Signs and symptoms of ovarian cancer:
Ovarian cancer may cause several signs and symptoms. Women are more likely to have symptoms if the disease has spread beyond the ovaries, but even early- stage ovarian cancer can cause them. The most common symptoms include:
a.Bloating
b.Pelvic or abdominal pain
c.Trouble eating or feeling full quickly
d.Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)
These symptoms are also commonly caused by benign (non-cancerous) diseases and by cancers of other organs. When they are caused by ovarian cancer, they tend to be persistent and represent a change from normal− for example, they occur more often or are more severe. If a woman has these symptoms more than 12 times a month, she should see her doctor, preferably a gynecologist.
Others symptoms of ovarian cancer can include:
1. Fatigue
2. Upset stomach
3. Back pain
4. Pain during sex
5. Constipation
6. Menstrual changes
7. Abdominal swelling with weight loss.
However, these symptoms are more likely to be caused by other conditions, and most of them occur just about as often in women who don’t have ovarian cancer.
Treatments for Ovarian Cancer:
a. Surgery for ovarian cancer
Surgery is the main treatment for most ovarian cancers. How much surgery you have depends on how far your cancer has spread and on your general health. For women of childbearing age who have certain kinds of tumors and whose cancer is in the earliest stage, it may be possible to treat the disease without removing both ovaries and the uterus.
For epithelial ovarian cancer, surgery has 2 main goals:ovarian-cancer-staging and debulking (this is discussed in detail further on). It’s important that this surgery is done by someone who’s experienced in ovarian cancer surgery.
Experts recommend that patients see a gynecologic oncologist for surgery. Gynecologic oncologists are specialists who have training and experience in treating, staging, and debulking ovarian cancer. If your cancer isn’t properly staged and debulked, you may need to have more surgery later. It has been shown that gynecologic oncologists are more likely than general surgeons and gynecologists to stage and debulk ovarian cancer optimally (see below).
For other types of ovarian cancer (germ cell tumors and stromal tumors), the main goal of surgery is to remove the cancer.
Staging epithelial ovarian cancer
Surgery for ovarian cancer has 2 main goals. The first goal is to the cancer − to see how far the cancer has spread from the ovary. Usually this means removing the uterus (this operation is called a hysterectomy), along with both ovaries and fallopian tubes (this is called a bilateral salpingo-oophorectomy or BSO). In addition, the omentum is also removed (an omentectomy). The omentum is a layer of fatty tissue that covers the abdominal contents like an apron, and ovarian cancer sometimes spreads to this tissue. Some lymph nodes in the pelvis and abdomen are biopsied (taken out to see if the cancer has spread from the ovary).
If there is fluid in the pelvis or abdominal cavity, it will also be removed for analysis. The surgeon may “wash” the abdominal cavity with salt water (saline) and send that fluid for analysis. He or she may also remove tissue samples from different areas inside the abdomen and pelvis. All the tissue and fluid samples taken during the operation are sent to a lab to be examined for cancer cells. ovarian-cancer-staging is very important because ovarian cancers at different stages are treated differently. If the staging isn’t done correctly, the doctor may not be able to decide on the best treatment.
Debulking epithelial ovarian cancer
The other important goal of surgery is to remove as much of the tumor as possible − this is called debulking.Debulking is very important in any patient with ovarian cancer that has already spread widely throughout the abdomen at the time of surgery. The aim of debulking surgery is to leave behind no tumors larger than 1 cm. This is calledoptimally debulked. Patients whose tumors have been optimally debulked, have a better outlook than those left with larger tumors after surgery (called sub-optimally debulked).
Sometimes the surgeon will need to remove a piece of colon to debulk the cancer properly. In some cases, a piece of colon is removed and then the 2 ends that remain are sewn back together. In other cases, though, the ends can’t be sewn back together right away. Instead, the top end of the colon is attached to an opening (stoma) in the skin of the abdomen to allow body wastes to get out. This is known as a colostomy. Most often, this is only temporary, and the ends of the colon can be reattached later in another operation.
Debulking surgery might also mean removing a piece of the bladder. If this occurs, a catheter (to empty the bladder) will be placed during surgery. This will be left in place until the bladder recovers enough to be able to empty on its own. Then, the catheter can be removed.
Debulking may also require removing the spleen and/or the gallbladder, as well as part of the stomach, liver, and/or pancreas.
If both ovaries and/or the uterus are removed, you will not be able to become pregnant. It also means that you will go into menopause if you haven’t done so already. Most women will stay in the hospital for 3 to 7 days after the operation and can resume their usual activities within 4 to 6 weeks.
Surgery for ovarian germ cell tumors and ovarian stromal tumors
Most ovarian germ cell tumors are treated with a hysterectomy and bilateral salpingo-oophorectomy. If the cancer is in only one ovary and the patient still wants to be able to have children, only the ovary containing the cancer and the fallopian tube on the same side are removed (leaving behind the other ovary and fallopian tube and the uterus).
Ovarian stromal tumors are often confined to just one ovary, so surgery may just remove that ovary. If the cancer has spread, more tissue may need to be removed. This could mean a hysterectomy and bilateral salpingo-oophorectomy and even debulking surgery.
b. Chemotherapy for ovarian cancer
Chemotherapy (chemo) is the use of drugs to treat cancer. Most often, chemo is a systemic treatment − the drugs are given in a way that lets them enter the bloodstream and reach all areas of the body. Systemic chemo can be useful for cancers that have metastasized (spread). Most of the time, systemic chemo uses drugs that are injected into a vein (IV) or given by mouth. For some cases of ovarian cancer, chemotherapy may also be injected through a catheter (thin tube) directly into the abdominal cavity. This is called intraperitoneal (IP) chemotherapy. Drugs given this way are also absorbed into the bloodstream, so IP chemotherapy is also a type of systemic chemo. This is discussed in more detail later in this section.
c. Targeted therapy for ovarian cancer
Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to identify and attack cancer cells while doing little damage to normal cells. These therapies attack the cancer cells’ inner workings − the programming that makes them different from normal, healthy cells. Each type of targeted therapy works differently, but all alter the way a cancer cell grows, divides, repairs itself, or interacts with other cells.
