Ovarian Cancer: Causes, Symptoms, Staging and Treatment

Have you ever struggled to understand about ovarian cancer?, well on this blog that’s exactly what we’re going to help you with, where you’ll learn about causes, symptoms, staging and treatment of ovarian cancer. This information is for you if you have ovarian cancer or want to know more about it. Being diagnosed with ovarian cancer will be a worrying and distressing time for you and your family. The team of doctors looking after you will support you and give you information that you might find helpful.

What is ovarian cancer and how common is it?

Every lady is born with two ovaries, one on each side of the womb. They have two main functions. Firstly, they produce and store eggs for reproduction. Secondly, they produce the female sex hormones and these hormones help develop your vagina, womb, fallopian tubes, breasts and body shape during puberty. They also regulate a woman’s menstrual cycle.

Cancer is a disease of cells in the body. Normal cells grow and multiply in an orderly way, with new cells made only when they are needed. When someone has cancer, this process goes wrong and cancer cells grow and multiply too quickly. As they multiply and grow, the cancer cells damage healthy tissue. Ovarian cancer occurs when abnormal cells within the ovary start to multiply, and form a tumour. Not all tumours are cancerous and those non-cancerous tumours are called benign tumours. Benign tumours don’t usually spread to other parts of the body. They may need treatment but they’re rarely life threatening.

In ovarian cancer, when cancer cells arise from the ovary its known as primary ovarian cancer. However, in some instances these cancerous cells are thought to come from other organs such as stomach and intestines and then fall on to the ovary then it’s called secondary ovarian tumors also known as Krukenberg tumor.

In India, ovarian cancer is the sixth most common cancer in women. Majority of cases occur in women who have gone through the menopause and are usually aged over 50, but younger women can also be affected. The earlier the disease is found and treated, the better the survival rate.

Normal ovary has several layers of cells and depending from which layer the cancer is arising there are different types of ovarian cancer. The most common type is epithelial ovarian cancer, which develops from the surface layer of cells in the ovary. This cancer type is rare in young women and is usually found in women who have been through the menopause.

What’s my risk of developing ovarian cancer?

A number of things can affect your risk of developing ovarian cancer. The two main risk factors are having certain cancers in your family, and getting older.

Ovarian or breast cancer in your family

  • If two or more relatives from the same side of your family have had ovarian or breast cancer, you may have a higher risk of developing ovarian cancer yourself. This is because you might have inherited a faulty gene (known as the BRCA1 or BRCA2 mutation) that creates a greater chance of developing ovarian cancer.

Ovarian, womb, colon, bowel or stomach cancers in your family

  • A rare condition called hereditary non-polyposis colorectal cancer (HNPCC), which runs in families can slightly increase your risk of developing ovarian cancer. It can also increase your risk of developing bowel, womb, stomach, colon, pancreatic, biliary and bladder cancer. HPNCC is caused by inherited faulty genes (known as the MLH1, MSH3 and MSH6 mutations).

Now coming to your 2nd risk, that’s getting older

Your risk of developing ovarian cancer increases as you get older and most ovarian cancer cases occur in women over the age of 50. However, some types of ovarian cancer do appear in much younger women. In addition to age and family history, the following may slightly increase your risk of ovarian cancer:
When someone has a long menstrual history, which can result from one or more of the following:

  • Starting your period before 12 years of age
  • Going through the menopause after 50 years
  • Having your first child after 30 years
  • Not having any children
  • Not breast feeding
  • Endometriosis (where in the lining of the womb is seen outside the womb). Despite being initially considered a benign disease, the wide opinion nowadays is that endometriosis of ovary are neoplastic conditions with the potential to become malignant. Large studies have demonstrated the presence of ovarian carcinoma in 5 to 10% of cases of endometriosis.
  • Using oestrogen-only hormone replacement therapy (HRT)
  • Smoking may increase your risk of developing mucinous type of ovarian cancer !

What are the symptoms to look out for?

