Ovarian cancer

The symptoms of ovarian cancer are usually missed at an early stage due to their resemblance to other medical conditions. Most of the following symptoms are recognizable at later stages of the condition:

• Abnormal vaginal discharge
• Pain or pressure in the pelvic area
• Abdominal pain and fullness
• Nausea
• Indigestion
• Bloating
• Constipation
• Feeling full quickly
• Urgency to urinate
• Increased frequency of urination
• Fatigue
• Back pain
• Loss of weight
• Persistent or recurrent genital pain that occurs just before, during, or after sexual intercourse
• Menstrual abnormalities
• Vaginal bleeding

Is your vaginal bleeding normal? Tap to know.

Before understanding the exact cause of ovarian cancer, it is important to comprehend the structure and function of the ovaries.

What are ovaries?

Ovaries are the primary reproductive glands in females that produce eggs. Women have two ovaries located on each side of their uterus. The egg produced by the ovaries travels through the fallopian tube and fuses with sperm. This fertilized egg then travels further and settles in the uterus, which nourishes the developing fetus prior to birth.

The ovaries also produce estrogen and progesterone, the two main reproductive hormones in women.

The exact cause of ovarian cancer is not known. However, there are certain theories regarding its origin, which include:

• Incessant ovulation theory: The surface epithelial cells of the ovary experience physical injury during ovulation, the process in which a mature egg is released from the ovary. The repetitive trauma to the epithelium can sometimes cause cellular DNA damage, potentially turning normal cells into cancerous cells.
• Fallopian tube theory: Some ovarian cancers originate from the epithelium of the fallopian tube, which then spreads over the surface of the ovary.

The path through cancer can truly be challenging! At Tata 1mg, our patient-centric cancer management platform aims to provide much-needed support and access to affordable care at every stage of the illness. Explore the platform.

Various risk factors are associated with an increased chance of ovarian cancer:

1. Genetic predisposition
   Mutations in BRCA1 and BRCA2 genes significantly increase the risk of developing ovarian cancer. Get tested for BRCA1 and BRCA2 Gene Sequencing test.
2. Age
   The risk increases steeply from around 45 years.
3. Race
   Certain ethnic groups, including Eastern European, Ashkenazi Jewish, North American, and Northern European populations, have a higher risk of ovarian cancer due to the prevalence of BRCA1 mutations.
4. Family history
   A positive family history of breast, ovarian, and fallopian tube cancer increases the risk of ovarian cancer.
5. History of cancer
   Individuals with a history of breast cancer, uterine cancer, and colorectal cancer have higher chances of contracting ovarian cancer.
6. Reproductive and hormonal factors
   
   • Early menarche (menstruation before age 12)
   • Late menopause (menopause after age 50)
   • Endometriosis (where uterine tissue grows outside the uterus)
   • Nulliparity (women who have never given birth) are more susceptible to ovarian cancer.
7. Hormonal replacement therapy (HRT)
   Prolonged HRT use, especially estrogen beyond 10 years, can particularly raise the risk of ovarian cancer for postmenopausal women.
8. Medical and genetic conditions
   
   • Diabetes
   • Lynch syndrome
   • Peutz-Jeghers syndrome (PJS)
   • Nevoid basal cell carcinoma syndrome (NBCCS)
   • Li-Fraumeni syndrome
   • Ataxia-telangiectasia
9. Lifestyle factors
   
   • Obesity
   • Smoking

The tests that help detect ovarian cancer are:

• Rectovaginal pelvic exam: A rectovaginal exam examines and identifies abnormalities in the pelvic area, including the cervix, uterus, ovaries, fallopian tubes, anus, and rectum.
• TVUS (transvaginal ultrasound): An ultrasound wand is inserted into the vagina to examine the uterus, fallopian tubes, and ovaries. It helps in the identification of any mass but cannot confirm its cancerous nature.
• Blood tests:
  • CA-125: This test measures the amount of a protein called CA-125, which is known to be elevated in ovarian cancer.
  • Human epididymis protein 4 (HE4): The level of HE4 in the blood is a more sensitive marker to predict ovarian cancer.
• Laparoscopy: In this procedure, the ovaries are examined through a thin tube inserted through a small cut in the abdomen.
• Biopsy: A biopsy is an examination of tissues or fluids under a microscope that helps confirm the diagnosis of ovarian cancer. It assists in identifying the type of illness, the stage of the disease, and in choosing the most suitable treatment.
• CT scan: This imaging test uses X-rays to generate a detailed picture of the internal organs to detect the spread of cancer.

Book all your tests with Tata 1mg for accurate and timely results.

Some factors may help to decrease the risk of ovarian cancer, even though complete prevention against it is not possible. Some of them include:

• Pregnancy: Full-term births can greatly reduce the risk of ovarian cancer.
• Contraceptive Pills: The use of oral contraceptives for at least three years reduces ovarian cancer risk, with the effect potentially lasting for up to three decades.
• Breastfeeding: Breastfeeding for one year or longer significantly diminishes the risk of ovarian cancer; the duration of breastfeeding may further reduce the risk.
• Surgical Procedures: Women who have undergone a hysterectomy (removal of the uterus) may have a lower risk of developing ovarian or fallopian tube cancer. Tubal ligation (tying of fallopian tubes) to prevent pregnancy also decreases the risk of ovarian cancer.

