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Ovarian cancer is a very aggressive tumor which causes more deaths worldwide than any other gynecological tumor. There are many types of ovarian cancer, depending on microscopic characteristics that determine their malign potency. Here is a collection of the most important features of ovarian cancer that every woman should read.

Epidemiology

Being the fifth most common malignant tumor in women, ovarian cancer produces a global incidence of 2 percent among women of all ages. Still, there are age-related differences. Older women are more susceptible to the development of ovarian cancer, and the highest number of cases has been detected in women aged between 60 and 70 years. Furthermore, the diagnosis is often delayed in the elderly, in contrast to young women who report their complaints and start the diagnostic process at an earlier stage of the disease.

Risk Factors

As stated above, increasing age is one of the risk factors for the development of ovarian cancer. Women with close relatives who had ovarian cancer have an up to 4 times increased risk of this disease. Therefore, genetic susceptibility also plays an important role. The most important genes identified as triggers of this disease are BRCA-1 and BRCA-2. Women with a history of endometriosis (presence of uterine tissue elsewhere in the organism) have a higher risk of developing ovarian cancer as well. Hormone replacement therapy is not entirely confirmed as a possible cause of ovarian cancer, although there were some studies showing a higher incidence of ovarian cancer in women exposed to estrogen for a longer period of time.

Besides these unchangeable risk factors, there are some other risk factors related to lifestyle. Smoking has been identified as one of the most important triggers of ovarian cancer and many other malignant tumors. Obese women have a higher risk of ovarian cancer, especially after menopause. Along with obesity, sedentary lifestyle also contributes to the initial changes in ovarian tissue and its malign alteration.

In contrast to estrogen, progesterone has been shown to decrease the risk of ovarian cancer.

Physiological states in which progesterone is the dominant hormone have a protective effect. These states include pregnancy, breastfeeding, and the use of oral contraceptives.

Signs And Symptoms Of Ovarian Cancer

Signs and symptoms of ovarian cancer often appear late in the course of the disease and most patients are diagnosed in advanced stages, III or IV. Early symptoms are undefined and often absent. They include bloating, unpleasant sensations in the lower abdomen, an urgency to urinate, and indigestion. Advanced stages of the disease bring other symptoms, such as abdominal and pelvic pain, back pain, fatigue, and weight loss. Depending on spreading of metastases, symptoms related to other organs appear with time. Metastases usually appear first in the nearby organs, such as uterus and vagina, so uterine bleeding can be one of the signs. The disease progresses quickly, affecting distant organs in a relatively short period of time.

Diagnosis

If you have any of the above stated symptoms, you should refer them to your doctor for detailed examination. The necessary tests include taking a patient’s medical history and family history, detailed physical examination, laboratory tests and imaging tests. In advanced stages, your doctor would probably be able to palpate the tumor through the front abdominal wall.

Unexplained weight loss, long-term fatigue and abdominal discomfort can be an alarm to perform a detailed examination. Laboratory tests include detection of tumor markers which can point out the probability of ovarian cancer, although they are not highly specific. The most important tumor marker for ovarian cancer is CA-125.

Ultrasound imaging is a very helpful technique in patients with ovarian cancer as it can show a great number of details. Still, CT and MRI are important in order to assess the presence of metastases and to properly determine the stage of the tumor.

The final investigation includes a tissue biopsy in order to determine microscopic characteristics of the tumor. This can be performed before or during surgical removal of the tumor.

Stages Of Ovarian Cancer

There are 4 stages of ovarian cancer, depending on the affected organs and spreading of the tumor.

In stage I, the tumor is present in ovaries only. Stage Ia means that the tumor is present in just one ovary, while stage Ib means that the tumor invaded both ovaries, but without affection of other organs or structures. In stage Ic, the tumor can be present in one or both ovaries, but there are cancer cells in the peritoneal cavity or on the surface of the ovaries.

Stage II ovarian cancer has already spread to some pelvic organs, and this stage again has sub-stages a, b, and c, depending on how many pelvic organs are affected and to what extent.

Stages III and IV are diagnosed when there are distant metastases outside of the pelvis.

Treatment

Ovarian cancer treatment includes surgical removal of the tumor, chemotherapy, and radiation therapy. If ovarian cancer is confirmed or highly suspected, it is recommended to remove not only the ovaries, but also as many as possible nearby structures because of the possible presence of microscopic metastases in these structures. Therefore, the fallopian tubes, the uterus, and nearby lymph nodes are usually removed along with the ovaries. After removal, pathologists perform a biopsy of the affected tissue in order to determine the histological type of the tumor.

If a woman still wants to have children, she can undergo less radical surgery in order to spare the organs necessary for reproduction. In that case, one ovary, its fallopian tube and the uterus can be saved.

Chemotherapy is recommended in women in all the stages of ovarian cancer as it significantly improves survival, especially in the early stages. The standard approach includes intravenous administration of chemotherapy, although in some cases it can be administered by intraperitoneal injections. New chemotherapy plans include monoclonal antibodies developed to attack specifically ovarian cancer cells as well as to inhibit some enzymes necessary for the growth of the tumor.

Radiation therapy is inferior to chemotherapy when it comes to ovarian cancer treatment, but it is frequently used as an additional therapy approach.

The prognosis for patients with ovarian cancer is expressed as 5-year survival. For stage I, the results with the appropriate treatment are satisfying with the 5-year survival over 90%. About 50-60% of women diagnosed in stage II survive 5 years. For stage III, the 5-year survival is a bit over 20% and for stage IV about 5%.

It can be concluded that early detection and appropriate treatment plan contribute to better survival. Therefore, it is important not to underestimate the significance of the early symptoms of ovarian cancer.

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