Ovarian Cancer

Ovarian Cancer: Description

Ovarian cancer (med. Ovarian cancer) is a malignant ovarian tumor. These lie to the left and right of the uterus and have a relatively large amount of space – because during the female cycle, their position and size changes a bit. Therefore, an ovarian tumor usually causes symptoms only at an advanced stage and is often noticed late. In about 50 percent of cases, the cancer affects both ovaries.

Physicians distinguish so-called germinal stromal tumors from cancer that arises from the ovarian cells themselves. This form of tumor develops from embryonic germinal cords. 15 to 20 percent of ovarian tumors arise in this way. An example is the Brenner tumor, a roundish, up to several centimeters large tumor, which is usually benign and degenerate only in 0.5 to 9 percent of cases.

Malignant ovarian cancer quickly forms secondary ulcers, called metastases. These spread mainly within the abdominal cavity and the peritoneum. The blood and lymph channels can also affect the liver, lungs, pleura or lymph nodes.

The disease occurs in four stages, which are classified according to the so-called FIGO classification:

• FIGO I: Early stage. Ovarian cancer affects only the ovarian tissue. It can be an ovary or both ovaries affected.
• FIGO II: The tumor has already spread in the pelvis.
• FIGO III: The cancer has spread metastases into the peritoneum (med. Peritoneal Carcinoma) or in the lymph nodes.
• FIGO IV: Highly advanced stage. The tumor tissue is already outside the abdominal cavity. For example, distant metastases can arise in the lungs. You get there via the bloodstream or lymphatic system.

Most older women are affected by the disease after menopause. Before age 40, ovarian cancer rarely occurs. Ovarian cancer is the second most common cancer of the female reproductive system after breast cancer. Every year between 7000 and 8000 women are newly diagnosed in Germany, writes the Robert Koch Institute. The risk of developing a malignant tumor on the ovaries is thus 1.5 percent (one in 68 women is affected).

Other ovarian tumors

In the ovaries, tumors may also occur that are not due to degeneration of the ovarian cells – such as secondary tumors of other cancers. These include the Krukenberg tumor, which arises as a secondary tumor of gastric cancer.

Ovarian cancer: symptoms

Everything important to the typical signs of ovarian cancer read in the article Ovarian Cancer Symptoms.

Ovarian cancer: causes and risk factors

Like almost every type of cancer, ovarian cancer arises from cells that grow unchecked. In the later stage, the tumor then forms metastases, which spread in the surrounding tissue, such as in the abdominal cavity. Why the cells degenerate is not known in detail. However, genetic factors seem to play a role, because ovarian cancer occurs familial and certain gene mutations (mutations) occur in cancer patients frequently. Furthermore, the number of female cycles plays a role in the pathogenesis. Women with a late first menstrual period and an early onset of menopause are therefore less likely to suffer from an ovarian tumor. This also applies to women who have been pregnant one or more times or who have used hormonal contraception over a longer period of time.

Genetic and environmental factors

Changes in the BRCA1 and BRCA2 genes significantly increase the risk of developing ovarian cancer. However, they were found only in a small proportion of the women affected. Further genetic factors are still the subject of research. Breast cancer patients also frequently have altered genes of the BRCA group (BReast CAncer). Women whose first-degree relatives have breast or ovarian cancer are at an increased risk of contracting. Harmful environmental influences and unhealthy diets can also play a role. There is evidence that overweight (obesity) increases the risk of disease.

Ovarian cancer: examinations and diagnosis

An initial indication of a tumor on the ovary is the palpation of the abdominal wall and the female reproductive organs. Usually follows an ultrasound examination (medical: sonography) of the abdominal region and the vagina. It already provides information about the size, location and condition of the cancerous tumors. It may also be possible to assess whether the tumor is benign or malignant. How far the disease has spread can be determined by computer or magnetic resonance imaging. Here, the doctor can detect metastases in the chest or abdomen. If there is any suspicion that the tumor has already affected the bladder or rectum, a cystoscopy or colonoscopy may be used. A reliable diagnosis is possible only after the examination of a tissue sample, which must be surgically removed beforehand (medical: biopsy).

To assess the course of the disease, the doctor can measure specific tumor markers in the blood. As the amount of these cellular proteins increases, this indicates increased metastases. After the surgical removal of a tumor, the investigation can provide evidence of a tumor relapse, a so-called relapse.

For ovarian cancer, there is no statutory screening for prevention. However, regular gynecological examinations and vaginal ultrasound can help to detect the cancer at an early stage. In the discussion is also whether a blood test in combination with ultrasound could be a standard procedure to get early evidence of ovarian cancer.

Ovarian cancer: treatment

Ovarian cancer therapy essentially involves two procedures: surgery and chemotherapy. The doctor usually treats the patient with a combination of both. Which therapy is used depends on the stage of the tumor.

surgery

The chances of recovery in ovarian cancer are highly dependent on the complete removal of the tumor: ovary (usually both), uterus, fallopian tubes and the large abdominal wall are therefore usually taken by the doctor. If the tumor is detected very early or in case of unilateral tumor involvement, it is also possible to deviate from this operation. If the tumor has already spread extensively, it may also be necessary to remove more parts of the peritoneum, parts of the intestine, the cecum or the lymph nodes.

The OP also serves diagnostic purposes. The doctor has the option to scan the entire abdomen for metastases. Tissue samples can be taken from suspicious, enlarged lymph nodes for further examination.

chemotherapy

After the operation usually chemotherapy is done. The treatment is designed to prevent the development of tumor foci that may or may not have been completely removed. The drugs either affect the entire body or can be specifically introduced into the abdominal cavity. They kill cancer cells. Most effective against ovarian cancer are platinum-containing substances such as carboplatin, which is given in combination with other drugs such as paclitaxel.

Additional drugs can specifically disrupt certain properties of the tumor and thus support chemotherapy. Substances that suppress the formation of new blood vessels worsen the supply of oxygen and nutrients to the tumor, thereby slowing its growth.

If the tumor was discovered very early on the ovary, chemotherapy may be unnecessary. For patients whom the doctor is unable to operate because of their poor health, even chemotherapy is successful. Only in exceptional cases a radiotherapy is used.

Ovarian cancer: disease course and prognosis

The sooner a tumor is detected, the better it is for ovarian cancer – chances of a cure decline drastically if metastases have already developed in the abdominal cavity. A disease limited to the ovaries has a very good prognosis – on average, the patients live 15 years and longer after the diagnosis. If the tumor tissue has been completely removed by surgery before the cancerous tissue has spread metastases, complete recovery is possible.

Unfortunately, many cases are diagnosed at an advanced stage. The reason: The disease shows no early symptoms. If the cancer has already spread in the abdomen, the chances of recovery are poor. In end stage ovarian cancer, the disease has spread to the whole body. Organs outside the abdominal cavity, such as the liver and lungs, also contain metastases. At this stage, the average ovarian cancer life expectancy is only 14 months. In patients with advanced ovarian cancer, the disease often returns following completed therapy.

The 5-year survival rate for ovarian cancer is about 40 percent – that is, five years after the diagnosis, about half of the patients still live. Overall, ovarian cancer has the worst prognosis of all gynecological cancers.