The treatment of ovarian cancer depends upon the stage of cancer. It includes:

1. Debulking surgery
   • The major aim of debulking surgery is to remove the tumor.
   • The unilateral salpingo-oophorectomy (removal of one ovary along with the fallopian tube) is usually performed in the early stage of ovarian cancer.
   • The hysterectomy/bilateral salpingo-oophorectomy or BSO (removal of both ovaries and fallopian tubes along with the uterus) may be required in advanced-stage ovarian cancer.
   • Sometimes, the spleen, gallbladder, a part of the stomach, liver, pancreas, and part of the colon are also removed depending upon the spread of cancer.
2. Radiation therapy
   • It uses high-energy X-rays to kill cancer cells.
   • The procedure is painless and each session takes a few minutes.
3. Chemotherapy

   It involves the use of medications to kill cancer cells. Chemotherapy is mostly effective in killing small-sized tumors that remain after surgery. In most cases, a combination of drugs is used as it seems to work better for ovarian cancer. The drugs used during chemotherapy include:

   • Paclitaxel
   • Altretamine
   • Capecitabine
   • Cyclophosphamide
   • Etoposide
   • Gemcitabine
   • Ifosfamide
   • Irinotecan
   • Melphalan
   • Pemetrexed
   • Topotecan
   • Vinorelbine
4. Hormonal therapy

   It involves the use of hormones to treat cancer, mainly used for ovarian stromal tumors. The classes of drugs used in hormonal therapy include:

   • Luteinizing hormone-releasing hormone (LHRH) agonists: These drugs block the production of estrogen by the ovaries. Common examples are goserelin and leuprolide.
   • Tamoxifen: Its primary function is to reduce the level of the female sex hormone, estrogen, thereby restricting the growth of cancer cells.
   • Aromatase inhibitors: These drugs block an enzyme known as aromatase, which converts other hormones into estrogen. Drugs in this category include letrozole, anastrozole, and exemestane.
5. Targeted drug therapy

   Targeted therapy focuses on specific proteins that aid in the growth, division, and spread of cancer cells. Examples include:

   • Bevacizumab
   • Olaparib
   • Rucaparib
6. Immunotherapy

   This approach modifies the immune system to destroy cancer cells. This is achieved through medications such as pembrolizumab.

Get all your medication from India’s largest and most trusted online pharmacy. Upload your prescription.

Certain dietary additions may help manage symptoms associated with ovarian cancer and its treatment. However, always consult your doctor before incorporating these into your routine.

• Shiitake mushrooms: Also known as medicinal mushrooms, they contain an active ingredient called lentinan, which helps inhibit the growth of cancers, including ovarian cancer. To use, boil the mushrooms in water, strain the liquid, and consume the extract.
• Soybean: Isoflavones present in soybeans help inhibit ovarian tumor growth. They also assist in alleviating the harmful impacts of chemotherapy and other conventional cancer treatments.
• Peppermint tea: It helps relieve abdominal pain, which is a common symptom of ovarian cancer. It can be easily prepared by boiling around four or five torn peppermint leaves in water.
• Ginger (Adrak) tea: It helps relieve symptoms such as pain and cramping associated with ovarian cancer. Studies also suggest that ginger inhibits the growth of ovarian cancer cells. It can be prepared by boiling a few slices of ginger in water.

• Ascites (accumulation of fluid between the layers of the abdomen and pelvis)
• Obstruction in the small or large intestine
• Pleural effusion (build-up of fluid between the tissues that line the lungs and the chest)
• Bladder obstruction (blockage in the urinary system)
• Nutritional disorders
• Spread of cancer to other parts of the body
• Chronic pain

Certain therapies help in managing symptoms and coping with the side effects of chemotherapy. They also aid in relieving stress and improving overall quality of life.

• Tai Chi
  It is a form of physical activity that enhances mental concentration through controlled breathing. It helps reduce stress and alleviates pain by improving flexibility, strength, and balance.
• Acupuncture
  This ancient technique, used in China and Japan, involves inserting fine metal needles into the skin at specific points. It helps alleviate symptoms of ovarian cancer, such as pain and other side effects of chemotherapy. Sometimes, needles are stimulated by electricity, known as electro-acupuncture.
• Relaxation Response
  This method includes techniques such as quiet sitting, progressive muscle relaxation, and the repetition of a specific word during inhalation and exhalation. Practicing for 10-20 minutes daily promotes emotional stability.
• Biofeedback
  This technique records individual responses such as heart rate, muscle tension, and brain activity after stimulation. It helps alleviate physical and emotional symptoms by analyzing triggers.

Whether you are a patient diagnosed with ovarian cancer or a caregiver for someone with the disease, it will significantly impact their lives. Consider the following:

1. Stay hydrated

Hydration is crucial to alleviate key symptoms of ovarian cancer, such as diarrhea and constipation. It also aids in smooth digestion and reduces gastrointestinal symptoms.

2. Managing side effects

Take an active role in your treatment plan. This helps you become aware of possible side effects in advance. Discuss any side effects with your doctor, as this may assist in alleviating and preventing them. Maintain a journal to document your experiences. Share your fears with loved ones to help reduce anxiety.

3. Managing emotional and social effects

Engage in activities you enjoy, such as crafting, painting, and singing. Regular exercise can help reduce stress. Consider joining a support group, either online or offline. Seek assistance from a professional counselor and connect with someone undergoing the same type of treatment.

4. Managing the cost of cancer treatment

Understand the costs of therapy in advance. Communicate any financial concerns with your cancer care team, as this may help doctors find affordable alternatives. Explore financial support resources through oncology social workers, oncology nurses, doctors, or online. Utilize assistance from your health insurance providers.