Ovarian Cancer
This disease is much more common in women over age 50 and after menopause. Approximately 25,000 American women develop this illness and 14,000 die as a result of it each year.
Cause
The cause of ovarian cancer is unknown, however, certain factors increase the risk of developing it:
- High dietary fat
- Infertility
- Family history of gynecological cancer
- Genetic factors
Signs and Symptoms
Early stage ovarian cancer produces absolutely no symptoms. Cancer may grow to the size of a grapefruit before it causes a noticeable problem. Any of the following may be an early symptom of this cancer:
- Urinary frequency
- Pressure feeling in rectum
- Abdominal bloating and swelling
Diagnosis
A physical examination, with a detailed pelvic exam, may reveal this illness. Visualization of the pelvis using Ultrasound or CT scan should be the next step. Blood test, CA125 is a tumor marker, which may be very helpful in establishing the diagnosis. When there is suspicion of this cancer, a tissue diagnosis is mandatory. This may be accomplished by:
- FNA or Trochar Biopsy of the tumor
- Examination of fluid in the abdomen
- Surgery, with removal of the tumor
Pattern of spread
If left untreated, or if ovarian cancer fails to respond to treatment, it can spread from the ovaries to
- Pelvic and abdominal lymph glands
- Abdominal cavity, and cause fluid production in the abdomen
- Lungs
- Pleural space
- Bones
- Liver
- Brain
Staging Work-Up
Once a diagnosis of the ovarian cancer is established, a thorough examination of the patient should be performed to disclose the extent of the cancer spread. A chest X-Ray along with CT scan of the abdomen and pelvis should be performed to determine the extent of cancer's spread. The purpose of these tests is to study the areas where cancer has a tendency to spread to. Detailed staging of ovarian cancer is accomplished by the laboratory examination of the tissues removed during surgery.
- Stage 1, when cancer is limited to one ovary
- Stage 2, when cancer involves both ovaries or extends to the pelvis
- Stage 3, when cancer spreads to the abdominal cavity or lymph glands
- Stage 4, when it spreads to other organs, e.g., lungs, brain, liver, etc.
Treatment
Treatment of ovarian cancer is complex and utilizes surgery, chemotherapy and radiation therapy. Surgery is the most important tool in management of this disease, especially in early Stages 1 and 2, when a cure is possible. The disease becomes very difficult to treat when it has reached Stage 3 or Stage 4.
Patients with Stages 1 or 2 may benefit from radiation to the abdomen. However, radiation can cause substantial side effects and complications, one of which is bowel obstruction, which is seen in 10 to 25% of patients.
All patients, in all stages, are offered chemotherapy. Most patients are treated with a combination of Taxol, Cisplatinum or Carboplatinum. Other commonly used drugs are: Cytoxan, Adriamycin, Thiotepa, Melphalan, VP-16, Topotecan. More recently Navelbine has shown activity in treatment of ovarian cancer, especially when combined with other drugs such as Taxol, Ifosfamide, etc.
Certain patients with ovarian cancer may be considered for treatment with Autologous Bone Marrow Transplantation. This is a rather experimental treatment and has not found its place in treatment of this cancer.
Metastatic Cancers to Ovaries
Certain cancers have a tendency to spread to ovaries, i.e., breast, stomach, colon. Such cancers, when they spread to ovaries, are already in advanced stages and are treated with methods and drugs that effective against the underlying cancer.
Special Situations
Patients with advanced ovarian cancer may develop any of the following complications:
- Spinal cord compression
- Brain metastasis
- Bone metastasis
- High Calcium level
- Pain
- Pleural effusion
Survival
Survival of patients with this cancer will depend on the extent of the cancer at the time of initial diagnosis. Most patients with early stages of ovarian cancer can be cured with surgery and chemotherapy. In the majority of patients in whom cure is not possible, survival could vary from months to years, depending on the extent of cancer, overall condition of the patient, as well as the response to treatments and the duration of that response.
Family Member issues
First-degree relatives of all patients with this cancer should be monitored carefully. This cancer has a tendency to run in families and be associated with genetic abnormalities, for which they can be tested. Family members should consider genetic counseling to determine their risk and possible work up for early detection of the cancer.
Follow-up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for a possibility of recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and her disease. In each follow-up visit, a patient is examined. Normally, a chest x--ray is obtained every few months and CT scan abdomen and pelvis once a year. Blood test, CA125 should be performed every few months.
Treatment of the recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are treated with chemotherapy using the same agents as mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas where the cancer has spread. If patients experience pain, various pain medications may be used to alleviate pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from Hospice.