If you’ve been getting any of the following symptoms regularly, you should talk to your doctor about getting tested for ovarian cancer: such as,

  • Persistent stomach pain
  • Persistent bloating of abdomen
  • Loss of appetite or feeling full quickly after eating
  • Needing to pee more frequently

Sometimes other symptoms can also be associated with ovarian cancer. You may get them on their own or at the same time as those listed above. These symptoms include:

  • Changes in bowel habits (e.g., diarrhoea or constipation)
  • Extreme fatigue
  • Back pain

Many of us get symptoms like these from time to time, and more often than not they’re down to other non-serious conditions. However, the symptoms of ovarian cancer are distinct in that they are:

  • Persistent (they don’t go away easily)
  • Frequent (you get them for more than 12 days a month)
  • Getting progressively worse
  • Symptoms are new (they started in the last months)
  • Unusual (not normal for you)

If you’re getting any of the above symptoms on most days of the month it’s important to see your doctor. Something else may be causing them, but it’s best to have them checked out.

What should I do if I notice symptoms?

If you think something’s changed with your body, don’t ignore it. And don’t be afraid to talk to your doctor. Your doctor will find it helpful if you can give them an idea of what’s been happening and how often your symptoms tend to come and go.
It’s easy to forget something important when you get to your doctor. That’s why you need to maintain symptoms diary to help you keep track. You can use it to note down each time symptoms occur, when you first noticed them and if they seem to be getting worse. So when you show the diary to your doctor, it’ll give them a better idea of what to do next.

The stages of ovarian cancer

If you’re diagnosed with cancer, you’ll be told what stage it’s at. This will help you and your doctors understand if the cancer has spread and the best way to treat it. There are four stages of ovarian cancer:

Stage 1: This is where the cancer is confined to one or both ovaries.

Stage 2: A stage 2 ovarian cancer occurs when the cancer is also found outside the ovary or ovaries, but has spread no further than the pelvic region (uterus, bladder, lower intestine).

Stage 3: ovarian cancer involves one or both ovaries and has spread beyond the pelvis into the abdominal cavity and/or to nearby lymph nodes.

Stage 4: indicates that cancer cells have spread to other parts of the body such as the liver, lungs and brain.

How quickly does ovarian cancer spread?

Different types of tumours grow at different rates. So when someone is diagnosed with cancer, their doctors will grade the tumour according to how quickly they expect it to develop. They work out the tumour’s grade by comparing how much the tumour looks like normal tissue. Cancers that look similar to normal tissue grow slowly and are considered low grade. High-grade cancers do not look like normal tissue and these types of cancers can spread quickly.

How is ovarian cancer is diagnosed?

Your gyneoncologist will carry out or arrange the following initial tests:

1. Physical examination

The first thing your doctor will want to do is to take a look at your stomach area, to feel for any lumps and bumps. They may also suggest an internal vaginal examination to see if there are any lumps around your womb or ovaries.

2. You will be advise to have blood test

The 2nd step will be to take a blood sample to test your levels of CA125 which is a protein all women have in their blood. Higher levels of it can often be associated with ovarian cancer.
However, some women have naturally high CA125 and there are other, less serious, conditions which can increase CA125. The test is therefore not completely conclusive but it can be used as an indicator to refer you for further tests.

3. Ultrasound

You will be advised to have a pelvic ultrasound scan. Ultrasound produces a picture of the inside of your body and can help detect any abnormalities. There are two types of pelvic ultrasound.

  • Transabdominal ultrasound: In this test, a handheld device is passed back and forth over your tummy, producing images of your ovaries, womb and other internal organs.
  • Transvaginal ultrasound: In this test, a probe is inserted into your vagina to obtain pictures of your womb, fallopian tubes and ovaries. The procedure is not painful but you may find it a little uncomfortable.

1. CT scan

A CT scan is an X-ray that produces a three-dimensional picture of the inside of your body. CT scans are able to spot any tumours in your ovaries and elsewhere. The scan takes up to half an hour and staff will take time to explain what will happen and make you feel comfortable. They will ask you to lie on a machine which passes you through the scanner device. You may be asked to drink a special fluid called a contrast that helps the machine take clearer pictures of your body. You will be asked to avoid eating food or drinking liquids a few hours before the scan.

2. MRI (Magnetic Resonance Imaging) scan

An MRI scan uses magnetic fields and radio waves to produce an image of your internal organs. A small device will be placed on your abdomen and you will be moved into the MRI machine. The MRI scan can be noisy and it makes a few patients feel claustrophobic. Make sure you tell the staff how you feel as some hospitals can offer you headphones or earplugs and a sedative so that you feel comfortable with the procedure. You will need to tell the radiographers if you have a pacemaker, artificial heart valve or other metal implant (such as an artificial hip).

