Ovarian cancer

Ovary is the women’s reproductive organ located inside the pelvis of the uterus, which produces eggs/ovum for reproduction. Eggs, which are produced by the ovary, are delivered to the uterus through follopian tubes for fertilization and further grow into an embryo.

Cancer is a disease caused by uncontrollable and continual cell proliferation.

Ovarian cancer is caused by abnormal proliferation of ovarian tissues or fallopian tubes resulting in continually enlarged ovary and finally metastasized. They usually spread into peritoneal lining or blood or lymph ducts, and appeared in the other parts of the body, e.g. pelvis, lung, or liver. This stage of ovarian cancer is called “Metastasis”

The true causes of ovarian cancer are not well understood. However, the studies show that the following risk factors increase the chance of developing ovarian cancer. Some patients may have disease with unknown reasons.

• Family members with history of cancer, particularly in mother, older/younger sister.

• Older age, particularly at the age older than 50 year. History of

• Breast cancer or intestinal cancer older/younger sister.

• History of endometriosis or chocolate cysts

• Long-term hormone replacement therapy

• Smoking

Early stage of ovarian cancer is likely to occur without symptoms, but if you notice the following symptoms, you should consult doctor for further diagnosis.

• Loss of appetite     

• Nausea/vomiting   

• Unexplained weight loss or gain weight frequent urination

• Dyspepsia bloating

• Unexplained fatique

• Chronic diarrhoea or constipation

• Abdominal pain or pelvic pain    

• Abnormal vaginal bleeding

• Abdominal discomforts    

• Early satiety after eating
  
  

These symptoms may result from the ovarian cancer or other diseases. You should see a doctor for physical examination to find the cause.

There has no specific screening for prevention of ovarian cancer.
As ovarian cancer in early stage likely occur without symptoms, the procedures that help to detect lesions early include

• Transvaginal ultrasound to determine ovary shape and size as well as amount of blood supply.

• Look for any abnormalities of the body 

• Annual vaginal and pelvic examination

• Blood test to measure a substance produced from ovaries, i.e. CA125
  
  *Blood test to measure a substance produced from ovaries, i.e. CA125, which may increase in some types of ovarian cancers and may also elevate in certain conditions; peritonitis, hepatitis, pelvic inflammation, endometriosis, uterine fibroids, pregnancy and menstruation, etc

People with risks of ovarian cancers should see a doctor for early diagnosis of cancer. Doctor and healthcare professional team can advise about the tests for screening, diagnosis, and follow-up in a timely manner.

As signs of cancer are neither specific nor similar to those caused by abnormalities of other systems, e.g. gastrointestinal tract or urinary tract, this can delay diagnosis and usually detected at later stages where cancer has already spread, thus compromising the effectiveness of the treatment.

1. Family history and genetic history. If there is ovarian or breast cancer in the family history, additional genetic tests related to cancer risks should be done.

2. Physical examination and vaginal and pelvic examination to detect tumor at the early stage to see if there is a lump in pelvis or fallopian tube.

3. Ultrasound is useful for diagnosis of ovarian cancer in the early stage. It is used to investigate tumor appearance and its location.

4. Blood test to determine tumor marker, e.g. CA-125 or others based on indication, e.g. CA19-9, CEA, HE4.

5. Radiodiagnosis, e.g. chest x-ray, CT, or MRI, to help diagnosis and to determine disease activity for treatment plan.

6. Tissue sampling for pathological examination (Biopsy)

Stage 1: Cancer cells can be found in 1 or 2 ovaries or fallopian tubes.

Stage 2: Cancer cells can be found in 1 or 2 ovaries or fallopian tubes and the cells spread into the surrounding tissues of the ovary, but within pelvic linings

Stage 3: Cancer cells can be found in 1 or 2 ovaries or fallopian tubes and the cells spread into the upper part of peritoneum or adjacent lymph nodes.

Stage 4: Cancer cells are spread into other parts of the body, e.g. liver, lung, etc.

