Cancer of the ovary (ovarian cancer) is the ninth most common cancer in women in developed countries. Ovarian cancer is the fifth leading cause of cancer deaths in women.
Epithelial Ovarian Cancer / Borderline Ovarian Tumors / germ Cell Ovarian Cancer / Stromal Ovarian Cancer.
Risk factors are related to two major categories: menstrual cycles (ovulation) and family history.
The more a woman ovulates (cycles) over her lifetime, the higher her risk of ovarian cancer.
Starting her period (menarche) at a younger age, ending her period menopause at a late age, and not getting pregnant (null parity) are all risk factors.
Approximately 10% of ovarian cancers are genetically related. Because of this, current guidelines suggest that all women with ovarian cancer should undergo testing for BRCA1 and BRCA2 gene changes (mutations).
Screening tests are used to test a healthy population in an attempt to diagnose a disease at an early stage.
Unfortunately, there are no good screening tests for ovarian cancer, despite extensive ongoing research.
Imaging (ultrasound, X-rays, and CT scans), and blood tests should not be used as a screen, as they are inaccurate and lead many women to surgery who do not need it.
Diagnosis is often suspected based on symptoms and physical exam, and these are followed by imaging.
Often vague symptoms eventually lead to a clinical diagnosis, or one based on suspicion generated by exams, laboratory tests, and imaging.
An accurate diagnosis requires some of the tumor to be removed, either by biopsy (less often), or preferably, surgery to verify the diagnosis.
Often a high clinical suspicion can trigger a referral to a gynecologic oncologist.
Various types of imaging studies like Ultrasound and CT (CAT) scans are the most common. These can often give pictures that show masses in the abdomen and pelvis, fluid in the belly (as cites obstructions of the bowels or kidneys, or disease in the chest or liver.
Many times this is all that is necessary to trigger a referral to a specialist, as the suspicion for ovarian cancer can be quite high. PET scans can be used, but often are not necessary if a CT scan is able to be performed.
Blood is tested for the tumor masters like CA-R5 for epithelial tumors.
AFP, BHEG, LDH for germ cell tumor.
Others masters like inhibin which aid on diagnosis and help during follow up periods.
Epithelial ovarian cancer treatment comprises of surgery and chemotherapy. The Surgery tries to remove all noticeable disease in the abdomen, also known as surgical debulking.
This surgery removes both tubes and ovaries, removal of the omentum, lymph node biopsies, the uterus (hysterectomy), and any other organ with the disease.
Any patient who is healthy enough to endure chemotherapy will benefit significantly from its use. The drugs used to treat ovarian cancer do not pose any major side effects, making it easier for everyone as opposed to other chemotherapy drugs. After the initial diagnosis, there are two drugs used in epithelial tumors, namely carboplatin and paclitaxel. The carboplatin is given every 21 days and the paclitaxel is given every 21 days, or every 7 days.
Alternatively, chemotherapy can also be given by placing it directly into the abdomen (intraperitoneal or IP). At present the drugs used are cisplatin and paclitaxel.