Coping with the news

Different people cope in different ways when they are diagnosed with ovarian cancer. Everyone, including friends and family, have differing needs which vary over time. What is important is that you get the information that you need, in a way that you can cope with and understand, with appropriate support as and when you want it.

Research shows that when people are first told they have cancer, a lot of the information they are given doesn’t sink in. It is important that you are given ways of accessing information when you’re ready so that you can make the best decisions about your care and come to terms with your diagnosis. Having the right information can help you to cope better.

Once you have received a diagnosis you will want to discuss treatment options and find out more about the type and stage your ovarian cancer. There may be a lot to take in so it is a good idea to take someone with you to your appointments who can write down important information.

Your gyne oncologist should be able to explain what is going on in simple, clear language. Do not be embarrassed if you don’t understand all of the terms they use – just ask them to explain it in a different way until you are happy that you understand. If you still feel uncertain write things down so you can look them up later. Also, do not be afraid of asking your oncologist to refer you to a counselor if you feel it would help you.

As time passes you may want more detailed information from your oncologist. If you want to do some background reading there are books, leaflets and Internet sites that provide information. Be aware that some online information may be out of date and statistics can therefore be misleading.

What does treatment for ovarian cancer involve?

Surgery

Surgery is used both to diagnose ovarian cancer and to treat it. A surgeon who specializes in the treatment of female pelvic cancers usually carries it out and they are known as gynaecological oncologist.
Depending on your cancer, you may need to have some or all of the following removed:

  • The affected ovary and its fallopian tube (oophorectomy/ salpingectomy)
  • Both ovaries, fallopian tubes and uterus (this is known as a total hysterectomy with bilateral salpingooophorectomy)
  • Nearby lymph nodes and surrounding tissue
  • The omentum (a fold of fatty tissue covering the intestines)
  • Any cancer that has spread into the abdominal cavity
  • The appendix

If you have to have either your ovaries or uterus removed, it will mean you will not be able to get pregnant naturally. However, there are procedures available that may enable you to have a family. You would need to discuss this with your oncologist before going ahead with surgery. Having both your ovaries removed will bring on the menopause and even if you have been through this already you are likely to experience side-effects, such as night sweats, as the body adjusts after surgery.

Preparing for surgery

Surgery for the treatment of ovarian cancer is usually a major procedure and therefore there is a small risk of developing postoperative problems, but this is very rare. Whilst you are unlikely to develop any problems as a result of your surgery it is worth discussing all the consequences of surgery with your gynaecological oncologist. You will then be prepared for any outcome and can deal with it quickly.
Following your surgery you may have to stay in hospital for four to seven days.

Recovering after surgery

After your hospital stay, it will take you about six to twelve weeks to recover at home. This is because you will need time for your abdominal muscles and tissues to heal.

Your recovery time will depend on the type of surgery you have and whether or not postoperative problems develop. Before you return home you should receive a visit from a physiotherapist who will give you a programme of gentle exercises as part of your recovery programme.

During your recovery period you must avoid lifting things as you will have many stitches that need time to repair. You will need to avoid lifting anything heavy for six weeks. Do not be afraid to ask for practical help from family and friends if you need it. Being surrounded by your loved ones will help you to recover faster.

Practical help may also be available from your local hospital. Ask your doctor whom to contact. It is sensible to organise these things prior to your surgery.

You will not be able to drive for six to eight weeks after the operation. Finally, bear in mind that you might need at least eight weeks off work after surgery. You may then need some more time off work when you start chemotherapy so have a discussion with your employer about this as soon as you can.

Longer term effects of surgery

Early menopause

If your ovaries have been removed you will enter menopause after your treatment. This can cause symptoms such as hot flushes, sweats, a dry vagina, thinning bones and feeling emotional and anxious. To control these symptoms some women are able to take hormone replacement therapy (HRT). Your oncologist can help you decide what’s best for you. Some women will not be able to take HRT as some types of ovarian cancer are sensitive to hormones.

