| Ovarian cancer
Ovarian cancer is the fourth most common type of cancer occurring in women, with about 7,000 new cases being diagnosed in the UK each year. The number of women suffering from the disease has risen by 19 per cent over the last 20 years. Most ovarian cancer develops after the menopause with half of ovarian cancers being found in women over the age of 65. One of the most worrying aspects of this type of cancer is that only 24 per cent of cases are diagnosed at an early stage, while the disease is confined to the ovary. When cases are diagnosed after the cancer has spread to other parts of the body it is much harder to treat successfully and so is more likely to be fatal. The ovaries are the part of the female reproductive organs that produce egg cells every month during a young woman's reproductive cycle. The ovaries are about 1.5 inches long, but after going through menopause they shrink down to about half their original size. They are located on either side of the lower abdomen. In young, relatively thin women, the ovaries can just barely be felt on a pelvic examination. Because they shrink in size after a woman stops having her periods, a normal ovary cannot be felt in post-menopausal woman. Women who are still having periods can develop cysts on the ovary, which can be felt on a pelvic examination or seen via X-rays or other tests. They are rarely cancerous, particularly in younger women. Cysts are less common in women who have already gone through the menopause, and when they do occur they are more likely to be cancerous. A cyst or an enlarged ovary in a woman who has gone through the menopause should always be evaluated quickly to make sure that it is not a cancer. With ovarian cancer, cells of the ovary grow and divide uncontrollably. The cells may grow to form a tumour on the ovary, and can break off from the main tumour and spread to other parts of the body. Although ovarian cancer can spread throughout the entire body, in most cases it stays in the abdomen and affects organs such as the intestines, liver and stomach. There are many different types of ovarian cancer. Most come from the cells that make up the outer lining and are called epithelial ovarian cancers. Although the majority of epithelial ovarian cancers occur in women who do not have a family history of the disease, about 5-7 per cent of women with ovarian epithelial cancer have other family members who have also had the same kind of cancer. Most women with ovarian cancer do not have symptoms at an early stage in their disease. However, when symptoms do occur they may include:
It is important to remember that many of these symptoms can occur without any serious underlying disease. Risk Factors for Ovarian Cancer No one knows what causes ovarian cancer but risk factors include:
If you have a close family history of ovarian cancer you may be referred to a counselling clinic that specialises in inherited disorders. Research is underway into a screening blood test for those at high risk. This test looks for raised amounts of a substance called CA125 that may be associated with ovarian cancer. It is too early to say how valuable this test will be. Unfortunately, unlike the smear test for cervical cancer there is no reliable screening tool available for ovarian cancer. It can be a very difficult condition to diagnose, mainly because there are often no symptoms, especially in the early stages. For the small number of women who are fortunate enough to have their cancer diagnosed before it has spread beyond the ovary, the chance for cure is 85-90 per cent. If you do have any worrying symptoms, see your doctor. He or she will probably perform some simple tests and may refer you to a specialist at a hospital for further investigations. Investigations for Suspected Ovarian Cancer Investigations are varied and may include:
If cancer is suspected, the surgeon usually removes the entire affected ovary to ensure that all potentially abnormal areas are removed. A pathologist evaluates the tissue and if cancer is confirmed, typically the second ovary, the uterus and the fallopian tubes are removed. To date, about five per cent of ovarian cancer cases are caused by inherited defects in the BRCA1 and BRCA2 genes. Genes, the pieces of the chemical DNA within your cells that are inherited from your parents, determine many aspects of your body's make-up. Scientists have known for years that genes determine risk for developing a disease like cancer. The BRCA1 and BRCA2 genes normally help to prevent cancer by making a protein that keeps cells from growing too much. But if you have a defect in either of these genes - inherited from either parent - they won't prevent the cancer from developing in your ovaries. If you have a defect in the BRCA1 gene, you have a 60 per cent chance of getting ovarian cancer. The risks are less with a mutated BRCA2 gene, but still greater than the ovarian cancer risk that most women face. Genetic testing for ovarian cancer has raised many questions, both scientific and ethical. Although tests are available to identify the mutations that may predispose you to this cancer, they are not absolutely positive predictors. In addition, many doctors are not yet fully educated about the tests that are available, how they are performed and how they are interpreted. The first step in genetic testing is to examine your family tree, and that's best done with the help of a specially trained genetic counsellor. If genetic testing is done properly, it can change lives drastically, both in terms of preventing the onset of ovarian cancer (by taking preventive steps) and the psychological impact of knowing you are predisposed to get the disease, or not, regardless of family history. Your doctor may be able to refer you to a genetic counselling clinic.) The type of treatment you receive for ovarian cancer will depend partly upon the degree to which the cancer has spread, or what 'stage' it has reached. Staging of the tumour may be assessed by a laparoscopy, where a small incision is made in your abdomen and a laparoscope is used so that your doctor can look at all your organs to see if they contain cancerous growths. Samples of tissue are taken so that a pathologist can investigate further. The following stages are used to define how far ovarian cancer has spread in the body:
Types of Treatment If you have been diagnosed with ovarian cancer, the first line of treatment is almost always surgery. Indeed, surgery may have been needed to establish the diagnosis. Chemotherapy is often used if the doctor feels that some cancer cells may have been left behind or if there is spread beyond the ovary. Radiotherapy is less commonly used but may be helpful in areas where the cancer cells return. Treatment options include:
After your treatment is finished, your doctor should discuss follow-up care. You will probably have to undergo regular blood tests, X-rays, ultrasound studies or 'second-look' surgery to make sure the cancer has not returned. Loss of appetite can be a serious problem for women receiving radiation therapy or chemotherapy, but those who can eat well are better able to withstand the side effects of the treatment. So, good nutrition is an important part of your treatment. Eating well means getting enough calories to prevent weight loss and having enough protein in the diet to build and repair skin, hair, muscles and organs. Many women say that eating several small meals throughout the day is easier than eating three large meals. The side effects that patients have during all of these cancer therapies vary from person to person and may even be different from one treatment to the next. Your doctor will try to plan treatment to keep problems to a minimum, and fortunately most side effects are temporary. It is important to tell your doctor about your reactions and side effects because he or she may be able to adjust treatments to help you feel better. For further support and information:
CancerBACUP Ovacome Research into Ovarian Cancer (ROC) |