Introduction
Ovarian cancer is one of the most common types of cancer among women. It is considered to be one of the most common types of cancer of the female reproductive system. According to McGuire and Markman (2003), “despite advances in treatment over the last 40 years, ovarian cancer is the second most commonly diagnosed gynaecological malignancy, and causes more deaths than any other cancer of the reproductive system” (p. 4). Despite the fact that ovarian cancer occurs less frequently than uterine cancer, it is more aggressive and can occur at any age.
In addition, it does not manifest itself in the first stages, and in most cases are diagnosed only in the later ones. All the malignant ovarian tumors are subdivided into epithelial, germ or stromal cell types (cancer). These cancers have the highest incidence among all other tumors. (Jordan, S., Green, A., & Webb, P. 2006 p.109-116).
Signs and symptoms of ovarian cancer
“Ovarian cancer has often been called the “silent killer” because symptoms are not thought to develop until advanced stages when chance of cure is poor” (Goff, Mandel, Melancon, & Muntz, 2004, p.
2705). That is why the symptoms of ovarian cancer are not specific and can be disguised as other more common diseases, such as diseases of the digestive system or urinary system. The reason for the lack of clearly defined symptoms is that ovarian cancer develops in the abdominal cavity and does not cause discomfort for the patient. The main sign of the presence of most disease is a constant presence of symptoms or their worsening.
For example, ovarian cancer symptoms are distinguished by their immutability of the manifestations: they progress gradually. (Goff, B. A., Mandel, L. S., Melancon, C. H., Muntz, H. G., 2004 p. 2705-2712). The main symptoms of ovarian cancer may include the following:
1. Feeling of overeating, swelling or bloating;
2. Urgent need to urinate;
3. Pain or discomfort in the pelvic area.
4. Constant indigestion or nausea;
5. Sudden, unexplained changes of stools, which include diarrhea or constipation;
6. Frequent urination;
7. Appetite loss;
8. Rapid weight loss or rapid weight gain;
9. Increased waist circumference, which can be seen by the fact that the clothing suddenly became small; 10. Pain during intercourse;
11. Permanent weakness;
12. Pain in the lumbar area, abdominal pain. The growing tumor extends through the fallopian tubes, causing the lower abdominal pain on the affected side. The large tumors can compress the large intestine that is manifested in bloating or constipation. (Goff, B. A., Mandel, L. S., Melancon, C. H., Muntz, H. G., 2004, p. 2705-2712). In addition, ovarian cancer is characterized by metastases at the “gate” of the liver that leads to the development of ascites – an accumulation of fluid in the abdominal cavity due to the compression of the hepatic portal vein. (Goff, B. A., Mandel, L. S., Melancon, C. H., Muntz, H. G., 2004, p. 2705-2712). The later stages (3 and 4) of ovarian cancer are characterized by more severe symptoms, such as intoxication and anemia. The doctors usually can diagnose ovarian cancer for three months after the first symptoms. However, sometimes it is necessary to wait for six months or even more in order to put the final diagnosis. (Goff, B. A., Mandel, L. S., Melancon, C. H., Muntz, H. G., 2004, p. 2705-2712).
Causes of ovarian cancer
Currently, the etiological factors of malignant ovarian tumors are not significantly determined. However, some researches have advanced several hypotheses about the etiology of epithelial ovarian tumors (Modugno et al., 2003, p. 439- 446). The first one being that ovarian cancer usually occurs when a tumor develops in one or both of a woman’s ovaries. (Modugno et al., 2003, p. 439- 446). Another hypothesis is based on the concept of “incessant ovulation” (early menarche, late menopause, a small number of pregnancies, the shortening of lactation).
Remember, the constant ovulations cause serious damage to epithelial inclusions in the ovarian cortex. The following hypothesis shows that ovarian cancer, most often, is caused by the glandular epithelial cells, which produce hormones. Therefore, a violation of hormonal regulation leads to the changes of malignant epithelial cells. Ovarian cancer often develops in the presence of chronic inflammation, benign tumors or ovarian cysts. (Jordan, S., Green, A., & Webb, P., 2006, p. 109-116).
