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 for Ovarian Cancer

• 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

• 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
• Fatigue
• Changes to bowel habits
• Irregular vaginal bleeding (especially postmenopausal)
• Menstrual changes in premenopausal women

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: 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).

FIGO Staging System:

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

Treatment Options for Ovarian Cancer

Treatment depends on stage, tumour type, and patient health. It includes both traditional and advanced therapies.

Traditional Treatments

• Surgery: Total hysterectomy + bilateral salpingo-oophorectomy, omentectomy, debulking surgery, or fertility-sparing options in select cases.
• Chemotherapy: Standard regimen of Carboplatin + Paclitaxel over 3–6 cycles.
• External Beam Radiation: Used palliatively for localized recurrence.

Advanced Treatments at Fuda Cancer Hospital

• Microinvasive Therapies: NanoKnife (Irreversible Electroporation) and Cryosurgical Ablation are used to treat deep or hard-to-reach tumours.
• Targeted Therapies: PARP inhibitors (olaparib, niraparib) for BRCA-mutated tumours; Anti-angiogenic agents (bevacizumab, cediranib).
• Brachytherapy / Radioembolization: Uses radioactive seeds (Iodine-125 or Palladium-103) for precise local radiation.
• Immunotherapy: Checkpoint inhibitors (pembrolizumab), T-cell therapy, and cancer vaccines under research.
• Microvascular Interventional Chemo: Direct infusion of chemo into the peritoneal cavity for higher local effect and fewer side effects.

Prevention and Lifestyle Management

• 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 early reporting of persistent symptoms.
• Maintain a healthy weight and diet.
• Avoid unnecessary hormone replacement therapy.
• Prophylactic salpingo-oophorectomy for high-risk women post-childbearing.

Prognosis and Survival Rates

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

Despite its aggressive nature, advances in surgery, chemotherapy, and targeted maintenance therapies have significantly improved survival and quality of life.

Conclusion

Ovarian cancer remains a major challenge due to its late presentation, but early detection, modern diagnostic tools, and advanced treatments like NanoKnife, Cryoablation, and Immunotherapy at Fuda Cancer Hospital offer new hope. Awareness, timely screening, and lifestyle management are key to improving outcomes and saving lives.