Cancer affects the cell, the cornerstone of our bodies. When the cancer affects the cell through various mechanisms, the cells begin to show an abnormal division redundantly and eventually grow out of control.
In healthy people, the ovaries are made up of cells that grow in line with the body’s needs. However, redundant cells are abnormal and they are called tumors. Tumors can be benign or malignant. For example, ovarian cysts filled with fluid are benign in women under 30 years of age. They can disappear by themselves or they can be removed by operation if necessary. Benign tumors do not invade surrounding tissues. But the tumors we call malignant occupy both the ovaries and the surrounding tissues. Ovarian cancer can spread throughout the abdomen to the intestines, stomach, or even to remote areas of the body through blood or lymphatic spread. This is called spreading, namely “metastasis”.
There are several types of ovarian cancers. Here we will mention about the most common “epithelial ovarian cancer”. Other types are rarer.
Ovarian cancer is the 6th most common cancer in women in Turkey. Although it is mostly seen between the ages of 50-70, it can also occur at an earlier and later age. A woman has a 1.4% chance of developing ovarian cancer throughout her life.
Factors that increase the risk of developing ovarian cancer in a woman include:
Early menarche (first menstrual age) or late menopause
Those who had never conceived
Ovarian, breast or endometrial (uterine) cancer in the family
Some genetic mutations (e.g. BRCA1 andBRCA2)
Some particular cases inherited from the family (e.g. Lynch Syndrome)
Ovarian cancer is insidious, it whispers. Thus, it is necessary to listen it well. There may be some vague complaints in the early stages of ovarian cancer. It is necessary to pay attention to mild complaints such as slight abdominal pain, abdominal swelling or bloating feeling, decreased appetite, feeling full sooner than normal or after eating less and frequent urination.
Most of the ovarian cancers that we have diagnosed at an early stage came to attention during the annual routine gynecologic examination. Cancer risk is determined according to the ultrasonographic features of the mass and some additional tests; then ideal approach options are evaluated.
Many ovarian cancer patients do not develop any specific complaints. Therefore, most patients come to us at advanced stages of the disease. At this point, the patient had already developed symptoms such as abdominal bloating, nausea and weight loss.
Ovarian Cancer Treatment
Open or keyhole (laparoscopy/robotic surgery) surgery is recommended for patients with suspected ovarian cancer, depending on the characteristics of the mass.
In cases that are thought to have early stage ovarian cancer, the mass is removed and the pathological examination is done at that time of operation (frozen section). After this examination, which lasts no longer than 30 minutes, if the cancer is diagnosed, the ideal treatment involves removal the uterus, ovaries and tubes, adjacent and related lymph nodes, the entire omentum (intra-abdominal fatty tissue) and taking samples from the abdominal membrane. In this way, microscopic spread of the disease is evaluated. In patients who are diagnosed with early-stage ovarian cancer and who want to have children in the future, the surgical procedure can be completed by protecting the uterus and an ovary.
If ovarian cancer has spread to other organs, the name of the surgery is referred to as ‘debulking’ or ‘cytoreduction’ surgery. In this case, the purpose is to remove all tumor tissues without leaving any visible tumor. For this purpose, it may be necessary to remove some parts of the bowels (intestinal resection), part of the liver, spleen, diaphragm membrane and abdominal membrane. Detailed information that may be different for each patient is shared with the patient and relatives before surgery.
Six cycles of chemotherapy is recommended after surgery in patients with ovarian cancer more advanced early than early stage.
In patients whose general condition is not well enough to tolerate the the first surgery, 3-4 cycles of chemotherapy is given to reduce the tumor size and spread and operation is planned.
The two most important factors that determine the course of the disease (prognosis) in ovarian cancer are the absence of visible tumor in surgery and response to chemotherapy.
Ovarian Cancer Stages
st stage: In the first stage, ovarian cancer can occur in only one or both ovaries. However, it has not yet spread to any other organ in the body. The first stage is also divided into three phases within itself. At the beginning of the first stage, ovarian cancer is found only in one ovary. In the second phase of the first stage, ovarian cancer has spread to both ovaries, but it has not spread elsewhere. In the next phase, the cancer has crossed the ovarian border. A cyst on the ovary may have ruptured, and a cancer cell can be detected somewhere outside the ovary.
2nd stage: In the second stage of ovarian cancer, the cancer may have spread to other organs in the pelvis. The second stage also has three phases. In the first of these phases, cancer spread to the uterus and tubes. In the second phase of the second stage, cancer cells can also be seen in the bladder or large intestine. At the last phase of this stage, cancer has crossed the ovarian border and any of the first two phases has already taken place. In addition, cancer cells can be seen in the abdominal fluid.
3rd stage: In the third stage, the cancer spreads into the abdomen and shows involvement of the lymph nodes. In the first phase of this stage, cancer cells can be seen in a small proportion in the abdomen. Cancer cel growth is a little more extensive in the second phase and this growth exceeds two centimeters in the third phase of this stage.
In the fourth stage, which is the last stage of ovarian cancer, cancerous cells also spread to far more distant organs. Cancer cells can also be seen in the liver or lung.
Approximately 70% of patients are diagnosed when they have stage 3 or 4 disease.