Risk factors
It is difficult enough to determine the risk factors for ovarian cancer. However, it is believed that the healthy women, who have relatives diagnosed with breast cancer, ovarian cancer or uterine cancer, are at risk of those diseases. Supporting this point of view, Cannistra (2004) states that “a strong family history of ovarian or breast cancer is the most important risk factor” for women. Too often ovarian cancer develops after menopause. However, the risk is increased only after 60 years. In turn, Cannistra (2004) supports this information and adds that “the median age of patients with ovarian cancer is 60 years, and the average lifetime risk for women is about 1 in 70”. (p. 2519-2522)
Despite the fact that most ovarian cancers are diagnosed in postmenopausal women, the disease can also occur in women who are in the premenopausal period. Women, who have been pregnant at least once, are less likely to have ovarian cancer. The use of birth control pills also reduces this probability. (Kuper, H., Cramer, D. W., & Titus-Ernstoff, L., 2002., p. 455-463). The appearance of cysts is a normal process that occurs during ovulation in women who are premenopausal. However, cysts formed in the postmenopausal period have a great chance to cause cancer. Women are at increased risk if they are having trouble conceiving. Environment factors also affect the incidence of ovarian cancer. (Kuper, H., Cramer, D. W., & Titus-Ernstoff, L., 2002., p. 455-463).
Ovarian cancer can be primary, secondary and metastatic. The malignant tumors, which primarily affect the ovary, are known as primary cancer. Secondary ovarian cancer (cystadenocarcinoma) occurs due to the benign or borderline tumors. Metastatic ovarian cancer (Krukenberg tumor) is a spreading of the primary tumor, which is often located in the gastro-intestinal tract, stomach, breast, thyroid or uterus. (Rossing, M. A., Tang, M. C., Flagg, E. W., Weiss, L. K., Wicklund, K. G., & Weiss, N. S.,2006, p. 713-720).
Ovarian cancer staging
It is possible to trace the following ovarian cancer stages, such as:
Stage 1 — limited to one or both ovaries;
• 1A) cone ovary is affected, no ascites;
• 1B) both ovaries are affected, no ascites;
• 1C) appearance of the tumor on the surface of the ovary (s), ascites.
Stage 2 — disease spreads in the small pelvis;
• 2A) affection of the uterus or fallopian tubes;
• 2B) affection of other tissues of the small pelvis;
• 2C) tumor on the surface of the ovary (s), ascites.
Stage 3 — affection of the peritoneum, metastases in the liver and other organs within the abdomen, affection of groin lymph nodes;
• 3A) — microscopic peritoneal metastasis beyond the pelvis;
• 3B) — metastasis less than 2 cm in size;
• 3C) — metastases more than 2 cm in diameter, involving retroperitoneal and inguinal lymph nodes. Stage 4 — distant metastases. (Rossing, M. A., Tang, M. C., Flagg, E. W., Weiss, L. K., Wicklund, K. G., & Weiss, N. S., 2006., p. 713-720). Thus, these are the basic ovarian cancer stages, which help to find out how widespread ovarian cancer is. Classification of ovarian tumors
1) Surface epithelial-stromal tumors – the largest group of benign epithelial ovarian tumors are cystadenoma. 2) Sex cord-stromal tumors with a minimum number of elements have the structure of sex cord-tech fibroids and may contain small nests or tubules of sex cord-type cells. 3) Germ cell tumors are teratomas, which in most cases are benign. . (Rossing, M. A., Tang, M. C., Flagg, E. W., Weiss, L. K., Wicklund, K. G., & Weiss, N. S., 2006., p. 713-720). Ovarian cancer treatment
Ovarian cancer can be suspected by a gynecologist during a standard pelvic examination. However, “much of the problem is that ovarian cancer is often detected too late. Not everyone has symptoms, and the classic ones—bloating, pelvic pain, difficulty eating and urinary frequency, are easily confused with other maladies” (Johannes, 2010, para. 6). That is why the doctor should regularly check the pelvis and conduct the palpation of the uterus, vagina, tubes, ovaries, bladder, and rectum. In addition, it is essential to use a pelvic organ ultrasound, magnetic resonance imaging (MRI), radionuclide studies (scintigraphy), intestinal endoscopy, as well as a laparoscopic examination of the pelvis with a biopsy. (Zhang, M., Xie, X., Lee, A. H., & Binns, C. W., 2004, p. 83-89). Remember that ovarian cancer does not have any obvious symptoms in the early stages. Therefore, the annual gynecological examination and ultrasonography of the groin area are very important. Main treatment usually involves surgery, chemotherapy, and sometimes radiotherapy.
Depending on the extent of tumor spread, surgery can be performed in various capacities. The obtained material must be sent for further examination. If the tumor significantly extends, the doctor should conduct the courses of chemotherapy, and then perform surgery. Mainly, surgery is performed in a radical way: the uterus with the tubes, pelvic tissue with lymph nodes, and omentum in the form of an apron are removed completely. Gland contains lymph nodes, which are often affected by metastases. Ovarian cancer has the ability to affect a healthy ovary through the cross metastases. (Rossing, M. A., Tang, M. C., Flagg, E. W., Weiss, L. K., Wicklund, K. G., & Weiss, N. S., 2006., p. 713-720). Therefore, it is very important to remove both ovaries in order to preserve the life of the patient. Taking into consideration the aggressive nature of the disease, chemotherapy is considered to be a required component of ovarian cancer treatment.
