1st Revision: Ihsan Shawki Akili 
Cancer is a popular word in healthcare nowadays. Some types are very hard to cure, while others have a better chance of survival. Thankfully, due to healthcare advancements, there are now therapies and other cancer treatments. There are different types of cancer depending on the organ they affect. Cancer refers to the abnormal growth of cells. Ovarian cancer is a cancer affecting the ovary(ies) that are part of the female reproductive system. All people assigned female at birth (AFAB) have two ovaries that produce eggs in the menstrual cycle. These eggs are crucial for reproduction.
Overview
In the UK, around 7400 women are diagnosed with ovarian cancer annually. According to Cancer Research UK, ovarian cancer is the 6th most common cancer in women.
Ovaries, fallopian tubes, and peritoneum are close to each other, so the cancers developing in these regions are named and treated in similar manners. Studies suggest that the majority of ovarian cancers begin in the cells of fallopian tubes and then spread to the ovaries and the peritoneum.
Types of ovarian cancer
There are different types of ovarian cancer depending on which cells the cancer starts from. These tumours can be benign or malignant.¹,²
- Epithelial ovarian cancer: According to Cancer Research UK, almost 90% of cases belong to this category. These tumours start from the cells covering the outer surface of the ovary. Epithelial ovarian tumours can be benign, borderline, or malignant. According to the American Cancer Society, malignant epithelial ovarian tumours are of different types:
- Serous carcinoma (52%)
- Clear cell carcinoma (6%)
- Endometrioid carcinoma (10%)
- Mucinous carcinoma (6%)
- Ovarian germ cell tumours: These tumours start in the germ cells of ovaries that produce eggs. These are rare types and mostly affect young people. They can be either benign or malignant.. Malignant germ cell ovarian cancers are of the following sub-types:
- Immature teratomas
- Dysgerminomas
- Yolk sac tumours
- Choriocarcinomas
- Embryonal carcinomas
- Ovarian stromal tumours: These account for around 1% of ovarian cancers. It mostly affects people who are AFAB and above the age of 50 years. These also have sub-types. Malignant ovarian stromal tumours are granulosa cell tumours, sertoli-leydig tumours, and granulosa theca tumours. Benign ovarian stromal tumours are thecomas and fibromas
- Ovarian cysts: these are fluid collections inside the ovary. Sometimes functional cysts occur during ovulation and they don't require any treatment. But, if there are cysts in young girls before puberty or menopausal people who are AFAB, then some tests are required. Cysts can be benign or malignant
- Primary peritoneal carcinoma (PPC): It is a rare form of cancer similar to epithelial ovarian cancer. It starts in the cells lining the fallopian tubes. Surgery and chemotherapy are the treatment options
- Fallopian tube cancer: Another cancer similar to epithelial ovarian cancer. It is also a rare type. As the name suggests, this cancer begins in the fallopian tubes
Stages of ovarian cancer
Doctors stage cancer from 1 to 4, according to the International Federation of Gynaecological Oncologists (FIGO).²
Stage 1: It means that the cancer is in the ovaries only.
Stage 1A: It means the cancer is in only one ovary.
Stage 1B: It means the cancer is inside both ovaries.
Stage 1C: It is further divided into three sub-groups.
Stage 1C1: It means the cancer is in one or both ovaries and the ovary bursts during surgery.
Stage 1C2: It means the cancer is in one or both ovaries and the ovary bursts prior to surgery.
Stage 1C3: It means the cancer is in one or both ovaries and the cancer cells are present in the abdominal fluid collected during surgery.
Stage 2: It means that the cancer has spread to the pelvis.
Stage 2A: It means the cancer is growing in the fallopian tubes.
Stage 2B: It means the cancer is growing in the bladder or rectum.
Stage 3: It means the cancer has spread into the abdominal cavity or lymph nodes.
Stage 3A1: It means that the cancer has spread to lymph nodes in the back of the abdomen.
Stage 3A2: It means the cancer has spread to the abdominal lining and maybe to the lymph nodes.
Stage 3B: It means that the cancer size is 2 cm or smaller in the abdominal lining.
Stage 3C: It means the cancer size reaches more than 2 cm in the abdominal lining.
Stage 4: It means the cancer has spread to the liver or lungs.
Stage 4A: It means the cancer is making fluid in the lungs. It is called pleural effusion.
Stage 4B: It means the cancer has spread to the liver, spleen, lungs, or lymph nodes outside the abdomen.
Causes of ovarian cancer
Cancer is an abnormal growth of cells caused due to a variety of factors. These are the causes of ovarian cancer.²,⁴
- Age: Chances of getting ovarian cancer increase after the age of 45 years
- Genes: According to Cancer Research UK, around 5-10% of ovarian cancers are due to faulty genes. Faulty versions of the two genes BRCA1 and BRCA2 are linked to ovarian and breast cancer. If anyone has a family history of ovarian cancer, the risk increases three times
- Breast cancer: If anyone has a history of breast cancer, especially at a young age, then they have a high chance of getting ovarian cancer as well
- Hormone Replacement Therapy (HRT): HRT is often prescribed for people who are AFAB to manage the symptoms of menopause. Around 4% of ovarian cancer cases in the UK are linked to the use of HRT
- Smoking: Numerous studies have proved that smoking is hazardous to health. Smoking is linked to ovarian cancer too
- Medical conditions: Certain medical conditions such as diabetes or endometriosis are believed to be a risk factor for ovarian cancer
- Obesity: Obesity is also harmful to health. It can increase the risk of ovarian cancer
- Pregnancy: Studies suggest that multiple pregnancies or breastfeeding reduces the risk of ovarian cancer
- Menarche: Menarche is the first menstrual cycle in people who are AFAB. Having menarche at an early age, menopause at a late age,or not having any baby at all increases the risk of ovarian cancer
Signs and symptoms of ovarian cancer
In the early stages, it might be difficult to recognise the symptoms of ovarian cancer. The following symptoms could happen²,⁴,⁵
- Loss of appetite
- Unexplained tiredness
- Abdominal pain
- Unexplained weight loss
- Back pain
- Frequent urination
- Constipation
- Feeling full quickly after eating
- Vaginal bleeding after menopause
Management and treatment for ovarian cancer
As already discussed, there are different stages and types of ovarian cancer. The treatment depends on the condition of the patient and the stage of cancer. It can range from surgery to therapy.²,⁴,⁵
Surgery: Doctors make a decision about surgery after assessing the diagnostic reports. Depending on the spread of the cancer, the surgery is performed. When surgery aims to remove both ovaries, fallopian tubes, cervix, and the womb, this procedure is called total abdominal hysterectomy (TAH). During surgery, the surgeon will take some biopsy samples and send them to the lab.
