Cancer is the abnormal mutation of specific cells in the body that do not follow the typical cell cycle. The cells grow and reproduce uncontrollably, skipping natural cell death, and then invade and destroy surrounding cell tissues. Ovarian cancer originates in the ovaries and affects several cell types, spreading throughout the body. However, this condition has subtle symptoms in the early stages, and is often diagnosed when it has advanced.1
Many lifestyle factors contribute to ovarian cancer, the key one being alcohol consumption. Increased alcohol consumption increases the risk of ovarian cancer, due to its far-reaching effects in the body. It disrupts the processes in the body, damaging cells on the DNA level. Therefore, it is crucial to understand alcohol’s role in ovarian cancer to try and prevent it.1
Ovarian cancer develops when cells near the ovaries mutate. This means there is an alteration in the DNA sequence coding these cells. The DNA instructs cells on what to do, but the mutation disrupts this script and causes the cells to multiply uncontrollably. This rapid proliferation produces a mass of cancer cells, called a tumour. The healthy cells begin to die while the cancer cells continue to grow. The cancer cells can also break off from the original tumour and spread around the body, which is known as metastasis.1
There are different types of ovarian cancer, determined by the mutated cell type. Each form requires a specialised treatment.
Epithelial ovarian cancer is the most common form. The epithelial cells are specialised cells which form an outer layer around organs. They are crucial for protection and absorption. This type develops in the epithelial cells that cover the ovaries and the fallopian tubes. 75% of epithelial ovarian cancers are high-grade serous ovarian carcinomas (HGSOC). They start by growing slowly in the fallopian tube and can take up to 6 years to reach the ovaries. Other less common epithelial ovarian cancers include:2
Stromal tumours are diagnosed at an earlier stage than other ovarian cancers, and they develop in the structural connective tissues that produce female hormones, such as estrogen and progesterone. The tumours produce excessive estrogen which results in abnormal vaginal bleeding. They can be noncancerous or cancerous; this is determined by the type of stromal cells that make up the tumour. This ovarian cancer is prevalent in women aged 50+.1
Germ cell tumours are a rare form of ovarian cancer and occur in young women, aged 30 and under. The germ cells in the ovaries mature into eggs, which then go on to be fertilised or discarded. It is here that germ cell tumours develop, in the germ (egg) cells of the ovary. The cells stick together, creating a mass. This tumour is benign (non-cancerous) but has the potential to become malignant (cancerous) and spread to healthy tissues. It is the malignant germ cell tumours which produce this rare form of ovarian cancer. There are two common types of germ cell tumours:3
There are several more subtypes of these types of ovarian cancer, all of which require a different method of treatment. By identifying the origin and symptoms of each cancer, doctors can manage it effectively.
The exact causes of ovarian cancer are not fully known. However, we do know what risk factors can increase the likelihood.
There are several diagnostic tests to confirm ovarian cancer:4
Once ovarian cancer has been confirmed, the stage and type are determined.
Stage I is when cancer is found in only one ovary or fallopian tube and outside the ovary.
Stage IIA is when the cancer is in the ovary and has spread to the uterus and further into the pelvis.
In Stage III, the cancer has spread within the lymph nodes, which can impact the liver and spleen.
Stage IV is the most severe form of cancer. At this point, the cancer has spread to the inside of organs, such as the liver, spleen, lungs, groin or chest.4
Alcohol consumption is a known risk factor in several cancers. High consumption increases the risk, which is possible even with moderate drinking. There are a multitude of ways that alcohol disrupts the body:
We have established the great effects alcohol has on cancer risks. However, when it comes to ovarian cancer, there is no established link between alcohol consumption and ovarian cancer risk. Numerous studies have explored this relationship and have found conflicting results. One study showed that women who drank more than 20 drinks per week had a higher risk of ovarian cancer than women who did not drink. The same study stated that women who drank moderately showed no elevated risk factors.7 Whereas another study in California demonstrated that wine intake did not affect the ovarian cancer risk in these women. Rather, it was the non-alcoholic components of wine that were the cause of elevated ovarian cancer risk. Researchers are exploring different combinations of drinking patterns, types of beverages and demographics to determine a baseline understanding.8
When researching alcohol consumption, several variables must be controlled. The type of alcohol, the level of consumption and the lifestyle of the participants must all be taken into account. Women involved in studies may be at different stages of life, e.g. menstruation, premenopausal, menopausal, etc. Additionally, studies must be carried out over long periods to capture any impacts. This proves that determining the direct role of alcohol in causing ovarian cancer is difficult. It is important to look at the differences in hormone spikes when comparing ovarian cancer to other cancers to understand the underlying triggers.8
Ethanol in alcohol can influence cancer risk through its effects on steroid hormones, specifically estrogen. Elevated levels of alcohol consumption were associated with higher levels of available estrogen and decreased menstrual cycle length. This means an overall elevated level of estrogen across the cycle. Furthermore, there is the promoted DNA damage, disrupted mineral metabolism, lack of carcinogen clearance and increased potential for metastasis. These key mechanisms of the body are disturbed by alcohol consumption, and as a result, they harbour a risk of ovarian cancer.
Ovarian cancer cannot be prevented entirely, however, you can alter your lifestyle to lower your risks as much as possible. Maintaining a healthy weight, regular physical activity, a balanced diet and avoiding smoking can decrease the potential risk.
However, it is crucial to consult with your doctor for any familial links to ovarian cancer. Especially any association with the BRCA gene mutation. Depending on the threat level, a doctor may recommend removing the ovaries and tubes before they become cancerous. However, this causes immediate menopause, which has several clinical side effects.9
Targeted therapies are being developed to attack the specific cancer cells. PARP inhibitors are used to stop the cancer cells from repairing their damaged DNA, causing them to die. The BRCA gene is especially susceptible to these inhibitors. This treatment has revolutionised ovarian cancer treatment as it can treat cancer in the later stages. Furthermore, there is an improvement in screening and molecular diagnosis underway to develop preventative approaches. This is all to give patients personalised therapies which target their specific type of ovarian cancer.10
Ovarian cancer is a complex condition which is yet to be fully explored. Due to its many risk factors, it is important to fully understand each one. Alcohol has a great impact on cancer development, and so its role in ovarian cancer must be grasped. Current research shows conflicting evidence. This calls for further research to be done to establish the exact link between alcohol and ovarian cancer, to advance treatment therapies.
