Overview of an ovarian cancer-
Ovaries are reproductive glands found only in females (women). The ovaries produce eggs (ova) for reproduction. The eggs travel through the fallopian tubes into the uterus where the fertilized egg implants and develops into a fetus. The ovaries are also the main source of the female hormones estrogen and progesterone. Ovarian cancer is the cancer that forms in the ovaries. There are two types of ovarian cancer, one is the epithelial ovarian cancer (EOC) and the other is the low malignant potential treatment (OLMPT).
- EOC can be benign and malignant. Benign are the ovarian tumors which don't spread to other cells and don't create serious illness. A tumor becomes cancerous when it is malignant. Malignent are the one spread to other tissues of the body. Epithelial ovarian cancers tend to spread to the lining and organs of the pelvis and abdomen (belly) first. This may lead to the build-up of fluid in the abdominal cavity (called as cites). As it becomes more advanced, it may spread to the lung or liver, and rarely to the brain, bones and skin.
- OLMPT are some cancerous cells which are not cancerous. They are also known as borderline epithelial ovarian cancer. Likewise, if they spread outside the ovary, for example, into the abdominal cavity (belly), they might grow on the lining of the abdomen but often don't grow into it. LMP tumors tend to affect younger women than the typical ovarian cancers. These tumors grow slowly and are less life-threatening than most ovarian cancers. LMP tumors can be fatal, but this isn't common.
Symptoms of ovarian cancer-
There are certain risk factors which are linked with the higher chance of developing the cancer, they are-
- Family history-Any woman who has a close relative having ovarian cancer or breast cancer can increase the risk of having the cancer. The risk can also come from father's side.
- Age-The risk of having ovarian cancer increases with age. The case of woman having ovarian cancer less than 40 is less. It increases after menopause.
- Obesity-Obese woman who have a body mass index of at least 30 or above than that have a risk of having ovarian cancer.
- Reproductive history-Women with a pregnant record at the age of 26 or before that lower the risk of ovarian cancer. The risk increases with the age of being pregnant.
- Estrogen and hormone therapy-Women taking estrogen after menopause or on any other hormone therapy increases the risk of having ovarian cancer. Use of androgen (male hormone) also increases the risk of ovarian cancer.
- Birth control pills and fertility drugs-Women that are on oral contraceptive pills, has lower chance of getting ovarian cancer, then them who are not. And women taking fertility drugs for more than one year has a higher chance of getting ovarian cancer.
- Gynecologic surgery-Tubal ligation (having your tubes tied) may reduce the chance of developing ovarian cancer by up to two-thirds. A hysterectomy (removing the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer by about one-third.
- At the early stage, screening can be done by two ways-
- Ultrasound-Use of ultrasonography to see an image of any fluid filled tumor is present or not.
- CA-125 blood test-The blood test is done for a protein called CA-125 in blood. Increase in the number of cA-125 count can suggest a gynecologic oncologist.
- At the later stage, diagnosis by more advanced method-
- Positron emission tomography (PET) scan-The scan uses radioactive glucose to look for the cancer, as cancer cell uses much glucose than the other cells.
- Laparoscopy-Thin, light tube which is inserted through lower abdomen to look for the tissues and their abnormalities.
- Biopsy-To remove a sample from the infected area and look it under the microscope, to look if there is any abnormal growth or not.
- Computed topography (CT) scans-A CT scan is an X-ray which produces detailed image of our body. Small tumors cannot be seen, but large one can be diagnosed.
- Barium enema X-ray-This is a test to see if the cancer has invaded the colon (large intestine) or rectum.
Ovarian cancer can be considered in four stages-
- Stage I-The cancer is limited to the ovaries
- Stage II-The cancer has spread to the ovaries or other pelvic region.
- Stage III-The cancer has moved to lymph nodes or lining tissue of the abdomen.
- Stage IV-The cancer has spread to distant site, like liver or lungs.
Different treatment for ovarian cancer:
- Surgical method-
- Staging-That removing the organ to which the cancer has passed. That may be uterus, ovaries, fallopian tubes, some lymph nodes in pelvis etc.
- Debunking-It means removing the tumor not leaving behind more than 1cm of tumor. Sometime, some organ part is removed to debunk the tumor.
