What is ovarian cancer?

When cells in the body begin to grow out of control, cancer develops. Cancerous cells can arise in almost any place of the body and spread throughout the body. To gain a better understanding of how cancer begins and spreads.

Ovarian malignancies were once thought to develop only in the ovaries, but new research reveals that many ovarian cancers may begin in cells at the far (distal) end of the fallopian tubes.

Ovarian cancer is a cancerous development of cells in the ovaries. The cells reproduce rapidly and have the ability to infiltrate and kill healthy body tissue.

Two ovaries, one on each side of the uterus, make up the female reproductive system. Each ovary, about the size of an almond, produces eggs (ova) as well as oestrogen and progesterone hormones. Surgery and chemotherapy are generally used to treat ovarian cancer.

Epithelial ovarian tumors

Ovarian epithelial cancers begin on the ovaries’ outer surface. These tumours can be benign (non-cancerous), borderline (perhaps cancerous), or malignant (cancerous) (cancer).

Benign epithelial ovarian tumors

Benign epithelial ovarian tumours do not spread and do not usually cause serious sickness. Serous cystadenomas, mucinous cystadenomas, and Brenner tumours are all examples of benign epithelial tumours.

Borderline epithelial ovarian tumors

Some ovarian epithelial tumours do not appear to be malignant when examined in the lab, and are referred to as borderline epithelial ovarian cancer. Atypical proliferative serous carcinoma and atypical proliferative mucinous carcinoma are the two most common forms. Previously, these tumours were known as tumours with a minimal malignant potential (LMP tumors). These malignancies differ from traditional ovarian cancers in that they do not spread to the ovary’s supporting tissue (called the ovarian stroma). They may grow on the lining of the abdomen but not inside it if they spread outside the ovary, for example, into the abdominal cavity (belly).

Borderline tumours are more common in younger women than ovarian malignancies. These tumours grow slowly and pose a lower risk of death than the majority of ovarian malignancies.

Malignant epithelial ovarian tumors

Cancerous epithelial tumors are called carcinomas. About 85% to 90% of malignant ovarian cancers are epithelial ovarian carcinomas. These tumor cells have several features (when looked at in the lab) that can be used to classify epithelial ovarian carcinomas into different types. The serous type is by far the most common, and can include high grade and low grade tumors. The other main types include mucinous, endometrioid, and clear cell.

• Serous carcinomas (52%)
• Clear cell carcinoma (6%)
• Mucinous carcinoma (6%)
• Endometrioid carcinoma (10%)

Each ovarian cancer is given a grade, based on how much the tumor cells look like normal tissue:

• Grade 1 epithelial ovarian carcinomas look more like normal tissue and tend to have a better prognosis (outlook).
• Grade 3 epithelial ovarian carcinomas look less like normal tissue and usually have a worse outlook.

Other traits are also taken into account, such as how fast the cancer cells grow and how well they respond to chemotherapy, to come up with the tumor’s type:

• Type I tumors tend to grow slowly and cause fewer symptoms. These tumors also seem not to respond well to chemotherapy. Low grade (grade 1) serous carcinoma, clear cell carcinoma, mucinous carcinoma and endometrioid carcinoma are examples of type I tumors.
• Type II tumors grow fast and tend to spread sooner. These tumors tend to respond better to chemotherapy. High grade (grade 3) serous carcinoma is an example of a type II tumor.

Symptoms of ovarian cancer

When ovarian cancer first appears, it may not show any signs or symptoms. When ovarian cancer symptoms appear, they’re sometimes mistaken for symptoms of other, less serious illnesses.

Signs and symptoms of ovarian cancer may include:

• Abdominal bloating or swelling
• Quickly feeling full when eating
• Weight loss
• Discomfort in the pelvic area
• Fatigue
• Back pain
• Changes in bowel habits, such as constipation
• A frequent need to urinate

Causes of ovarian cancer

Ovarian cancer has yet to be recognised as a cause, yet scientists have identified factors that potentially raise the risk of the disease.

Ovarian cancer develops when cells in or near the ovaries have alterations (mutations) in their DNA, according to doctors. The DNA of a cell includes the instructions that tell it what to do. The alterations cause the cells to reproduce and develop rapidly, resulting in a mass (tumour) of cancer cells. When healthy cells die, malignant cells continue to live. They can infect adjacent tissues and break away from a primary tumour to move to other parts of the body (metastasize).

Risk factors of ovarian cancer

Factors that can increase your risk of ovarian cancer include:

• Older age. The risk of ovarian cancer increases as you age. It’s most often diagnosed in older adults.

• Inherited gene changes. A small percentage of ovarian cancers are caused by genes changes you inherit from your parents. The genes that increase the risk of ovarian cancer include BRCA1 and BRCA2. These genes also increase the risk of breast cancer.

  Several other gene changes are known to increase the risk of ovarian cancer, including gene changes associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D.

• Family history of ovarian cancer. If you have blood relatives who have been diagnosed with ovarian cancer, you may have an increased risk of the disease.
• Being overweight or obese. Being overweight or obese increases the risk of ovarian cancer.
• Postmenopausal hormone replacement therapy. Taking hormone replacement therapy to control menopause signs and symptoms may increase the risk of ovarian cancer.
• Endometriosis. Endometriosis is an often painful disorder in which tissue similar to the tissue that lines the inside of your uterus grows outside your uterus.
• Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.
• Never having been pregnant. If you’ve never been pregnant, you may have an increased risk of ovarian cancer.

