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May 8, 2024

World Ovarian Cancer Day: Understanding Risk Factors and Promoting Early Detection for Ovarian Cancer

Ovarian cancer is a silent killer, often diagnosed at an advanced stage when treatment options are limited. However, it doesn’t have to be this way.

In this comprehensive guide, we delve into the intricacies of ovarian cancer, exploring its risk factors, symptoms, screening methods, and strategies for prevention and early detection.

Understanding Ovarian Cancer

Ovarian cancer occurs when abnormal cells in the ovary begin to grow out of control and form a tumour. The ovaries, which are part of the female reproductive system, produce eggs and hormones such as oestrogen and progesterone.

Ovarian cancer can develop in different parts of the ovary, including the epithelial cells lining the surface, the germ cells that produce eggs, and the stromal cells that produce hormones.

Risk Factors for Ovarian Cancer

Several factors may increase a woman’s risk of developing ovarian cancer:

Ovarian cancer is more common in older women, with the highest incidence occurring in those aged 63 and older.
Women with a family history of ovarian cancer, breast cancer, or certain genetic mutations (such as BRCA1 and BRCA2) are at a higher risk.
A history of breast, uterine, or colorectal cancer may increase the risk of ovarian cancer.
Women who have never been pregnant or have had few or no full-term pregnancies are at a higher risk, as are those who started menstruating at an early age or reached menopause at a later age.
Long-term use of hormone replacement therapy (HRT), particularly oestrogen alone, may slightly increase the risk of ovarian cancer.
Endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus, may increase the risk of certain types of ovarian cancer.

Symptoms of Ovarian Cancer

Ovarian cancer may not cause noticeable symptoms in the early stages, or symptoms may be vague and easily attributed to other conditions. However, as the cancer progresses, the following symptoms may develop:

Persistent discomfort or pain in the abdomen or pelvis, often feeling like pressure, bloating, or fullness.
Changes in bowel movements, such as constipation, diarrhoea, or frequent urination, persist for an extended period without any clear cause.
Persistent bloating or swelling in the abdomen may cause clothes to fit tighter or discomfort when wearing tight clothing.
A sudden decrease in appetite or feeling full after eating only a small amount, even when not consuming large meals.
Significant and unexplained weight loss that occurs without changes in diet or exercise habits.
Persistent fatigue or low energy levels that do not improve with rest, which may be accompanied by weakness or lethargy.
Irregular menstrual cycles, including heavier or lighter bleeding than usual, or changes in the timing of periods.
Persistent pain or discomfort during sexual intercourse may be caused by pressure from ovarian tumours.
Chronic or persistent back pain, especially in the lower back, that does not improve with rest or changes in posture.
Chronic indigestion, gas, heartburn, or nausea that does not improve with dietary changes or over-the-counter medications.

It’s essential to note that these symptoms can be caused by conditions other than ovarian cancer. However, if they persist for more than a few weeks or worsen over time, it’s crucial to consult a healthcare professional for further evaluation.

The Importance of Early Detection in Improving Outcomes

Early detection plays a critical role in improving outcomes for ovarian cancer by enabling timely diagnosis and intervention. Ovarian cancer often presents with vague or subtle symptoms in its early stages, making it challenging to detect. However, when diagnosed early, the cancer is more likely to be confined to the ovaries, making treatment more effective and increasing the chances of successful outcomes.

Early detection allows for less aggressive treatment options, such as surgery and chemotherapy, which can preserve fertility and improve quality of life. Additionally, early diagnosis provides opportunities for patients to participate in clinical trials and access innovative treatments that may further enhance their prognosis.

Diagnosis and Screening

Although early detection is key to improving outcomes for ovarian cancer patients, unfortunately unlike breast or cervical cancer, there are currently no reliable screening tests that can determine the average risk of the disease in women.

The most commonly used screening test, known as the CA-125 blood test, measures the levels of a protein called CA-125 in the blood. Elevated CA-125 levels may indicate the presence of ovarian cancer, but this test is not specific to ovarian cancer and can be elevated in other conditions, leading to false-positive results.

Transvaginal ultrasound (TVUS) is another imaging test that may be used to detect ovarian abnormalities. During a TVUS, a wand-shaped device is inserted into the vagina to produce images of the ovaries. While TVUS can help identify ovarian masses, it is not recommended for routine screening due to its limited ability to detect early-stage disease.

Despite the lack of effective screening tests for the general population, women at high risk of ovarian cancer, such as those with a family history of the disease or known genetic mutations, may benefit from regular monitoring and screening, including CA-125 testing and TVUS.

Ovarian Cancer Staging

The stage of ovarian cancer is determined by where the cancer started and how much it has spread throughout the body.

Stage 1

Cancer in the ovaries can be confined to just one or both ovaries, with the tumour either on the surface or inside.

Stage 2

The cancer has spread to other pelvic organs, including the uterus and fallopian tubes. It has also spread to other pelvic organs like the bladder.

Stage 3

The cancer has spread from the pelvis to the abdomen lining or nearby lymph nodes. It could also have spread to other areas like the peritoneum or lymph nodes in the abdomen or behind the peritoneum, with varying sizes and spread.

Stage 4

The cancer has spread to distant organs, as well as to the fluid around the lungs. It has also spread to other organs like the liver or spleen.

Treatment Options Available for Ovarian Cancer Patients

Treatment options for ovarian cancer depend on factors such as the stage of the cancer, the patient’s overall health, and personal preferences. Common treatment modalities include:

Surgery

Surgery is a common treatment for ovarian cancer, especially in the early stages. It involves removing as much of the tumour as possible to reduce symptoms and possibly eliminate the cancer cells. Surgery may be followed by other treatments like chemotherapy or radiation. Patients should talk to their healthcare team about the risks and benefits of surgery.

