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Ovarian Cancer


OVERVIEW OF Ovarian Cancer :

The cancer or malignant cells forms in the ovary which is present in uterus.


STRUCTURE of Ovarian Cancer :

The female reproductive system consists of a pair of ovaries on each side. The ovary is connected to the fallopian tube. The ovaries produce the egg which aids in fertilization process. The ovaries are also the main source of oestrogen and progesterone secreation.

Types of ovarian cancer:

Epithelial tumour: The epithelial tumour arises from the cells that covers the outer surface of the ovary.

Germ cell tumour: the germ cell tumour occurs in the cells that produces the egg

 Stromal Tumour:Stromal tumors start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone.

 


EPIDEMIOLOGY :

 Mostly it occurs in women who has crossed 50 years of age.


CAUSES :

  • Obesity
  • Having metabolic syndrome.
  • Having type 2 diabetes.
  • Exposure of endometrial tissue to estrogen made by the body. This may be caused by:
    • Never giving birth.
    • Menstrurating at an early age.
    • Starting menopause at a later age.
  • Having polcystic ovarian syndrome.
  • Hypertension
  • Age greater than 50 years
  • Ovulation dysfunction
  • Having a family of ovarian cancer in a first degree relation(mother, sister, or daughter).
  • Having certain genetic conditions such as Lynch syndrome
  • Having endometrial hyperplasia
  • Talcum powder:
  • It has been suggested that talcum powder might cause cancer in the ovaries if the powder particles (applied to the genital area or on sanitary napkins, diaphragms, or condoms) were to travel through the vagina, uterus, and fallopian tubes to the ovary.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Vaginal bleeding or discharge not related to menstruation (periods).
  • Difficult or painful urination
  • Pain during sexual intercourse.
  • Pain in the pelvic area.
  • Bloating in abdomen
  • Loss of appetite
  • Constipation

 

 


DIAGNOSTIC :

The physician might look for your history to come into the conclusions. It might includes the type of cancer suspected, signs and symptom of the individual, age and general health of the individual, results of previous medical tests.

Pelvic examination:

     The physician palpate the uterus, vagina, ovaries and rectum to check for any possible findings.

Barium swallow or modified barium swallow:

 It is used to check the barium swallowing. During an x-ray exam, the patient is asked to swallow liquid barium and the ovarian cancer spread to the small intestine or colon is investigated.

Computed tomography (CT or CAT) scan:

  • A  CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

Magnetic resonance imaging:

  • It uses a specific xray to see the uterus images. It is mainly used to treat the early stages of cancer.

Molecular testing of the tumor:

 Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor.

Genetic testing:

               This test is done to look for BRCA1 and BRCA2 gene mutations. It helps to detect the familial inherited ovarian cancer.

The following is the stage of the endometrial cancer:

  • Stage 1: The cancer is only present in the ovarian.
  • Stage 2: The cancer is present in the ovarian and other tissues.
  • Stage 3: The cancer has spread outside the uterus, but not as far as the rectum or bladder. It might be present in fallopian tube, vagina, ovaries and lymph node.
  • Stage 4: The cancer has spread beyond the pelvic area. It might be present in the bladder, rectum, and/or distant tissues or organs.

 


TREATMENT AND PROGNOSIS :

Treatment of Ovarian cancer:

Hysterectomy and Bilateral salphingo oophorectomy:

It is the procedure wherein surgeon removes the uterus,cervic and vagina.

Bilateral salphingo oophorectomy is the procedure wherein the surgeon removes the fallopian tube along with the ovary. This procedure can be done involving one ovary or both the ovaries.

Omentectomy:

The omentum is the fatty tissue that covers the stomach and the small intestine. The ovarian cancer might spread to the omentum. Hence omentum is removed along with ovary.

Lymphadenectomy:

There are multiple lymph nodes present around the ovaries. Hence the ovarian cancer can easily spread to the nearby lymph nodes. Hence the doctor prefers the removal of the surrounding lymph nodes.

Chemotherapy:

A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously

It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.

Internal radiotherapy: the rays are focused inside the uterus , fallopian tube and ovaries.

External radiation: the rays are focused externally.

Immunotherapy

it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.

Hormonal therapy:

This therapy uses hormones to slow down the cancer process.

Ovarian cortex preservation:

Ovarian cortex cryopreservation is the process of freezing ovarian tissue before cancer treatment begins so women may be able to have children later.


PROGNOSIS :

The 20 year survival rate f the patient with endometrial cancer is 46%. When it is localized the survival rate is 90%.

 


PREVENTION :

To reduce your risk of endometrial cancer, you may wish to:

  • Talk to your doctor about the risks of hormone therapy after menopause. If you're considering hormone replacement therapy to help control menopause symptoms, talk to your doctor about the risks and benefits. Unless you've undergone a hysterectomy, replacing estrogen alone after menopause may increase your risk of endometrial cancer. Taking a combination of estrogen and progestin can reduce this risk. Hormone therapy carries other risks, so weigh the benefits and risks with your doctor.
  • Consider taking birth control pills. Using oral contraceptives for at least one year may reduce endometrial cancer risk. The risk reduction is thought to last for several years after you stop taking oral contraceptives. Oral contraceptives have side effects, though, so discuss the benefits and risks with your doctor.
  • Maintain a healthy weight. Obesity increases the risk of endometrial cancer, so work to achieve and maintain a healthy weight. If you need to lose weight, increase your physical activity and reduce the number of calories you eat each day.
  • Maintain the healthy lifestyle.

 

 


Medicines used in the Treatment :

Drugs used:

Bevazizumab

Olaparib

Rivaparib

Adavosertib

Rucaparin(newly approved drud)