The treatment of ovarian cancer depends on multiple factors which include type of cancer, location, severity, and patient’s overall health. It is important to discuss with the physician before making a decision for the best treatment. The combination of surgery and chemotherapy are commonly used in the majority of patients. 

It is important to know that even if you have the same type of cancer as someone else, your DNA mutations may differ, and you may need different treatment. By taking a look into your cancer DNA mutations with Comprehensive Genomic Profiling, your doctor can consider this information for identifying the most appropriate treatment approach for your cancer.4-6

Treatment guidelines for ovarian cancer are as follows:

Surgery is the primary procedure in ovarian cancer treatment. This should be done by a gynaecologist. The main objective of the surgery is to remove tumor out of the body as much as possible. Surgical intervention is based on tumor size, its location, and site of metastases
If the doctor determines that cancer cells in the ovary have not progressed to the extent that it is inoperable, he/she may consider the surgical treatment to remove the tumor and surrounding tissues. The following organs; both ovaries, fallopian tubes, pelvis, and uterus including cervical area, lymph node and peritoneal linings, are often surgically removed in patients with ovarian cancers. This depends on the physician’s diagnosis.

Chemotherapy is the treatment that use medicine to destroy or inhibit the rapid proliferated cells all over the body, either cancer cells or normal cells, e.g. hair. nails, blood cells, and gastrointestinal lining, etc.

In patients with early stage of ovarian cancers, but without tumor lesion or spread to outside of the ovary, only surgery may be sufficient for the treatment without chemotherapy. In patients with metastases, they are often given chemotherapy drugs following the surgery that is called “adjuvant treatment after surgery” to remove the remaining cancer cells. This treatment is to reduce the chance of cancer recurrence and to increase patient survival rate.

Chemotherapy drugs may also be used in patients with metastatic or inoperable ovarian cancer to prevent the spread of the cancer cells and to alleviate symptoms or suffering from the ovarian cancer, to enhance the quality of life, and to increase patient’s survival rate.

Common side effects of chemotherapy drugs are loss of appetite, nausea, vomiting, hair loss, fatigue, anaemia, low platelet count, and more susceptible to infection, etc.

Targeted therapy is the treatment using other medicines or active chemicals that are specific to cancer cells, causing less damage to normal cells than chemotherapy or radiotherapy. To date, targeted therapy is categorised into 2 main groups which are;

• Anti-angiogenesis agents work by inhibiting the formation of new blood vessels that supply the tumor and by decreasing the production of abdominal fluid. It is available in form of an injection.

• PARP inhibitors work by inhibiting the restoration of the genetic code of cancer cells. It is available in form of oral dosage.

Use of hormone or anti-hormonal agents is an alternative which may delay or inhibit growth and metastases of ovarian cancer cells. It may be used as supportive treatment.

Treating doctor will follow up with patients after treatment to continue to provide medical care. The frequency of follow up depends on the disease and patient’s health condition. In general, patients will meet with doctor every 3 months after treatment in the first 2 years during which recurrence of cancer is highly likely, then every 6 months. Physical examination, vaginal and pelvic examination, blood test for tumor marker,
x-ray, and other tests will usually be conducted during the follow up. The doctor will determine the interval in an appropriate manner.

Reference

1. American Cancer Society. Ovarian Cancer. Available at:Last accessed December 2018

2. The National Comprehensive Cancer Network, Inc. NCCN Guidelines for Patients®OvarianCancer Version 1.2017. Available at: https://www.nccn.org/patients/guidelines/ovarian/index.html.

   Last accessed December 2018

3. European Society for Medical Oncology (ESMO). ESMO Patient Guide Series “What is Ovarian Cancer”. Available at:Last accessed December 2018

4. Heim D et al. Int J Cancer 2014; 135: 2362–2369

5. Baumgart M et al. Am J Hematol Oncol 2015: 11: 10–13

6. Schwaederle M, Kurzrock R. Oncoscience 2015; 2: 779–780.  

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