Ovarian Cancer - Symptoms, Causes, Stages & Treatment

Ovarian cancer is characterised by the growth of abnormal cells in the ovaries or fallopian tubes. The ovaries are the female reproductive glands where eggs are formed and released during ovulation.  

The ovarian cancer survival rate varies depending on the age of the women and the stage of the disease. The overall five-year survival rate is 49%. 

Types of Ovarian Cancer

Types of ovarian cancer is based on the origin of the cells where the cancer begins. Understanding the types helps in determining the appropriate treatment approach and prognosis. The following are the main types of this condition: 

1. Epithelial Ovarian Cancer: This is the most common type, accounting for about 85% to 90% of ovarian cancers. It arises from the epithelium, the outer layer of the ovary. 

2. Stromal Tumours: These account for about 7% of ovarian cancers and begin in the ovarian tissue that contains hormone-producing cells. 

3. Germ Cell Tumours: It is a rare ovarian cancer that begins in the egg-producing cells. 

When we talk about ovarian cancer stages, we refer to how far the cancer has spread. According to the FIGO (International Federation of Gynecology and Obstetrics) system, there are four stages of the disease, with the lower stages being less severe. These include:

1. Stage I: Cancer is limited to one or both ovaries or the fallopian tubes. 

2. Stage II: It is present in one or both ovaries and has spread to other pelvic tissues. 

3. Stage III: The malignant cells have metastasised to the abdominal cavity outside the pelvis or to the pelvic lymph nodes.

4. Stage IV: The most advanced stage that indicates distant metastasis to the lungs, liver, or spleen. 

Ovarian Cancer Signs and Symptoms

During the early stages, ovarian cancer symptoms are not easily noticeable. When symptoms occur, they can be associated with other common conditions. 

Common symptoms of ovarian cancer may include the following: 

1. Abdominal or pelvic pain 

2. Bloating 

3. Feeling full quickly when eating 

4. Unexplained weight loss 

5. Persistent tiredness or exhaustion 

6. Back pain 

7. Bowel changes, such as constipation or diarrhoea 

8. Increased urgency or frequency of urination

If you experience any of these symptoms, you should consult the doctor right away. It is important to note that a person with this condition may not necessarily experience all these symptoms. Moreover, having these symptoms does not guarantee a cancer diagnosis.  

Ovarian cancer develops when mutations occur in the DNA of cells within the ovaries. The exact causes of these genetic changes are unknown.

Most ovarian cancers are linked to genetic changes that occur during a woman’s lifetime due to environmental factors or various reasons. In about 1 in 500 cases, ovarian cancer is caused by genetic mutations inherited from a parent. This type of cancer is known as hereditary ovarian cancer.

Several risk factors can increase the likelihood of developing ovarian cancer. However, having one or more of these factors does not guarantee that you will get this condition. These aspects are as follows: 

Non-Modifiable Risk Factors

Individuals have no control over these factors, making them impossible to change or modify. The following may increase the risk of the disease: 

1. Age: Postmenopausal women over the age of 60.

2. Genetic Mutations: Inherited mutations in the BRCA1 or BRCA2 genes.

3. Family History: Having blood relatives with ovarian cancer.

4. Reproductive History: Factors such as never giving birth, late age at first childbirth, early menstruation, or late menopause.

5. History of Endometriosis: A tissue similar to the uterine lining grows outside the uterus.

Modifiable Risk Factors

These can potentially be altered through lifestyle changes or medical interventions. The following factors can increase the risk: 

1. Being overweight or obese.

2. Long-term use of hormone replacement therapy to control menopause signs and symptoms.

Preventing ovarian cancer can be challenging, especially since the exact causes of the disease are not understood. However, several strategies may help reduce the risk of developing the disease. These include:

1. Genetic Testing and Counseling: If you have a family history of breast and ovarian cancers, genetic testing can identify specific inherited mutations (such as BRCA1 or BRCA2). Being tested positive, you may consider preventive measures, such as the removal of the ovaries and fallopian tubes.

2. Oral Contraceptives: Using birth control pills reduces the risk of ovarian cancer. Patients should consult their doctor before considering oral contraceptives. 

3. Regular Gynaecologic Care: Women aged 40 and above should have regular screening for ovarian cancer once a year. This includes tests like transvaginal ultrasound and CA-125 blood tests.   

How is ovarian cancer diagnosed?

Ovarian cancer diagnosis is challenging in the early stages due to a lack of screening tests. If the doctor suspects the disease, they will ask you about the symptoms and perform a pelvic exam to look for abnormal growths. They may also order additional tests, which include the following: 

1. Imaging Studies: Tests such as pelvic ultrasound, CT scan, MRI, and PET scan are used to visualise the ovaries and surrounding areas for abnormalities. 

2. Blood Tests: They measure the level of CA-125, a protein that is elevated in women with ovarian cancer. However, elevated levels can also occur in other conditions. The CA-125 ovarian cancer range varies, but a significantly high level might prompt further diagnostic evaluation. 

3. Laparoscopy: Sometimes, laparoscopic surgery may be performed to obtain a biopsy and visually inspect the ovaries and other abdominal organs. This procedure involves making small cuts and inserting a camera and surgical instruments.

4. Biopsy: The definitive diagnosis of ovarian cancer requires a biopsy, typically obtained during surgery. A tissue sample is examined under a microscope to determine if cancer cells are present.

How to prepare for a doctor consultation? 

