Stromal ovarian cancer begins in the ovarian tissue containing hormone producing cells. The main types of Stromal ovarian cancer are granulosa cell tumors, granulosa-theca tumors, and Sertoli-Leydig cell tumors. They are rare and can produce estrogen or testosterone. Often detected at an earlier stage than other types.
- Primary Peritoneal Cancer:
Primary peritoneal cancer do not start in the ovaries. It originates from cells lining the pelvis and abdomen, similar to the epithelial cells of the ovary. This cancer behaves and is treated similarly to epithelial ovarian cancer.
Fallopian Tube Cancer arises from the fallopian tubes that connect the ovaries to the uterus. It is similar in behavior and treatment to epithelial ovarian cancer. Fallopian tube cancer is rare.
Each type of ovarian cancer has its unique characteristics, risk factors, and prognosis. Due to the potential for vague or non-specific symptoms in the early stages of ovarian cancer, awareness, regular check ups, and understanding personal risk factors are vital for early detection and optimal treatment outcomes.
Symptoms of Ovarian Cancer
Ovarian cancer is often referred to as a "silent" disease because its symptoms can be vague and easily mistaken for other conditions, especially in the early stages. However, being aware of the potential signs can lead to earlier diagnosis and improved outcomes. Some common symptoms of ovarian cancer include:
- Abdominal Bloating or Swelling: A noticeable increase in abdominal size.
- Pelvic or Abdominal Pain: Discomfort or pain in the lower abdomen or pelvic area.
- Feeling Full Quickly or Difficulty Eating: A sensation of fullness even after consuming a small meal.
- Frequent Urination: An urgent need to urinate or going more frequently without an apparent reason.
- Changes in Menstruation: Irregular periods or heavier bleeding than usual.
- Unexplained Weight Loss: Losing weight without trying or making dietary or lifestyle changes.
- Pain During Intercourse: Discomfort or pain during sexual activity.
- Back Pain: Particularly in the lower back.
- Fatigue: Feeling unusually tired or low on energy.
- Constipation or Changes in Bowel Habits: Including diarrhea or other digestive issues without any clear cause.
- Nausea or Upset Stomach: Feeling queasy or experiencing other digestive disturbances.
It is essential to remember that these symptoms can also be caused by many other conditions, most of which are benign. However, if these symptoms are new, persist for more than a couple of weeks, and feel different from typical digestive or menstrual problems, it's important to seek medical evaluation.
Early detection is crucial for improved treatment outcomes. Women should be proactive about their health, know their bodies, and consult with healthcare providers regarding any persistent or unusual symptoms.
Diagnosis of Ovarian Cancer
Diagnosing ovarian cancer involves several steps and tests to both determine the presence of cancer and ascertain its type and extent. If ovarian cancer is suspected based on symptoms or a routine check up, the following diagnostic approaches might be employed:
- Pelvic Examination: The doctor examines the vagina, uterus, rectum, and pelvis for any masses or growths. While it is a basic first step, small ovarian tumors are often hard to feel during a pelvic exam.
- CA-125 test: This blood test measures the level of the protein CA-125, which is often elevated in women with ovarian cancer. However, other conditions can also raise CA-125 levels, so it is not specific for ovarian cancer.
- Other tumor markers: Apart from CA-125, other tumor markers like HE4, AFP, LDH, or hCG might be assessed, especially if germ cell tumors or other non epithelial ovarian cancers are suspected.
- Ultrasound: Transvaginal and pelvic ultrasounds use sound waves to create images of the ovaries. These images can help determine the size, shape, and structure of ovarian masses.
- Computed Tomography (CT) Scan: Provides detailed images of the abdomen and pelvis and can help determine if cancer has spread to other organs.
- Magnetic Resonance Imaging (MRI): Helps provide detailed images of the ovaries and surrounding tissues, often used when other imaging results are inconclusive.
- Biopsy: The definitive way to confirm ovarian cancer is by taking a tissue sample. This is usually done during surgery. A pathologist then examines the sample under a microscope to check for cancer cells.
- Laparoscopy: A minimally invasive surgical procedure using a thin tube with a camera (laparoscope) to inspect the ovaries and remove tissue samples if needed.
- Colonoscopy: If there is concern that the cancer has spread to the colon.
- Chest X-ray: To determine if cancer has spread to the lungs.
- Positron Emission Tomography (PET) Scan: It can help identify areas of cancer that might not be detected by other imaging methods.
- Paracentesis: If there is fluid buildup in the abdominal cavity, a sample might be taken using a needle. The fluid is then checked for cancer cells.
- Barium Enema X-ray: Might be done to see if the cancer has spread to the colon or rectum.
- Lower GI (Gastrointestinal) Series: Can help determine if the cancer has spread to the colon or rectum.
If ovarian cancer is diagnosed, additional tests or procedures may be used to determine the stage and extent of the disease, which aids in treatment planning. It is essential for patients to discuss their symptoms, test results, and concerns with their doctor to ensure a comprehensive evaluation and accurate diagnosis.
