Ovarian cancers are the most common gynecological cancer after uterine cancers. The cause of ovarian cancer is unknown.
• Hereditary gene mutations: Approximately 10% of ovarian cancers are caused by a hereditary gene mutation. Genes that are known to increase the risk of ovarian cancer are called breast cancer genes 1 and 2 (BRCA1 and 2). Although these genes are known to cause breast cancer, the risk of ovarian cancer is also significantly increased in women with these genes. Therefore, the risk of ovarian cancer is higher in patients with a family history of breast cancer.
• Family history of ovarian cancer: Women with a family history of ovarian cancer have a higher risk of developing this disease.
• A previous cancer diagnosis: Women who have previously been diagnosed with breast, colon, rectum or uterine cancer have a higher risk of ovarian cancer.
• Advanced age: The risk of ovarian cancer increases with age. Ovarian cancer is most commonly seen after menopause. But it can occur at any age.
• Not pregnant at all: Women who are not pregnant at all have a higher risk of ovarian cancer. However, ovarian cancer is less common in women who have a large number of births.
Symptoms of ovarian cancer are not disease specific. It often mimics the symptoms of many other common diseases, including the digestive system and bladder problems. Therefore, the diagnosis is made in the late and advanced stages.
- Feeling of pressure in the abdomen and bloating
• Fullness or pain in the groin
• Long-term indigestion, gas or nausea
• Changes in intestinal habits
• Changes in the need for frequent urination in bladder habits
• Loss of appetite or a feeling of fastness
• Vaginal bleeding
• Weight loss
Is there a screening and prevention method for ovarian cancer?
There is no method to predict ovarian cancers. Diagnosis is by chance in routine gynecological examinations. Patients are often referred to the doctor late due to the above complaints. Therefore, when ovarian cancer is diagnosed, the disease is usually advanced. Therefore, women are recommended to have a routine gynecological examination and pelvic ultrasound every year. Although there is no significant prevention method, giving birth and using at least one year of contraceptive pills reduce the risk of ovarian cancer.
How is the diagnosis of ovarian cancer diagnosed?
- Gynecological examination: A gynecological and abdominal examination may involve a mass. In addition, accumulated fluid in the abdomen may be detected swelling.
• Radiological examinations (ultrasound, CT, MRI): These methods can be used to detect cysts and masses of various sizes from the ovaries, which differ from the normal anatomical structure, fluid accumulation in the abdominal cavity, and tumoral masses and enlarged lymph nodes in other organs in the abdominal cavity.
• CA 125: CA 125 is a protein found on the surface of ovarian cancer cells and in some healthy tissues. Many women with ovarian cancer have abnormally high CA 125 levels in their blood. However, many diseases other than cancer cause increased CA 125 levels, and many women with early stage ovarian cancer have normal CA 125 levels. Therefore, a CA 125 test is not always used for ovarian cancer diagnosis and screening; however, it can be used to monitor how the treatment is progressing.
• Other tumor markers: HE-4, HCG, alpha-fetoprotein
• Diagnostic laparoscopy or laparotomy: Patients with complicated cysts suspected of having ovarian cancer are operated for tissue diagnosis, and the suspicious mass is fully removed and sent to pathological examination. If the diagnosis is malignant, a wide range of surgery is performed, called staging surgery and performed by gynecological oncologists. The aim is to detect the spread of the tissues and to ensure that there are no tumors left behind.
How is ovarian cancer treated?
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.
Ovarian cancer treatment generally involves both ovaries, fallopian tubes, uterus (hysterectomy and bilateral salpingoophorectomy), as well as surrounding lymph nodes (pelvic and paraaortic lymphadenectomy) and appendectomy. The aim of ovarian cancer surgery is to leave no tumor tissue behind. This means the removal of every tissue and organs (diaphragm, intestine, spleen, some parts of the liver) from which the cancer is spreading (cytoreductive or debulking surgery). Chemotherapy cannot affect large, bulky ovarian tumors. By removing the tumor as much as possible, chemotherapeutic treatment can more effectively penetrate the tumor. Thus, the tumor will respond more to chemotherapy and the patient’s survival will increase. Adequate surgery will prolong the life span of patients.
6 cycles of chemotherapy are usually performed at 3-week intervals. Chemotherapy is the drugs designed to kill the remaining cancer cells. It can be given by intravenous or intra-abdominal cavity.
In the first operation or especially in recurrent disease, if the tumor can be completely cleaned by a second operation, hot chemotherapy is applied to the abdominal cavity without awakening the patient. In this treatment, a higher dose of chemotherapy is administered directly to the target site (42.5 degrees centigrade) for about 1-1.5 hours.
Neoadjuvant Chemotherapy and Interval Debulking:
In some patients diagnosed with ovarian cancer, the disease may be very common and the tumor may not seem to be completely removed in the first operation. Also, the general condition of some patients may not be able to tolerate such a large operation. In these two cases, treatment is started with chemotherapy. After 3-4 cycles of chemotherapy, if the patient’s tumor becomes fully removable and the general condition of the patient is corrected, it is operated.
Is it possible to protect fertility?
If ovarian cancer is detected at a very early stage, or if there are germ cell ovarian cancers especially seen in young women, it can be operated by leaving the other ovaries and uterus. Thus, the ability to have children and the production of hormones is preserved in young women who have not given birth to children. This is called fertility sparing surgery.
Can ovarian cancers be operated with closed method (laparoscopy)?
If the tumor is small in the early stage and limited in the ovaries, laparoscopy or robotic surgery can be performed with the standard procedure in which the uterus, ovaries, omentum, appendix and lymph nodes are removed. Thus, it will be possible for the patient to start chemotherapy in a short time as the recovery time will be very fast compared to the open surgery. However, these methods are not suitable for common, advanced stage cancers.
What are the expectations after a treatment in a patient with ovarian cancer treatment? How is the patient followed?
The majority of those receiving ovarian cancer treatment repeat the cancer within the first 5 years. Although it depends on the stage of the disease, the chance to live within 5 years is usually less than 50%. Therefore, patients are followed for 10 years after the end of the treatment interval of 3-4 months. Women with recurrent disease have a chance for re-treatment with different chemotherapy regimens or surgery.