almost 70 percent of women with the common epithelial ovarian cancer are not diagnosed until the disease is advanced in stage.

There are some ovarian epithelial tumors whose appearance under the microscope does not clearly identify them as cancerous. These are called borderline tumors or tumors of low malignant potential (LMP tumors).

Epithelial ovarian carcinomas (EOCs) account for 85 to 90 percent of all cancers of the ovaries. We must continue research and expand our knowledge about this group of cancers in order to improve treatment and save lives.

Germ Cell Tumors - Ovarian germ cell tumors develop from the cells that produce the ova or eggs. Most germ cell tumors are benign (non-cancerous), although some are cancerous and may be life threatening. The most common germ cell malignancies are maturing teratomas, dysgerminomas, and endodermal sinus tumors. Germ cell malignancies occur most often in teenagers and women in their twenties. Today, 90 percent of patients with ovarian germ cell malignancies can be cured and their fertility preserved.

Stromal Tumors - Ovarian stromal tumors are a rare class of tumors that develop from connective tissue cells that hold the ovary together and those that produce the female hormones, estrogen and progesterone. The most common types are granulosa-theca tumors and Sertoli-Leydig cell tumors. These tumors are quite rare and are usually considered low-grade cancers, with approximately 70 percent presenting as Stage I disease (cancer is limited to one or both ovaries).

 

Primary Peritoneal Carcinoma

The removal of one's ovaries eliminates the risk for ovarian cancer, but not the risk for a less common cancer called Primary Peritoneal Carcinoma. Primary Peritoneal Carcinoma is closely rated to epithelial ovarian cancer (most common type). It develops in cells from the peritoneum (abdominal lining) and looks the same under a microscope. It is similar in symptoms, spread and treatment.

 

 

Stages of Ovarian Cancer

Once diagnosed with ovarian cancer, the stage of a tumor can be determined during surgery, when the doctor can tell if the cancer has spread outside the ovaries. There are four stages of ovarian cancer - Stage I (early disease) to Stage IV (advanced disease). Your treatment plan and prognosis (the probable course and outcome of your disease) will be determined by the stage of cancer you have.

 

Following is a description of the various stages of ovarian cancer:

Stage I - Growth of the cancer is limited to the ovary or ovaries.

Stage IA - Growth is limited to one ovary and the tumor is confined to the inside of the ovary. There is no cancer on the outer surface of the ovary. There are no ascites present containing malignant cells. The capsule is intact.

Stage IB - Growth is limited to both ovaries without any tumor on their outer surfaces. There are no ascites present containing malignant cells. The capsule is intact.

Stage IC - The tumor is classified as either Stage IA or IB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant cells or with positive peritoneal washings.

Stage II - Growth of the cancer involves one or both ovaries with pelvic extension.

Stage IIA - The cancer has extended to and/or involves the uterus or the fallopian tubes, or both.

Stage IIB - The cancer has extended to other pelvic organs.

Stage IIC - The tumor is classified as either Stage IIA or IIB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) the capsule has ruptured; and (3) there are ascites containing malignant cells or with positive peritoneal washings.

Stage III - Growth of the cancer involves one or both ovaries, and one or both of the following are present: (1) the cancer has spread beyond the pelvis to the lining of the abdomen; and (2) the cancer has spread to lymph nodes. The tumor is limited to the true pelvis but with histologically proven malignant extension to the small bowel or omentum.

Stage IIIA - During the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has not spread to lymph nodes. However, when biopsies are checked under a microscope, very small deposits of cancer are found in the abdominal peritoneal surfaces.

Stage IIIB - The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm in diameter. The cancer has not spread to the lymph nodes.

Stage IIIC - The tumor is in one or both ovaries, and one or both of the following is present: (1) the cancer has spread to lymph nodes; and/or (2) the deposits of cancer exceed 2 cm in diameter and are found in the abdomen.

Stage IV - This is the most advanced stage of ovarian cancer. Growth of the cancer involves one or both ovaries and distant metastases (spread of the cancer to organs located outside of the peritoneal cavity) have occurred. Finding ovarian cancer cells in pleural fluid (from the cavity which surrounds the lungs) is also evidence of stage IV disease.

These statistics, and the information regarding tumor stage and grade, demonstrate that there is a critical need to establish an agenda for more research into the areas of basic and translational research, genetic susceptibility and prevention, diagnostic imaging, screening and diagnosis, and therapy. These could hold the most promise for future discoveries that will lead to improved prevention, detection, and treatment of ovarian cancer, particularly the common epithelial cancers.

 

Ref.Site http://www.ovarian.org