Prevention of ovarian cancer

Ovarian cancer cannot be completely avoided. However, there may be measures to lower your risk:

Take birth control tablets if you’re thinking about it. Consult your doctor to see if oral contraceptives (birth control tablets) are correct for you. Ovarian cancer risk is reduced by using birth control tablets. However, because some medications have dangers, talk to your doctor about whether the benefits outweigh the risks in your situation.
Consult your doctor about your risk factors. Inform your doctor if you have a family history of breast and ovarian malignancies. Your doctor can tell you what this means for your own cancer risk. A genetic counsellor may be referred to you to assist you determine whether genetic testing is best for you. If you have a gene mutation that raises your chance of ovarian cancer, you may want to have your ovaries removed to avoid cancer.

Diagnosis of ovarian cancer

Tests and procedures used to diagnose ovarian cancer include:

• Pelvic exam. During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel (palpate) your pelvic organs. The doctor also visually examines your external genitalia, vagina and cervix.
• Imaging tests. Tests, such as ultrasound or CT scans of your abdomen and pelvis, may help determine the size, shape and structure of your ovaries.

• Blood tests. Blood tests might include organ function tests that can help determine your overall health.

   

  Your doctor might also test your blood for tumor markers that indicate ovarian cancer. For example, a cancer antigen (CA) 125 test can detect a protein that’s often found on the surface of ovarian cancer cells. These tests can’t tell your doctor whether you have cancer, but they may provide clues about your diagnosis and prognosis.

• Surgery. Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer.
• Genetic testing. Your doctor may recommend testing a sample of your blood to look for gene changes that increase the risk of ovarian cancer. Knowing you have an inherited change in your DNA helps your doctor make decisions about your treatment plan. You may wish to share the information with your blood relatives, such as your siblings and your children, since they also may have a risk of having those same gene changes.

Once you’ve been diagnosed with ovarian cancer, your doctor will assign a stage to your cancer based on the results of your tests and procedures. Ovarian cancer is classified into four stages, which are frequently denoted by the Roman numbers I through IV. The earliest stage of cancer suggests that it has only spread to the ovaries. The cancer has spread to other parts of the body at stage 4.

Treatment of ovarian cancer

Surgery

The afflicted ovary and its fallopian tube may be removed during surgery for early-stage cancer that hasn’t progressed beyond one ovary. This surgery may help you keep your childbearing abilities.

If both of your ovaries have cancer and there are no other indicators of malignancy, your surgeon may remove both of your ovaries and fallopian tubes. Because your uterus is left intact, you may still be able to conceive using your own frozen embryos or eggs, or eggs from a donor.

Your surgeon will remove the ovaries, fallopian tubes, uterus, adjacent lymph nodes, and a fold of fatty abdominal tissue if your cancer is further advanced or if you don’t want to maintain your ability to have children (omentum).

Your doctor may propose surgery to remove as much of the cancer as possible if your cancer has progressed. In this case, chemotherapy may be given before or after surgery.

Chemotherapy

Chemotherapy is a medication treatment that employs chemicals to eliminate rapidly multiplying cells in the body, such as cancer cells. Chemotherapy medications can be given intravenously or orally.

Chemotherapy is frequently administered following surgery to eliminate any remaining cancer cells. It’s also a good idea to utilise it before surgery.

Chemotherapy medications may be heated and administered into the abdomen during surgery in some cases (hyperthermic intraperitoneal chemotherapy). Before being drained, the medications are left in situ for a period of time. The surgery is then done.

Targeted therapy

Targeted medication treatments concentrate on specific flaws found in cancer cells. Cancer cells can be killed by targeted medication treatments that targeting these flaws.

If you’re considering targeted therapy for ovarian cancer, your doctor may do a test on your cancer cells to see which targeted therapy is most likely to work.

Hormone therapy

Drugs that prevent the effects of the hormone oestrogen on ovarian cancer cells are used in hormone treatment. Because some ovarian cancer cells rely on oestrogen to develop, inhibiting oestrogen may aid in cancer control.

Hormone therapy could be used to treat some types of slow-growing ovarian malignancies. It’s also a possibility if the cancer returns after initial treatment.

Immunotherapy

Immunotherapy is a type of cancer treatment that makes use of the body’s own immune system. Because cancer cells develop proteins that assist them hide from immune system cells, the body’s disease-fighting immune system may not assault them. Immunotherapy works by interfering with the immune system’s natural processes.

In some cases, immunotherapy may be an option for treating ovarian cancer.

CAR T-Cell therapy for the treatment of ovarian cancer

A recently created immunotherapy for the treatment of tumours is called chimeric antigen receptor-engineered T-cell (CAR-T) therapy. Its usage in the treatment of solid tumours, such as ovarian cancer, has been investigated because CAR-T therapy has demonstrated remarkable efficacy in the treatment of CD19-positive haematological malignancies.

Application of CAR T-Cell therapy has started and this has given new hope to patients suffering from late stage ovarian cancer.