This disease is much more common in women over age 50 and after menopause. Approximately 25,000 American women develop this illness and 14,000 die as a result of it each year.
CAUSES OF OVARIAN CANCER
The cause of ovarian cancer is unknown, however, certain factors increase the risk of developing it:
• High dietary fat
• Infertility
• Family history of gynecological cancer
• Genetic factors
SIGNS AND SYMPTOMS
Early stage ovarian cancer produces absolutely no symptoms. Cancer may grow to the size of a grapefruit before it causes a noticeable problem. Any of the following may be an early symptom of this cancer:
• Urinary frequency
• Pressure feeling in rectum
• Abdominal bloating and swelling
Diagnosis:
A physical examination, with a detailed pelvic exam, may reveal this illness. Visualization of the pelvis using Ultrasound or CT scan should be the next step. Blood test, CA125 is a tumor marker, which may be very helpful in establishing the diagnosis. When there is suspicion of this cancer, a tissue diagnosis is mandatory.
This may be accomplished by:
• FNA or Trochar Biopsy of the tumor
• Examination of fluid in the abdomen
• Surgery, with removal of the tumor
Pattern of spread:
If left untreated, or if ovarian cancer fails to respond to treatment, it can spread from the ovaries to
• Pelvic and abdominal lymph glands
• Abdominal cavity, and cause fluid production in the abdomen
• Lungs
• Pleural space
• Bones
• Liver
• Brain
STAGING
Once a diagnosis of the ovarian cancer is established, a thorough examination of the patient should be performed to disclose the extent of the cancer spread. A chest X-Ray along with CT scan of the abdomen and pelvis should be performed to determine the extent of cancer's spread. The purpose of these tests is to study the areas where cancer has a tendency to spread to. Detailed staging of ovarian cancer is accomplished by the laboratory examination of the tissues removed during surgery.
• Stage 1, when cancer is limited to one ovary
• Stage 2, when cancer involves both ovaries or extends to the pelvis
• Stage 3, when cancer spreads to the abdominal cavity or lymph glands
• Stage 4, when it spreads to other organs, e.g., lungs, brain, liver, etc.
TREATMENT
Treatment of ovarian cancer is complex and utilizes surgery, chemotherapy and radiation therapy. Surgery is the most important tool in management of this disease, especially in early Stages 1 and 2, when a cure is possible. The disease becomes very difficult to treat when it has reached Stage 3 or Stage 4.
Patients with Stages 1 or 2 may benefit from radiation to the abdomen. However, radiation can cause substantial side effects and complications, one of which is bowel obstruction, which is seen in 10 to 25% of patients.
All patients, in all stages, are offered chemotherapy. Most patients are treated with a combination of Taxol, Cisplatinum or Carboplatinum. Other commonly used drugs are: Cytoxan, Adriamycin, Thiotepa, Melphalan, VP-16, Topotecan. More recently Navelbine has shown activity in treatment of ovarian cancer, especially when combined with other drugs such as Taxol, Ifosfamide, etc.
Certain patients with ovarian cancer may be considered for treatment with Autologous Bone Marrow Transplantation. This is a rather experimental treatment and has not found its place in treatment of this cancer.
