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Ovarian Cancer

Clinical OncologyGeneral Surgery

The ovaries are a part of the female reproductive system, consisting of two small organs in the pelvic cavity on either side of the uterus. Their function is to produce eggs and female hormones. Ovarian cancer is one of the most common gynaecological cancers and has the highest mortality rate among female cancers.

Symptoms

Early-stage ovarian cancer may not have symptoms, and in later stages, symptoms become more noticeable. Here are some signs that may be associated with ovarian cancer:

Abdominal bloating or a feeling of pressure: The presence of a tumour may cause a sensation of fullness in the abdomen.
Abdominal or pelvic pain: Long-term mild or moderate pain may be present.
Digestive symptoms: Including indigestion, diarrhoea, or constipation.
Loss of appetite: Possibly related to the tumour affecting gastrointestinal function.
Frequent urination: Ovarian tumours may affect the urinary system, leading to increased frequency.
Menstrual changes: Irregular menstrual cycles or other menstrual variations.
Weight loss: Unexplained weight loss may be one of the symptoms.
Fatigue: Prolonged feelings of fatigue may be part of the body's response.

Factors

Most ovarian cancers do not have specific causes, but several risk factors that may contribute to the development of ovarian cancer have been identified in medicine:

Genetic Factors:
- Carrying mutations in the BRCA1 or BRCA2 genes.
- Lynch syndrome.
Hormonal and Ovulatory Factors:
Menstrual cycle patterns are significantly related to ovarian cancer. Early menarche (before the age of 12), late childbirth, nulliparity, and infertility increase the risk of ovarian cancer.
Age: Women of any age have the chance of developing ovarian cancer, but the highest incidence occurs between the ages of 55 and 64.
Family History: Even without carrying gene mutations, having a family member who previously had ovarian cancer increases the risk. Women with a first-degree relative (e.g., grandmother, mother, daughter, or sister) who had ovarian cancer have a lifelong chance of 5% (compared to the average risk of 4% in other women).
Obesity: Several studies have found an association between obesity and ovarian cancer. A 2009 study showed that obesity increased the risk of ovarian cancer by nearly 80% in postmenopausal women who had never taken hormones.
Environmental Factors: Substances like asbestos, travelling from the vagina to the ovaries, expose the abdominal and pelvic cavities to carcinogens, leading to the development of ovarian cancer.
Hormone Replacement Therapy: The use of hormone replacement therapy increases the risk of ovarian cancer in women.

The spread of ovarian cancer typically occurs through malignant cells directly invading other organ tissues within the abdominal cavity, such as the surfaces of the peritoneum, omentum, and intestines, as well as the surfaces of the bladder and diaphragm. Other spreading mechanisms include dissemination through the bloodstream and lymphatic system.

Diagnosis

Clinical Examination

The doctor will use their hands to press on the abdomen to assess if there are any hard lumps. Simultaneously, the doctor will insert one or two fingers into the patient's vagina to examine the size, shape, and position of the ovaries and uterus, evaluating the presence of any abnormalities.

Vaginal Ultrasound

The doctor will insert an ultrasound probe into the woman's vagina, which can accurately show the location, size, and firmness of ovarian tumours. When ascites (abnormal fluid accumulation in the abdominal cavity) is present, ultrasound scanning can also confirm it.

CT Scan

CT scans can show the shape, size, and structure of the ovaries and any signs of tumours or ovarian cancer. It can also examine nearby tissues and organs to determine if there is any spread.

MRI

MRI provides better resolution for detailing tissue and tumour characteristics, making it particularly suitable for thoroughly examining ovarian tissue. It can assist doctors in seeing the features of ovarian tumours more clearly for further assessment.

Cancer Markers

When ovarian tumours are suspected, tumour markers such as the CA125 antigen test have significant value in tracking and detecting recurrences.

Although the CA-125 blood test is more accurate for detecting ovarian cancer in postmenopausal women, it is not a reliable method for detecting early-stage ovarian cancer. In approximately 20% of late-stage ovarian cancer cases and 50% of early-stage ovarian cancer cases, patients do not experience an elevation in CA-125 levels. On the other hand, some benign gynaecological conditions, such as endometriosis or fibroids, may cause an increase in CA-125 levels. Therefore, it is necessary to complement the CA-125 test with other examinations and diagnostic methods.

Laparoscopy

A small incision is made below the navel, and a long, illuminated tube is inserted into the abdominal cavity. A camera at the end of the tube allows observation of the pelvic cavity's internal conditions.