INTRODUCTION
The ovaries are the female organ of reproduction that produces the egg [ovum]; and the female hormone, estrogen, and progesterone. Ovulation occurs in the ovaries every month and involves the monthly release of an egg.
Ovarian cancer is the 3rd commonest gynaecological cancer in Nigeria. Worldwide 300, 000 new cases are diagnosed each year with about 185, 000 deaths. It constitutes about 5 -10 % of gynaecological malignancies in Nigeria. It is common in women from the fifth decade of life. However, young women are not immune to it.
SYMPTOMS
Ovarian cancer spreads through the blood, direct spread, through the lymphatic channel and the peritoneum. The spread of ovarian cancer goes undetected as the disease has no specific symptoms and most patients are diagnosed with late-stage disease.
These symptoms include:
- Abdominal swelling
- Feeling bloated
- Easy satiety
- Abdominal pains
- Irregular vaginal bleeding
CAUSES
The exact cause is unknown. It is known to be related to:
- Incessant ovulation: This may be due to the constant rupture of the ovary to release eggs and repair. If there is an abnormal repair, it could lead to cancer. Thus ladies who have not had babies are at increased risk while pregnancy and oral contraceptives reduce the risk.
- Family history: Women with a family history of ovarian cancer have an increased risk of developing it in the future. A history of breast cancer in the patient also increases the risk of ovarian cancer.
PREVENTION
Ovarian cancer has no defined precancer stage, so no screening method is currently approved for its prevention. CA 125 and transvaginal ultrasound scanning may be useful.
Its risk can be reduced by:
- Encouraging women to get pregnant.
- Taking oral contraceptive pills prevents regular ovulation.
- For women with a strong family history, removing the ovaries and fallopian tubes [salpingo-oophorectomy] is indicated. If a woman is found to have an alteration of the BRCA [Breast Cancer] gene she is at high risk of developing cancer. The BRCA gene suppresses cancers and restricts their growth.
DIAGNOSIS
If a patient is suspected to have ovarian cancer routine tests include:
- Blood Test: Full blood count, CA 125 [non-specific] which is normal in up to 45% of women with ovarian cancer.
- Radiological test: Abdominal Ultrasound Scan, CT scan of abdomen and pelvis, Chest X-ray to check for spread to the lungs.
- Staging and Diagnostic Laparotomy: This is used for the final diagnosis. Involves surgery to observe cancer, estimate the extent of spread and collect a specimen for testing.
TREATMENT
Surgery [Debulking Surgery]
This involves taking out as much of the cancerous structures as possible. It may involve removal of the ovaries and fallopian tube, uterus, omentum [fold of tissue connecting the stomach and other organs] and lymph nodes.
It allows chemotherapy given subsequently to be effective because the drugs can’t penetrate tumours more than 2 cm in diameter.
If a woman did not have debulking surgery before treatment or the debulking surgery wasn’t adequate, she could have an interval debulking surgery after some courses of chemotherapy.
Chemotherapy
Chemotherapy is the standard of care following debulking surgery.
Drugs used include Carboplatin, Paclitaxel, and Cisplatin.
Chemotherapy can be used in several forms:
- Neoadjuvant chemotherapy: Women who have advanced inoperable disease may have several cycles of chemotherapy before surgery is carried out. The drug reduces the bulk of cancer and makes it operable.
- Adjuvant chemotherapy: Drugs are administered after surgery [in addition to surgery]. This is the standard of care.
- Intraperitoneal chemotherapy: Involves administration of the drugs into the peritoneal cavity.
- Second-line chemotherapy: This is the use of other chemotherapeutic drugs in patients who were treated successfully but presented with a recurrence of the disease.
- Maintenance chemotherapy: This is done for persons who have achieved a cure to reduce the risk of relapse. It involves about 12 cycles of the medications.
WHEN TO SEE A DOCTOR
- If you have any of the above non-specific symptoms, you can book an appointment with your doctor to discuss the possible reason for your symptoms.
- If you have a relative who has or had ovarian, colorectal or breast cancer you should see a doctor and review your risk of ovarian cancer.
