Ovarian cancer

The Function of the Ovaries and Complications Associated with Ovarian Cancer

The ovaries are paired reproductive glands located on either side of the uterus. They have two main roles: producing oocytes (eggs) and secreting sex hormones—estrogen and progesterone—that regulate the menstrual cycle, fertility, and secondary female characteristics. Diseases affecting the ovaries can disrupt hormonal balance, fertility, and reproductive health.

Ovarian cancer often goes undetected until advanced stages due to subtle early symptoms. As it progresses, complications include fluid accumulation in the abdomen (ascites), bowel or urinary obstruction, hormonal irregularities, and metastasis to the peritoneum, liver, lungs, or lymph nodes. Persistent bloating, pelvic pain or vaginal bleeding may initially be misinterpreted as harmless symptoms; timely awareness and screening are vital in improving prognosis.

Categories Associated With Primary and Secondary Ovarian Tumours

Ovarian tumours are classified into primary (originating in the ovary) and secondary (metastatic) types:

Primary Ovarian Cancer:

This includes tumours emerging from ovarian tissue:

  • Epithelial Tumours: Represent ~90% of ovarian cancers:
    • High-grade serous carcinoma (most common)
    • Low-grade serous carcinoma
    • Endometrioid carcinoma
    • Clear cell carcinoma
    • Mucinous carcinoma
  • Germ Cell Tumours: Rare and occur mostly in younger women:
    • Dysgerminoma
    • Mature and immature teratoma
    • Yolk sac tumour
    • Embryonal carcinoma
  • Sex Cord–Stromal Tumours:
    • Granulosa cell tumour
    • Thecoma–fibroma group
  • Rare Tumours: Such as ovarian sarcomas or small cell carcinoma of the ovary.

Secondary (Metastatic) Ovarian Cancer:

These occur when cancers from organs like the breast, colon, or stomach spread to the ovary (e.g., Krukenberg tumours).

Risk factors include:

  • Family history (especially BRCA1/BRCA2 mutations)
  • Age (most cases occur after menopause)
  • Endometriosis
  • Use of hormone replacement therapy
  • Nulliparity or delayed childbearing
  • Obesity
  • Early menarche or late menopause

Signs And Symptoms of Ovarian Cancer

Ovarian cancer often remains clinically silent until the later stages, but may include:

  • Persistent bloating or increased abdominal girth
  • Pelvic or abdominal pressure/pain
  • Feeling full quickly or experiencing loss of appetite
  • Urinary urgency or frequency
  • Unplanned weight loss or gain Its Fatigue Changes to bowel habits Irregular vaginal bleeding (particularly postmenopausally) Or any menstrual changes among premenopausal women.

These signs are common and non-specific, making early recognition difficult yet crucial.

Diagnosis of Ovarian Cancer

Evaluation involves multiple steps:

Clinical History & Physical Exam:

Detailed gynecologic assessment and abdominal/pelvic examination.

Laboratory Tests:

  • CA-125: Elevated in most epithelial ovarian cancers but can also rise due to benign conditions.
  • Other markers like HE4, LDH, AFP, β-hCG are especially useful for germ cell tumours.

Imaging Studies:

  • Transvaginal/transabdominal Ultrasound: First-line imaging to evaluate masses
  • CT Scan / MRI of Abdomen & Pelvis: Assess tumour size, spread, and ascites
  • PET-CT: For evaluating metastasis

Surgical Evaluation:

  • Diagnostic Laparoscopy/Laparotomy: Direct visualisation, biopsy, and potentially staging.
  • Surgical Staging: Includes optimal tumour debulking (removal of as much tumour as possible).

Staging:

Based on the FIGO (International Federation of Gynaecology and Obstetrics) system:

  • Stage I: Cancer confined to the ovaries
  • Stage II: Pelvic extension
  • Stage III: Peritoneal implants outside the pelvis or lymph node spread
  • Stage IV: Distant metastases (e.g., liver parenchyma, lungs)

Best Treatment for Ovarian Cancer

Treatment depends on the disease stage, tumour type, and patient health. Strategies include:

A. Traditional Treatments

B. Advanced and Alternative Treatments

C. Traditional Treatment for Ovarian Cancer

1. Surgical Procedures

  • Total Hysterectomy + Bilateral Salpingo-Oophorectomy: Removal of uterus, both ovaries, and fallopian tubes.
  • Omentectomy: Removal of the omentum (common site of metastasis).
  • Debulking Surgery: Removal of visible tumour masses; optimal cytoreduction (<1 cm residual) correlates with better outcomes.
  • Fertility-Sparing Surgery: In select early-stage germ cell tumours.

