Ovarian Cancer is the 4th commonest cancer in women in India, though worldwide it ranks 7th. Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries or fallopian tubes. Malignant cancer cells in the ovaries can spread in two ways: directly to other organs in the pelvis and abdomen (the more common way), through the bloodstream or lymph nodes to other parts of the body.
The type of cell where cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:
While most women with ovarian cancer do not have any known risk factors, some do exist. If a woman has one or more risk factors, she will not necessarily develop ovarian cancer; however, her risk may be higher than the average woman’s.
About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 5 to 10 percent of all ovarian cancers.
Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer.
Another known genetic link to ovarian cancer is an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC or Lynch Syndrome). While HNPCC poses the greatest risk of colon cancer, women with HNPCC have about a 12 percent lifetime risk of developing ovarian cancer.
Women who have one first-degree relative with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer. The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent (the average woman’s lifetime risk is 1.4 percent).
All women are at risk of developing ovarian cancer regardless of age; however, a woman’s risk is highest during her 60s and increases with age through her late 70s. The median age (at which half of all reported cases are older and half are younger) at diagnosis is 63.
Reproductive History and Infertility
Research suggests a relationship between the number of menstrual cycles in a woman’s lifetime and her risk of developing ovarian cancer. A woman is at an increased risk if she:
Infertility, regardless of whether or not a woman uses fertility drugs, also increases the risk of ovarian cancer.
Hormone Replacement Therapy
Doctors may prescribe hormone replacement therapy to alleviate symptoms associated with menopause. Hormone replacement therapy usually involves treatment with either estrogen alone (for women who have had a hysterectomy) or a combination of estrogen with progesterone or progestin (for women who have not had a hysterectomy).
Women who use menopausal hormone therapy are at an increased risk for ovarian cancer. Recent studies indicate that using a combination of estrogen and progestin for five or more years significantly increases the risk of ovarian cancer in women who have not had a hysterectomy. Ten or more years of estrogen use increases the risk of ovarian cancer in women who have had a hysterectomy.
Various studies have found a link between obesity and ovarian cancer.
Tests and procedures used to diagnose ovarian cancer include:
To create a picture of your ovaries, your doctor may insert an ultrasound probe into your vagina. This procedure is called transvaginal ultrasound. Ultrasound imaging can create pictures of the structures near your ovaries, such as your uterus.
During surgery, a gynecologic oncologist makes an incision in your abdomen to explore your abdominal cavity and determine whether cancer is present. In some cases, the surgeon may use several small incisions and insert special surgical tools to perform minimally invasive surgery or robotic surgery.
The surgeon may collect samples of abdominal fluid and remove an ovary or other tissue for examination by a pathologist. If cancer is discovered, the surgeon may immediately begin surgery to remove as much of the cancer as possible.
Doctors use the results of your surgery to help determine the extent — or stage — of your cancer. Your doctor may also use information from imaging tests, such as computerized tomography (CT). Your cancer’s stage helps determine your prognosis and your treatment options.
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.
Treatment for ovarian cancer usually involves an extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads. Your surgeon also removes as much cancer as possible from your abdomen (surgical debulking).
Less extensive surgery may be possible if your ovarian cancer was diagnosed at a very early stage. For women with stage I ovarian cancer, surgery may involve removing one ovary and its fallopian tube. This procedure may preserve the ability to have children.
After surgery, you’ll most likely be treated with chemotherapy — drugs designed to kill any remaining cancer cells. Chemotherapy may also be used as the initial treatment in some women with advanced ovarian cancer. Chemotherapy drugs can be given in a vein (intravenously) or injected directly into the abdominal cavity, or both methods can be used. Chemotherapy drugs can be given alone or in combination.
We do know that some women are more likely than others to develop uterine cancer.
Many women who get uterine cancer have none of these risk factors, and many women who have known risk factors don’t develop the disease.
The most common symptom of uterine cancer is abnormal vaginal bleeding. It may start as a watery, blood-streaked flow that gradually contains more blood. After menopause, any vaginal bleeding is abnormal.
These are common symptoms of uterine cancer:
These symptoms may be caused by uterine cancer or by other health problems. Women with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible.
If you have symptoms that suggest uterine cancer, your doctor will try to find out what’s causing the problems.
You may have a physical exam and blood tests. Also, you may have one or more of the following tests:
If cancer is found, the pathologist studies tissue samples from the uterus under a microscope to learn the grade of the tumor. The grade may suggest how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. Tumors with higher grades are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.
If uterine cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body. In most cases, surgery is needed to learn the stage of uterine cancer. The surgeon removes the uterus and may take tissue samples from the pelvis and abdomen. After the uterus is removed, it is checked to see how deeply the tumor has grown. Also, the other tissue samples are checked for cancer cells.
To learn whether uterine cancer has spread, your doctor may order one or more tests prior to surgery: like PAP test, Ca 125, Chest Xray, Ct scan or MRI
These are the stages of uterine cancer:
Treatment options for people with uterine cancer are surgery, radiation therapy, chemotherapy, and hormone therapy. You may receive more than one type of treatment.
The treatment that’s right for you depends mainly on the following:
Your treatment will be planned by a team of specialists through a tumour board. Specialists who treat uterine cancer include gynecologic oncologists (doctors who specialize in treating female cancers), medical oncologists, and radiation oncologists. Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.