Preparing for a gynaecological oncologist consultation for ovarian cancer involves several important steps to ensure that patients can benefit from the appointment. Below are some crucial tips: 

1. Compile all relevant medical records, including any test results and imaging studies.

2. Keep a detailed list of the symptoms, noting their frequency, severity, and any factors that alleviate or exacerbate them. 

3. Enlist all current medications, including prescriptions, over-the-counter medications, supplements, and herbal remedies.

Questions to ask the Doctor 

During a consultation for ovarian cancer, patients should ask the right questions to their gynaecological oncologist. This helps them understand their diagnosis and make informed decisions about treatment plans. The following are some questions to consider: 

1. What is the cause of my symptoms? 

2. What stage is my ovarian cancer at? 

3. What treatment options are available, and which do you recommend? 

4. What are the potential side effects of these treatments? 

5. How will these treatments affect my fertility and overall quality of life?

The goal of ovarian cancer surgery is to remove as much cancer from the body as possible. It involves a combination of approaches, which are as follows: 

1. Surgery: The doctor recommends the type of surgery depending on the stage of the cancer. Options include: 

1. Salpingo-Oophorectomy: Removing one or both fallopian tubes and ovaries

2. Hysterectomy: Removal of the uterus if the cancer has spread

3. Pelvic or Para-Aortic Lymphadenectomy: The lymph nodes in the abdomen and pelvis are removed 

4. Debulking Surgery: If cancer spreads beyond the ovaries, an attempt is made to remove as much of it as possible 

2. Chemotherapy: This treatment uses drugs to kill cancer cells before or after surgery. Chemotherapy for ovarian cancer can be administered intravenously or directly into the abdomen (intraperitoneal).

3. Hormone Therapy: These medications are used to treat some types of ovarian cancers, like stromal tumours. They block oestrogen production or lower oestrogen levels to slow the growth of tumours.  

4. Targeted Therapy: It target specific pathways or mechanisms involved in cancer growth and spread. The doctor tests the patient’s cancer cells to determine the most effective target therapy. 

5. Immunotherapy: This treatment helps boost my immune system's ability to fight cancer.

Note: The treatment approach is selected based on the stage and type of ovarian cancer, the individual’s condition, and the doctor’s opinion. 

Estimated Cost of Ovarian Cancer Treatment 

The ovarian cancer treatment cost in India varies based on the type of surgery, the facility, and the surgeon’s expertise. The table below provides an overview of the approximate prices: 

Note: Patients are advised to speak with HexaHealth consultants for up-to-date pricing information. 

Delaying treatment for ovarian cancer can have significant and serious consequences. Early intervention is key to managing ovarian cancer effectively, and any delay can lead to a number of risks:

1. Progression of Cancer: Postponing treatment allows the cancer to spread to other parts of the abdomen and pelvis and eventually to distant organs. 

2. Worse Prognosis: According to the American Cancer Society, 94% of patients live five years or longer after an early diagnosis of ovarian cancer. Delaying treatment is linked to advanced disease stages at diagnosis, which reduces survival rates. 

3. Increased Complications: As the tumour grows, it can cause more severe symptoms and complications. For example, large tumours might cause bowel or urinary obstructions, which require more complex medical interventions.

Ovarian Cancer Survival Rates

Ovarian cancer is a significant health concern among Indian women, ranking as the third most common cancer. Additionally, it is one of the leading causes of cancer-related deaths among Indian women, contributing to 3.34% of all cancer deaths in the country.

In India, the estimated incidence of ovarian cancer varies widely, from 0.9 to 8.4 per 100,000 women, depending on the region. The risk of developing ovarian cancer increases with age, starting to rise around age 35 and peaking between the ages of 55 and 64.

Early detection is critical for survival. Below are the survival rates:

1. The 5-year survival rate is 94% when ovarian cancer is diagnosed at Stage I. 

2. However, only 15% of cases are caught at this early stage. Unfortunately, the majority (62%) of ovarian cancer cases are identified at more advanced Stages III and IV, where the 5-year survival rate drops to just 28%. This makes late-stage ovarian cancer with the highest fatality rate.

3. More than 70 out of 100 women (more than 70%) will survive their cancer for 5 years or more after being diagnosed with stage 2.

4. More than 30 out of 100 women (more than 30%) will survive their cancer for 5 years or more after they are diagnosed with stage 3.

5. Around 15 out of 100 women (around 15%) will survive their cancer for 5 years or more after they are diagnosed with stage 4.

Maintaining a balanced diet helps support the body during treatment, aid in recovery, and improve overall well-being. Here are some dietary guidelines that might be beneficial for those with ovarian cancer:

Foods to eat

1. Colourful Fruits and Vegetables: These are packed with vitamins, minerals, antioxidants, and fibre that maintain health and support the immune system. Examples include blueberries, mango, broccoli, and cauliflower. 

2. Whole Grains: Brown rice, oats, and quinoa provide necessary fibres, which help maintain a healthy digestive system.

3. Lean Proteins: It helps in healing and recovery. Sources include soy products, legumes, fish, etc. 

Foods to avoid

1. Red and Processed Meat: Beef, pork, and bacon are some sources that can increase inflammation. 

2. Full Fat Milk: Higher intake of whole milk can increase the risk of ovarian cancer.

Ovarian cancer presents vague symptoms that may not be recognised until the disease has progressed to an advanced stage. Effective treatment requires a combination of approaches. Early detection significantly enhances the chances for improved outcomes.

The experts at HexaHealth are committed to providing access to quality healthcare services. We help individuals recognise early signs of ovarian cancer and seek timely medical advice. Our team connects you with specialists who can guide you through diagnosis and treatment.