2. Systemic Chemotherapy

  • Standard regimen: Carboplatin + Paclitaxel combination.
  • Administered intravenously over 3–6 cycles.
  • Side effects include hair loss, nausea, neuropathy, and bone marrow suppression.

3. External Beam Radiation Therapy

Not commonly used as primary treatment, but may be used palliatively for localised recurrences or bone metastases.

B. Advanced Treatments for Ovarian Cancer

1. Microinvasive Therapies and Surgeries

  • Nano knife for Liver cancer

U.S. and European authorities issued their approval in December 2012, and later in June 2015, the FDA of China also sanctioned the use of Non-thermal ablation techniques, more commonly known as NanoKnife ablation or Irreversible Electroporation (IRE) for clinical purposes. Reports suggest that the Nanoknife is useful in treating tumours residing in solid organs like the pancreas, liver, lungs, kidneys and prostate. Its efficacy is unmatched, particularly with tumours abutting gallbladders, bile ducts, and ureters. Fuda Cancer Hospital holds the record in Asia for the most number of cases treated, as it was the first hospital to use Nanoknife in Asia. Learn more….

  • Cryosurgical Ablation for liver cancer

Cryosurgical Ablation (also known as Cryosurgery or Cryo-ablation) is possibly the most promising among so many clinically used ablation treatments. It is carried out by hardening the excrescence kerchief with extremely low temperature. Within the tissue of the wart, ice plates begin to develop after the tip’s temperature falls below – 40°C. The process involves the death of the tumour cell, causing it to undergo necrosis within the excrescence kerchief. Thus, we can assume that progressive failure of microcirculation under cryosurgery implies porous vessel walls of endothelial caste destruction, interstitial oedema, platelet aggregation, microthrombi and finally obliteration in the vascular bed.  Learn More…

2. Targeted Therapies

  • PARP Inhibitors (e.g., olaparib, niraparib) — especially effective in BRCA-mutated tumours; used as maintenance therapy.
  • Anti-angiogenic Agents (e.g., bevacizumab) to block tumour blood supply.
  • VEGF Receptor Inhibitors (e.g., cediranib) selectively disrupt tumour vascularisation.

3. Targeted Radiation Therapy (Brachytherapy / Radioembolization)

  • An important form of cancer treatment is Brachytherapy, utilising seeds of Iodine-125 or Palladium-103. It’s not as invasive as surgery, but it is equally effective compared to other forms of treatment.

4. Immunotherapy and Biologic Agents

  • Checkpoint Inhibitors (e.g., pembrolizumab) are being explored in clinical trials for recurrent disease.
  • Adoptive T-cell Therapy and cancer vaccines are under investigation.

5. Microvascular Interventional Chemo

  • Direct infusion of chemotherapy into the peritoneal cavity increases local concentration with fewer systemic effects.

Prevention and Lifestyle Management

Preventive strategies help reduce risk and improve early detection:

  • Genetic testing for BRCA1/2 and counselling for high-risk families
  • Use of oral contraceptives (lowers risk)
  • Pregnancy and breastfeeding have protective effects
  • Regular pelvic exams and vigilance for persistent symptoms
  • Maintaining a healthy weight and a balanced diet
  • Avoiding hormone replacement therapy unless medically necessary
  • Prophylactic removal of ovaries and tubes (salpingo-oophorectomy) in at-risk women after childbearing

Prognosis and Survival Rates

The prognosis for ovarian cancer is generally linked to stage at diagnosis:

  • Stage I 5‑year survival: ~90%
  • Stage II: ~70%
  • Stage III: ~39%
  • Stage IV: ~17%

Despite aggressive disease behaviour, enhanced surgical techniques, chemotherapy regimens, and targeted maintenance therapies like PARP inhibitors have improved survival and quality of life in many patients.

Conclusion

Ovarian cancer can be an intimidating challenge due to its gradual and advanced-stage presentation; however, strong outcomes are achievable through early detection, comprehensive surgery, multimodal treatments such as chemotherapy or targeted agents and innovative strategies such as HIPEC or immunotherapy. Risk assessment, preventive measures, and patient education remain essential in reducing incidence and improving survival outcomes.