Loss of fertility

With the removal of your ovaries, fallopian tubes and womb you will not be able to become pregnant but depending on the type and stage of your cancer you may be able to have fertility-sparing surgery.

Fertility-sparing surgery may be an option for women with:

  • Early stage disease (stage 1)
  • Ovarian tumours of low malignant potential
  • Malignant ovarian germ cell tumours;
  • Ovarian sex cord-stromal tumours

Fertility-sparing surgery involves removing the areas affected by the cancer but sparing the uterus and an unaffected ovary.
Where fertility-sparing surgery is not appropriate, it may be possible for your ovarian tissue or eggs to be removed and preserved. This is in preparation for IVF at a later stage.
Your oncologist will need to work closely with a fertility specialist so that a rapid referral can be made. Therefore, try and discuss your fertility concerns with your oncologist as soon as possible.

Impact on your sex life

The removal of your ovaries reduces your oestrogen levels and this may lead to symptoms, which can affect your sex life. The lack of oestrogen can cause thinning of the skin around your vagina, a reduction in the mucus that lubricates your vagina and a loss of fat tissue around your genital area. This makes your vagina shorter, less elastic and drier.

These changes may not happen, every woman is different, and if they do happen they usually take months or years to develop. These changes in your private parts may cause the following symptoms:

  • Pain or general discomfort during sex, due to your vagina being smaller and drier
  • Vaginal itchiness due to the increased sensitivity of the skin around your vagina
  • Urinary problems may occur if the tissue round the neck of your bladder thins or weakens. You may experience an urgency to use the toilet or recurring urinary infections
  •  Changes to your libido These symptoms can be treated quite effectively in some cases with a topical cream and/or with over-the-counter drugs.

For vaginal dryness you can try a vaginal moisturizer like KY jelly. Alternatively oestrogen cream can be applies near the vagina and this helps to restore oestrogen to your vagina and surrounding tissues. These can be prescribed by your doctor but should not be used as a substitute for lubricating gels, which should be used separately. Hormone Replacement Therapy (HRT) can be used for relieving some symptoms. Discuss this with your oncologist to see if this is the best option for the type of cancer that you have had – some cancers are sensitive to hormones so use them under supervision. Some women experience concerns about body image, energy levels and sexuality. These issues can be overcome with the right support from your oncologist, psychosexual counselors. If you are concerned about your sex life, talk to your oncologist. They can help you out.

Chemotherapy and ovarian cancer

Most women with ovarian cancer are offered chemotherapy. Chemotherapy is given to reduce any disease remaining after surgery or to reduce the likelihood of the cancer returning.

What is chemotherapy?

Chemotherapy works by attacking cells that divide rapidly. Cancer cells behave in this way. If your cancer has been discovered at an early stage you may not require chemotherapy. However, most patients need to have some chemotherapy and this is usually started after surgery. In some cases, chemotherapy is given first and surgery is carried out afterwards.

Other treatments you may have heard of, such as radiotherapy, may not be suitable for treating your type of ovarian cancer.
There are many different chemotherapy drugs available. The two most common treatments for epithelial ovarian cancer at first presentation are:
Paclitaxel with carboplatin

How chemotherapy is given

Chemotherapy drugs are usually given by mouth or injected into a vein, which enables them to enter the bloodstream in order to kill cancer cells. Paclitaxel and carboplatin are given intravenously (injected into the vein). The treatment is generally given in a specialist day ward but you may require a short stay in hospital.
Chemotherapy is usually given in cycles of treatment followed by a rest period that allows normal cells to recover from the effect of the drugs. A typical course of chemotherapy for ovarian cancer involves 6 cycles.

Follow-up after treatment

Your doctor will advise you to have regular hospital follow-ups after treatment. For the first couple of years you will have follow-up appointments every 2–3 months. If all remains well, the visits will then become less frequent and you may only be seen once or twice a year for up to 5 years. It is important to attend these follow-up visits even if you are feeling well, as cancer can return even when you have no symptoms. Should you get symptoms or be worried about anything, contact your doctor as soon as possible. Do not wait until your next appointment.
At your follow-up visit, the doctor will ask you how you are feeling and whether you have any symptoms or are suffering from side effects of treatment. He or she will usually examine you. You may also have blood tests, scans or X-rays to see how your cancer has responded to treatment.