Treatment of Ovarian cancer
Robotic Surgery
Robotic surgery has increasingly been utilized in the management of various gynecological conditions, including ovarian cancer. The precision, flexibility, and control offered by robotic assisted surgery can provide some advantages, especially in complex procedures. Here is a look at how robotic surgery plays a role in the treatment of ovarian cancer:
- Staging: Determining the extent and spread of ovarian cancer is critical for treatment planning. Robotic assisted laparoscopy can be used for staging procedures, allowing for detailed exploration of the abdominal and pelvic cavities, biopsies, and the removal of suspicious tissues.
- Debulking Surgery: The primary treatment for advanced ovarian cancer is cytoreductive or debulking surgery, which aims to remove as much of the tumor as possible. While open surgery is traditionally used for this purpose, early stage tumors or selected cases may be approached using robotic assistance to achieve optimal cytoreduction.
- Oophorectomy and Salpingo-oophorectomy: In some early stage ovarian cancers or as a preventive measure for high risk individuals, the ovaries (oophorectomy) or both the ovaries and fallopian tubes (salpingo oophorectomy) might be removed. Robotic assistance can make these procedures less invasive with quicker recovery times.
- Hysterectomy: In cases where the cancer has spread or there's a high risk of it doing so, the uterus may need to be removed in addition to the ovaries. Robotic-assisted hysterectomy can offer a minimally invasive option, resulting in reduced blood loss, shorter hospital stays, and faster recovery.
- Lymph Node Assessment: Robotic surgery can be employed to remove lymph nodes in the pelvic and para aortic regions to determine if the cancer has spread.
Chemotherapy:
- Administered after surgery to kill any remaining cancer cells.
- Sometimes used before surgery to shrink large tumors.
- Can be given intravenously (IV) or directly into the abdomen (intraperitoneal or IP).
Targeted Therapy:
- Uses drugs that target specific aspects of cancer cells without affecting normal cells. Examples include bevacizumab (Avastin) and PARP inhibitors like olaparib (Lynparza) and niraparib (Zejula).
Hormone Therapy:
- Used for certain types of ovarian cancer that are hormone-sensitive.
- Includes drugs like letrozole (Femara), tamoxifen, or anastrozole (Arimidex).
Radiation Therapy:
- Not commonly used as a primary treatment for ovarian cancer but may be employed in certain situations or for symptom relief.
Immunotherapy:
- A relatively new approach that boosts the body's natural defenses to fight cancer.
- Examples include checkpoint inhibitors, which remove the "brakes" cancer puts on the immune system, allowing it to attack the cancer cells more effectively.
Clinical Trials:
- Ongoing research might offer new treatments or combinations of treatments. Participating in a clinical trial can give access to the latest treatments, but there's no guarantee they'll be more effective than current treatments.
Palliative Care:
- Focused on providing relief from symptoms and improving the quality of life. It can be combined with other treatments or used when curative treatments are no longer effective.
It is essential for patients to discuss potential benefits, risks, and side effects of any treatment with their doctor. Being informed and understanding all available options helps in making decisions that align with the patient's wishes and overall health objectives.
What is difference between Ovarian cancer and Ovarian tumor?
Both ovarian cancer and ovarian tumors concern growths in the ovaries, but they represent different concepts in terms of their nature and potential malignancy. Here is a breakdown of the differences:
Basic Definitions:
- Ovarian Tumor: A tumor simply refers to an abnormal growth or lump in the ovary. This growth can be benign (non-cancerous) or malignant (cancerous).
- Ovarian Cancer: This specifically refers to malignant tumors or growths in the ovary. When cells in the ovary begin to grow uncontrollably and have the potential to spread to other parts of the body, they are considered cancerous.
Nature of Growth:
- Ovarian Tumor: Not all ovarian tumors are harmful. They can be cystic (filled with fluid), solid, or a mix of both. Many are benign and pose no serious threat, though they may cause symptoms due to their size or location.
- Ovarian Cancer: This is always a cause for concern as it involves malignant growths. If left untreated, ovarian cancer can spread to other parts of the body, a process known as metastasis.
Treatment:
- Ovarian Tumor: Benign tumors might be monitored for changes or removed to alleviate symptoms or prevent potential complications. The treatment approach often depends on the tumor's size, type, and the patient's age and overall health.
- Ovarian Cancer: Treatment is more aggressive and can involve surgery, chemotherapy, radiation therapy, targeted therapy, or a combination of these. The goal is to remove or kill cancer cells and prevent recurrence.
Prognosis:
- Ovarian Tumor: Many benign ovarian tumors require minimal to no treatment and have an excellent prognosis. However, some benign tumors can have characteristics that make them more likely to become cancerous over time.
- Ovarian Cancer: The prognosis depends on the stage of the cancer, its type, and other factors. Early detection and treatment significantly improve the prognosis, but ovarian cancer is often diagnosed in later stages because its symptoms can be non-specific and similar to other conditions.
It is essential to understand that the presence of an ovarian tumor doesn't necessarily mean a person has ovarian cancer. However, any growth or changes in the ovary should be evaluated by a healthcare professional to determine its nature and the best course of action. Regular check-ups and being attentive to one's body can aid in early detection and timely intervention.
