Summary
Ovarian cancer (OC), as the name suggests, is a malignancy that develops in one or both ovaries. It represents a serious women’s health problem. It encompasses two main subtypes: epithelial and non-epithelial OC. It has many risk factors, but researchers found that the most significant risk factor is family history of ovarian or even breast cancer. It doesn’t have specific signs and symptoms, especially in the early stages, which makes it hard for early diagnosis. Diagnosis of OC entails a comprehensive evaluation of patient history, physical examination, imaging modalities, and laboratory tests. The Society of Gynecologic Oncology offers recommendations to help women reduce their risk of developing ovarian cancer through preventive measures.
Keywords: Ovarian cancer, Ovary, Ovarian neoplasms, Gynecology, Gynecological Cancer, Cancer of the Ovary, Women’s Cancers.
Why Ovarian Cancer matters?
OC is one of the most malignant women’s cancers, and it's the fifth most popular cause of death due to its subtle onset. During the initial stages of the disease, most women have no specific signs or symptoms, which make it more difficult to diagnose it early. According to the American Cancer Society, OC accounts for 5% of all female malignant tumors, with nearly 20,000 new cases yearly, with almost half of all cases occurring in females 63 or older. [1] This article provides you with an ultimate guide to ovarian cancer, from what it is to its types, signs, and symptoms, as well as its risk factors. Additionally, it offers practical tips to reduce the chances of having it.
Definition
Ovarian cancer originates in one or both ovaries. Ovaries are small glands found in the female's reproductive system, as shown in Figure 1, where eggs and hormones are produced. [2]
Fig 1: shows the anatomy of the female reproductive system. [2]
Types of ovarian cancer
Ovarian cancer isn’t considered a single disease, and it can be divided into 5 different subtypes that contain different origin cells, risk factors, molecular compositions, clinical characteristics, and treatment options. [9]
Ovarian cancer subtypes include:
Epithelial OC accounts for approximately 90% of OC and contains clear cell, serous, endometrioid, and mucinous carcinomas. [9]
Non-epithelial OC includes sex cord stromal tumours and germ-cell tumours, and it accounts for nearly 10% of OC. [9]
Risk factors
Risk factors for ovarian cancers include: [5]
Signs and symptoms
Throughout history, the silent killer has been the name given to ovarian cancer because its symptoms didn’t develop until advanced stages, which is suggestive of its bad prognosis. However, advanced research and articles have shown that identifying symptoms is vital in the diagnosis process of ovarian cancers. [3]
Here are some symptoms usually associated with ovarian cancer: [4]
●Distended abdomen
●Bloated abdomen or pelvis
●Mass in the abdomen cavity
●Loss of appetite
●Pain in the abdomen or pelvis
Other symptoms that doctors found helpful in diagnosing OC are:
●Diarrhea
●Weight loss
●Changes in bowel habits such as constipation, urinary urgency or frequency, discomfort in the upper abdomen (dyspepsia), and abnormal bleeding from the vagina.
Diagnostic procedures
History and physical examination
The diagnosis and evaluation of OC should be guided by an assessment of risk factors and a history of symptoms, essentially a personal and family history of gynecologic and other cancers. [7]
If you’re presented with OC symptoms, the doctor will do a physical examination, which will include a retrovaginal examination in which the doctor puts a finger in your vagina and another in your rectum to evaluate any masses that may indicate cancer. [6]
Additionally, the doctor will assess any signs of paraneoplastic syndrome, endocrine dysfunction, and metastatic disease.
Keep in mind that the physical examination has poor accuracy, particularly in overweight patients. Also if the doctor detected a mass, it could be due to diseases other than ovarian cancer or could be easily missed. [7]
Imaging
Based on clinical presentation or if pelvic mass is detected, women with suspected OC should undergo transvaginal ultrasonography, which is a painless procedure used to examine the bladder, fallopian tubes, vagina and uterus.