- Chemotheraphy for ovarian cancer-Chemo for ovarian cancer is most often a combination of 2 or more drugs, given IV every 3- to 4-weeks. Giving combinations of drugs rather than just one drug alone seems to be more effective in the initial treatment of ovarian cancer. The typical course of chemo for epithelial ovarian cancer involves 3 to 6 cycles. A cycle is a schedule of regular doses of a drug, followed by a rest period.
The drugs given for chemotherapy are-
- cisplatin or carboplatin, and a taxane, such as paclitaxel (Taxol®) or docetaxel (Taxotere®).
- carboplatin over cisplatin because it has fewer side effects and is just as effective.
- Albumin bound paclitaxel (nab-paclitaxel, Abraxane®)
- Altretamine (Hexalen®)
- Capecitabine (Xeloda®)
- Cyclophosphamide (Cytoxan®)
- Etoposide (VP-16)
There are other drugs known for the treatment. Chemotherapy drugs kill cancer cells but also damage some normal cells. Side effects which depend on the type of drugs, the amount taken, and the length of treatment.
Common temporary side effects include:
- Nausea and vomiting
- Loss of appetite
- Loss of hair
- Hand and foot rashes
- Mouth sores
- Targeted therapy for ovarian cancer-Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to identify and attack cancer cells while doing little damage to normal cells.
- Angiogenesis inhibitor-This inhibitors starve the cell by not allowing the flow of oxygen. Name of such drug is Bevacizumab. Rare but possibly serious side effects include blood clots, severe bleeding, slow wound healing, holes forming in the colon (called perforations), and the formation of abnormal connections between the bowel and the skin or bladder (fistulas).
- PARP inhibitors-Olaparib (Lynparza) and rucaparib (Rubraca) are drugs known as a PARP (poly(ADP)-ribose polymerase) inhibitors. Blocking don't allow cancer cells to repair dna damage pathway leading them to die.
- Hormone therapy for ovarian cancer-Hormone therapy is the use of hormones or hormone-blocking drugs to fight cancer.
- Luteinizing-hormone-releasing hormone (LHRH) agonists-LHRH agonists (sometimes called GnRH agonists) switch off estrogen production by the ovaries. These drugs are used to lower estrogen levels in women who are premenopausal. Examples of LHRH agonists include goserelin (Zoladex®) and leuprolide (Lupron®).
- Tamoxifen-The goal of tamoxifen therapy is to keep any estrogens circulating in the woman's body from stimulating cancer cell growth. The anti-estrogen activity of this drug can lead to hot flashes and vaginal dryness.
- Aromatase Inhibitor-Aromatase inhibitors are drugs that block an enzyme (called aromatase) that turns other hormones into estrogen in post-menopausal women. They don't stop the ovaries from making estrogen, so they are only helpful in lowering estrogen levels in women after menopause. They include letrozole (Femara®), anastrozole (Arimidex®), and exemestane (Aromasin®). These drugs are taken as pills once a day.
- Radiation therapy for ovarian cancer-Radiation therapy uses high energy x-rays or particles to kill cancer cells. These x-rays may be given in a procedure that is much like having a regular (diagnostic) x-ray.
- External beam radiation therapy-In this procedure, radiation from a machine outside the body is focused on the cancer. This is the main type of radiation therapy used to treat ovarian cancer. Treatments are given 5 days a week for several weeks. Each treatment lasts only a few minutes and is similar to having a regular x-ray.
Some side effects are-
- Skin changes - the skin in the treated area may look and feel sunburned or even blister and peel
- Fatigue (tiredness)
- Nausea and vomiting
- Vaginal irritation, sometimes with a discharge (if the pelvis is being treated)
- Radioactive phosphorus-Radioactive phosphorus was used in the past, but is no longer part of the standard treatment for ovarian cancer. For this treatment, a solution of radioactive phosphorus is instilled into the abdomen. The solution gets into cancer cells lining the surface of the abdomen and kills them.
Ovarian cancer can be treated and cured if the symptoms can be seen early and the cancer is diagnosed properly. With correct treatment, if the cancer cannot be cured, it can surely be delayed.