Bevacizumab
Bevacizumab (Avastin®) belongs to a class of drugs known as angiogenesis inhibitors. In order for cancers to grow and spread, they need new blood vessels to form to nourish the tumors (called angiogenesis). This drug binds to a substance called VEGF that signals new blood vessels to form. This can slow or stop the growth of cancers.
In studies, bevacizumab has been shown to shrink or slow the growth of advanced epithelial ovarian cancers. Trials to see if bevacizumab works even better when given along with chemotherapy have shown good results in terms of shrinking (or stopping the growth of) tumors. But it doesn’t seem to help women live longer.
This drug is given as an infusion into the vein (IV) every 2 to 3 weeks.
Common side effects include high blood pressure, tiredness, bleeding, low white blood cell counts, headaches, mouth sores, loss of appetite, and diarrhea. Rare but possibly serious side effects include blood clots, severe bleeding, slow wound healing, holes forming in the colon (called perforations), and the formation of abnormal connections between the bowel and the skin or bladder (fistulas). If a perforation or fistula occurs it can lead to severe infection and may require surgery to correct.
d. Hormone therapy for ovarian cancer
Hormone therapy is the use of hormones or hormone-blocking drugs to fight cancer. This type of systemic therapy is rarely used to treat epithelial ovarian cancer, but is more often used to treat ovarian stromal tumors.
Luteinizing-hormone-releasing hormone (LHRH) agonists
LHRH agonists (sometimes called GnRH agonists) switch off estrogen production by the ovaries. These drugs are used to lower estrogen levels in women who are premenopausal. Examples of LHRH agonists include goserelin (Zoladex®) and leuprolide (Lupron®). These drugs are injected every 1 to 3 months. Side effects can include any of the symptoms of menopause, such as hot flashes and vaginal dryness. If they are taken for a long time (years), these drugs can weaken bones (sometimes leading to osteoporosis).
Tamoxifen
Tamoxifen is a drug that is often used to treat breast cancer. It can also be used to treat ovarian stromal tumors and is rarely used to treat advanced epithelial ovarian cancer. Tamoxifen acts as an anti-estrogen in many tissues in the body, but as a weak estrogen in others. The goal of tamoxifen therapy is to keep any estrogens circulating in the woman’s body from stimulating cancer cell growth. The anti-estrogen activity of this drug can lead to hot flashes and vaginal dryness. Because tamoxifen acts like a weak estrogen in some areas of the body, it does not cause bone loss but can increase the risk of serious blood clots in the legs.
Aromatase inhibitors
Aromatase inhibitors are drugs that block an enzyme (called aromatase) that turns other hormones into estrogen in post-menopausal women. They don’t stop the ovaries from making estrogen, so they are only helpful in lowering estrogen levels in women after menopause. These drugs are mainly used to treat breast cancer, but can also be used to treat some ovarian stromal tumors that have come back after treatment. They include letrozole (Femara®), anastrozole (Arimidex®), and exemestane (Aromasin®). These drugs are taken as pills once a day.
Common side effects of aromatase inhibitors include hot flashes, joint and muscle pain, and bone thinning. The bone thinning can lead to osteoporosis and bone that break easily.
e. Radiation therapy for ovarian cancer
Radiation therapy uses high energy x-rays or particles to kill cancer cells. These x-rays may be given in a procedure that is much like having a regular (diagnostic) x-ray. In the past radiation was used more often for ovarian cancer, at this time radiation therapy is only rarely used in this country as the main treatment for this cancer. It can be useful in treating areas of cancer spread.
External beam radiation therapy
In this procedure, radiation from a machine outside the body is focused on the cancer. This is the main type of radiation therapy used to treat ovarian cancer. Treatments are given 5 days a week for several weeks. Each treatment lasts only a few minutes and is similar to having a regular x-ray. As with a regular x-ray, the radiation passes through the skin and other tissues before it reaches the tumor. The actual time you are exposed to the radiation is very short, and most of the visit is spent getting precisely positioned so that the radiation is aimed accurately at the cancer.
Some common side effects include:
- Skin changes – the skin in the treated area may look and feel sunburned or even blister and peel
- Fatigue (tiredness)
- Nausea and vomiting
- Diarrhea
- Vaginal irritation, sometimes with a discharge (if the pelvis is being treated)
These side effects improve after treatment is stopped. Skin changes gradually fade, and the skin returns to normal in 6 to 12 months.
If you are having side effects from radiation, discuss them with your cancer care team. There may be things you can do to obtain relief.
Brachy therapy
Radiation therapy also may be given as an implant of radioactive materials, called brachy therapy, placed near the cancer. This is rarely done for ovarian cancer.
Radioactive phosphorus
Radioactive phosphorus was used in the past, but is no longer part of the standard treatment for ovarian cancer. For this treatment, a solution of radioactive phosphorus is instilled into the abdomen. The solution gets into cancer cells lining the surface of the abdomen and kills them. It has few immediate side effects but can cause scarring of the intestine and lead to digestive problems, including bowel blockage.
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