The doctor inserts an ultrasound probe connected to a computer into the vagina, which basically sends sound waves off tissue and internal organs to make echoes that form the computer image as shown in figure 2. [8]
Transvaginal ultrasonography assesses the architecture of the ovaries, detects fluid collection in the abdomen, and distinguishes cystic masses from solid masses. [7]
Fig 2: Illustrate the transvaginal ultrasonography. [8]
Laboratory testing
If OC is suspected, a complete blood count, liver function test, and calcium needed to assess for paraneoplastic syndrome, as well as serum biomarkers, should be obtained.
A commonly tested biomarker is cancer antigen 125 (CA 125), however, its diagnostic ability depends upon disease stage and risk at the time of presentation. [7]
Tips for preventing and reducing the risk of ovarian cancer
Here are some tips on preventing and reducing the risk of ovarian cancer [10, 11]
1. Maintain a normal, healthy body weight (body mass index should be between 18.5-24.9).
2. If appropriate, use oral contraceptives, as many studies have shown that they decrease the risk of OC.
3. Parity provides protection against OC development.
4. Avoid a sedentary lifestyle and exercise regularly.
5. Breastfeeding.
6. Following a healthy diet, such as decreasing your saturated fat intake, and following a Mediterranean diet may decrease the risk of OC.
7. Avoid smoking and tobacco use.
In conclusion, ovarian cancer presents a serious threat due to its unclear early signs and symptoms and delayed diagnosis. If you possess a high risk of ovarian cancer, such as a family history of ovarian cancers or personal history of gynecologic cancers, and you’re experiencing symptoms that might be associated with ovarian cancer, it’s recommended that you see a doctor.
Stay safe, and defeat cancer with your knowledge.
Author: Alaa Amer
Editor: Angad Tiwari
References
1.Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA: a cancer journal for clinicians, 69(1), 7-34.
2.National Cancer Institute. Ovary (https://www.cancer.gov/publications/dictionaries/cancer-terms/def/ovary). Accessed 1/30/2024.
3.Friedman, G. D., Skilling, J. S., Udaltsova, N. V., & Smith, L. H. (2005). Early symptoms of ovarian cancer: a case–control study without recall bias. Family practice, 22(5), 548-553.
4.Ebell, M. H., Culp, M. B., & Radke, T. J. (2016). A systematic review of symptoms for the diagnosis of ovarian cancer. American journal of preventive medicine, 50(3), 384-394.
5.Momenimovahed, Z., Tiznobaik, A., Taheri, S., & Salehiniya, H. (2019). Ovarian cancer in the world: epidemiology and risk factors. International journal of women's health, 287-299.
6.Hoffman, Barbara L.; Schorge, John O.; Schaffer, Joseph I.; Halvorson, Lisa M.; Bradshaw, Karen D.; Cunningham, F. Gary (2012). "Well Woman Care". Williams Gynecology (2nd ed.). McGraw Hill Medical. p. 6. ISBN 978-0-07-171672-7.
7.Doubeni, C. A., Doubeni, A. R., & Myers, A. E. (2016). Diagnosis and management of ovarian cancer. American family physician, 93(11), 937-944.
8.National Cancer Institute. transvaginal ultrasound (https://www.cancer.gov/publications/dictionaries/cancer-terms/def/transvaginal-ultrasound). Accessed 2/08/2024.
9.Matulonis, U. A., Sood, A. K., Fallowfield, L., Howitt, B. E., Sehouli, J., & Karlan, B. Y. (2016). Ovarian cancer. Nature reviews. Disease primers, 2, 16061. https://doi.org/10.1038/nrdp.2016.61
10.Ali, A. T. (2018). Towards prevention of ovarian cancer. Current Cancer Drug Targets, 18(6), 522-537.
11.Walker, J. L., Powell, C. B., Chen, L. M., Carter, J., Bae Jump, V. L., Parker, L. P., ... & Gibb, R. K. (2015). Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer, 121(13), 2108-2120.