Chemotherapy

Chemotherapy is a common treatment for ovarian cancer patients post-surgery to destroy remaining cancer cells and reduce recurrence risk. It uses powerful drugs to target rapidly dividing cancer cells in the body. Administration methods include IV, oral, or intraperitoneal chemotherapy. Treatment varies based on cancer stage, subtype, and patient health. Despite side effects such as nausea and fatigue, advancements in supportive care help improve patient quality of life. Regular monitoring by healthcare providers is crucial for managing side effects and achieving optimal outcomes.

Targeted Therapy

Targeted therapy is a key treatment option for ovarian cancer patients, especially those with advanced disease. These drugs target specific molecular pathways in cancer cells, minimising harm to healthy tissues. Common targeted therapy drugs for ovarian cancer include PARP inhibitors and angiogenesis inhibitors. Patients should undergo molecular testing to determine eligibility for treatment and personalise their care with their healthcare team.

Immunotherapy

Immunotherapy is a promising treatment for ovarian cancer, especially in advanced cases. It harnesses the immune system to attack cancer cells. Drugs like immune checkpoint inhibitors help the immune system recognise and destroy cancer cells. Effectiveness varies based on factors such as tumour environment and biomarkers. Ongoing research aims to improve outcomes and expand the availability of immunotherapy for ovarian cancer patients.

Hormone Therapy

Hormone therapy is a treatment option for some ovarian cancer patients with hormone-sensitive tumours. It blocks hormone effects to slow or shrink tumour growth. It is not a first-line treatment but can be used for recurrent or metastatic disease with hormone receptor-positive tumours. Aromatase inhibitors and SERMs are common hormone therapy drugs. It can be taken orally or by injection, often in combination with other treatments. Close monitoring by healthcare providers is crucial to assess response and manage side effects.

Radiation Therapy

Radiation therapy is not always the first choice for treating ovarian cancer but may be used to relieve symptoms or target specific areas affected by the disease. It uses high-energy beams to destroy cancer cells or shrink tumours and can help with pain caused by metastatic tumours in the abdomen or pelvis. It can be a part of palliative care plans for advanced or recurrent cases and may be delivered externally or internally depending on the tumour location. Communication between patients, oncologists, and radiation therapists is important to personalise treatment and reduce side effects.

Clinical Trials

Clinical trials are important for advancing ovarian cancer treatment options by evaluating new drugs and therapeutic approaches. Participation in trials gives patients access to innovative treatments and allows them to contribute to the development of new therapies. Patients undergo a thorough evaluation before enrolling to understand the risks and benefits. Collaboration between patients, oncologists, and research teams is key for safe and effective participation in clinical trials.

Prevention Strategies

While it’s not possible to prevent ovarian cancer entirely, several strategies may help reduce the risk:

Oral Contraceptives: Taking birth control pills has been linked to a reduced risk of ovarian cancer, although it has also been linked to an increase in probability of cervical cancer in women. As more research is ongoing about the effects of oral contraceptives, take your doctor for more information during your regular screening or medical check-up.
Pregnancy and Breastfeeding: Pregnancy and breastfeeding may lower the risk of ovarian cancer.
Tubal Ligation and Hysterectomy: Surgical procedures such as tubal ligation (tying the fallopian tubes) or hysterectomy (removal of the uterus) may reduce the risk of ovarian cancer in women at high risk of the disease.
Healthy Lifestyle Choices: Maintaining a healthy weight, eating a balanced diet rich in fruits and vegetables, exercising regularly, and avoiding tobacco products may help reduce the risk of ovarian cancer, as well as other cancers and chronic diseases.

Living with Ovarian Cancer

Living with ovarian cancer can be challenging, but it’s important to remember that you are not alone. From managing symptoms like fatigue and pain to coping with emotional stress, there are numerous resources available to support you through this journey.

Surrounding yourself with a strong support system of family, friends, and healthcare providers can make all the difference in maintaining a positive outlook and staying motivated during treatment.
Taking time for self-care activities such as meditation, gentle exercise, or pursuing hobbies can also help alleviate stress and improve overall well-being.
Remember to communicate openly with your medical team about any concerns or questions you may have, as they are there to help guide you through each step of your treatment plan.

Hope is Stronger than Fear

Receiving a cancer diagnosis may be daunting. It is important to remember that knowledge is power. It is most important to understand the risk factors, symptoms, and screening methods for ovarian cancer to ensure you get a better understanding of the future.

Ensure to ask your medical team any questions that you may have in your mind. Proper communication will make the journey easier for you.

Frequently Asked Questions

What are the early warning signs of ovarian cancer?

Early warning signs of ovarian cancer include persistent abdominal or pelvic pain, bloating, difficulty eating, feeling full quickly, and changes in bowel or urinary habits.

How to prevent ovarian cancer?

Preventing ovarian cancer involves maintaining a healthy lifestyle, including regular exercise, a balanced diet rich in fruits and vegetables, and avoiding tobacco use.

Who is at high risk for ovarian cancer?

Individuals with a family history of ovarian cancer, BRCA gene mutations, or Lynch syndrome are at higher risk for ovarian cancer.

Require expert advice or specialized treatment? Please arrange an appointment with our specialist.

Dr Raja Arif Shah Raja Ismail
Consultant Obstetrician & Gynae-Oncologist

Go to Specialist Profile

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