Chemotherapy: It uses medications that kill cancer cells. It can be used before or after surgery. Sometimes it is used to treat recurring cancers. Often there are some side effects of chemotherapy that need to be discussed with the doctor.
Radiotherapy: As the name suggests, it uses radiation to kill cancer cells. It can be used to shrink the size of cancer cells, relieve pain and symptoms of advanced ovarian cancer. The number of sessions is decided based on the patient's condition. Radiotherapy has its side effects which need to be discussed with the treating doctor beforehand.
Targeted therapy: In this, medications are given to target the enzymes and/or molecules that help the cancer cells growth. These can be given in case of recurring cancers or in advanced cancer cases. These medications should be taken at the right dose as prescribed by the doctors.
Hormonal therapy: Hormones play an important part in the functioning of the human body. Oestrogen hormone is crucial for the female reproductive system. This hormone is needed for the growth of ovarian cancer, so hormonal therapy uses medications that inhibit the production of oestrogen. This can be used for low-grade cancers or recurring cancers.
Diagnosis of ovarian cancer
If you are suspecting symptoms of ovarian cancer, it is better to consult your GP and get an expert diagnosis. Some tests and scans will be performed to confirm the cancer.²,³,⁴,⁵
- Blood tests: A full body blood count needs to be done to check for cancer
- CA125 blood test: CA125 is a tumour marker produced by ovarian cancer cells. CA125 blood test is not very reliable as it can be confused with other diseases such as endometriosis, pregnancy, fibroids, and pelvic inflammatory disease
- Ultrasound: Vaginal or abdominal ultrasound can be helpful in diagnosing ovarian cancer. Experts can check the size of the ovaries or any cysts. However, sometimes, in postmenopausal women, ovaries are not visible on the scan
- CT scan: Computed Tomography (CT) is a radiological procedure that uses X-rays to provide detailed images of the body
Complications
Cancer is a deadly disease that, even today, has no perfect cure. But, due to medical advancements, we have screenings and treatments for several types of cancers. Treatment varies depending on the stage and spread of cancer. It is a good idea to get regular health check-ups and screenings. Diagnosis in the early stages gives a better chance of survival. But, in the later stages, things might be different as there are various treatment options that can cure cancer or relieve the symptoms to some extent. But, these treatments can have some side effects.
Side effects of chemotherapy and radiotherapy can be tiredness, hair loss, loss of appetite, diarrhoea, and increased chances of infection.
Sometimes, these treatments result in infertility issues. But, with better treatment, the patient has a chance of survival.
FAQs
How can I prevent ovarian cancer?
Birth control pills are said to lower the chances of ovarian cancer. Consult your GP to find out if you are susceptible to ovarian cancer and what preventive measures can be adopted.
How common is ovarian cancer
In the UK, around 7400 women are diagnosed with ovarian cancer annually.
When should I see a doctor?
If you experience any pelvic pain, bleeding after menopause, feeling tired, or loss of appetite then you need to contact your GP.
Summary
Ovarian cancer is cancer affecting people who are AFAB. It affects the ovaries, fallopian tubes, and peritoneum. There are different stages and types of ovarian cancer. Chances of ovarian cancer increase after the age of 45 years of age. Loss of appetite, unexplained weight loss, vaginal bleeding after menopause, frequent urination, or abdominal pain can be a sign of ovarian cancer. CT scans, ultrasound, and blood tests can be helpful in diagnosis. Surgery, chemotherapy, radiotherapy, hormonal therapy, or targeted therapy can be helpful in managing the symptoms and curing cancer. According to Cancer Research UK, more than 70% of the patients diagnosed with ovarian cancer will survive for one year or more.
References
- What is ovarian cancer | ovarian tumors and cysts [Internet]. [cited 2023 Apr 30]. Available from: https://www.cancer.org/cancer/ovarian-cancer/about/what-is-ovarian-cancer.html
- Epithelial ovarian cancer [Internet]. [cited 2023 Apr 30]. Available from: https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/types/epithelial-ovarian-cancers/epithelial
- Ovarian cancer [Internet]. [cited 2023 Apr 30]. Available from: https://www.macmillan.org.uk/cancer-information-and-support/ovarian-cancer
- Ovarian cancer - Symptoms and causes [Internet]. Mayo Clinic. [cited 2023 Apr 30]. Available from: https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941
- Ovarian cancer - Symptoms [Internet]. nhs.uk. 2017 [cited 2023 May 2]. Available from: https://www.nhs.uk/conditions/ovarian-cancer/symptoms/