The standard chemotherapy protocol consists of two major drugs, such as Carboplatin and Taxol. (Kiani, F., Knutsen, S., Singh, P., Ursin, G., & Fraser, G., 2006, p. 137-146). Medication duration, dosage and additional drugs are determined individually: in accordance with the type of tumor, the degree of spreading and other indicators. It is possible to conduct the additional courses of chemotherapy after surgery. Ovarian cancer treatment has its specific nature. It is connected with the fact that the tumor in the ovary cannot be seen. Therefore, in cases when the doctor does not operate the patient, the only way to be sure that the tumor is gone completely is use a high-dose chemotherapy. The main features of chemotherapy for ovarian cancer
Chemotherapy is performed in almost all the stages of the disease.
Sometimes it is used to fight against the tumor, sometimes to contain the tumor and prevent it’s spreading, sometimes in order to delay the total defeat of the body. In any case, chemotherapy for ovarian cancer is proved as an effective fighting method. Chemotherapy does serious damage to the body, but its main advantage is that the drugs work in the body, and thus blocks the development of the last stage of cancer, as well as the spreading to adjacent organs. Chemotherapy for ovarian cancer has a greater chance of success than radiotherapy, because it comes to the heart of the problem.
The most important thing is that chemotherapy can get rid of cancer cells, which have already started to progress, but have not yet appeared in the specific symptoms. In other words, it can nip with the problem in the bud. Thus, if the use of chemotherapy for ovarian cancer is offered, do not refuse to do it. This is one of the few chances that could save your life, and give a reason to hope for the restoration of a normal life and future. In some cases, in addition to chemotherapy, the doctor can prescribe radiotherapy in order to kill the cancer cells. However, it is not commonly used and does not play an important role in the treatment of ovarian cancer. How to prevent the development of ovarian cancer?
Every woman should know her vulnerabilities – “loopholes” through which cancer can penetrate into the body. Loophole 1: Late arrival to the gynecologist
The annual preventive gynecological examination is required for all the women. Women, who have ovarian cancer, address to the doctor too late. This is due to the irregular visits to the gynecologist, because of this the initial stages of the disease go unnoticed. At first, cancer progresses usually without any of the characteristic symptoms. Subsequently, women can suffer from uterine bleeding, that doesn’t usually coincide with the period of menstruation and often ignore the abnormality. (Grilli, R., Apolone, G., Marsoni, S., Nicolucci, A., Zola, P., & Liberati, A., 1991, p.50-63). Women need to understand that the existence of such a symptom is a serious cause for concern, because any vaginal bleeding aside from the normal monthly menstruation may indicate a malfunction in the body. Another characteristic which women often ignore is lower abdominal pain. These pains can be short or long, weak, or strong.
However, it is not desirable to immediately take analgesics to numb the unpleasant feelings. In such a case, it will be more reasonable to see a gynecologist. In addition, it is important to conduct an ultrasound of the uterus and ovaries. Usually a pelvic examination and ultrasound can detect ovarian cancer at the early stages. (Titus-Ernstoff, L., Rees, J. R., Terry, K. L., & Cramer, D. W., 2010, p. 201-207). The growth of ovarian tumors may be accompanied by low-grade temperature, shivering, and weakness. If you do not have an infectious disease and severe pain, but constant weakness and nausea, it is essential to consult with a gynecologist. (Titus-Ernstoff, L., Rees, J. R., Terry, K. L., & Cramer, D. W., 2010, p. 201-207).
Loophole 2: Changes in hormonal balance
Many women going through menopause also experience profound changes in the level of sex hormones. “An excess of female hormones can lead to ovarian tumors and other serious gynecological diseases” (Jordan, S. J., Purdie, D. M., Green, A. C., & Webb, P. M., 2004, p.359-365). The patients, who have had surgery on the uterus and ovaries, are also at increased risk. In addition to various infectious complications, they can also have a hormonal disorder. One of the reasons for ovarian cancer is an excess of sex hormone called gonadotropin, which leads to the development of other hormone-dependent tumors. (Jordan, S. J., Purdie, D. M., Green, A. C., & Webb, P. M., 2004, p.359-365).
Therefore, women with hormonal malfunctions should be evaluated by a gynecologist with special attention. Loophole 3: Change of sexual partners and childlessness Sexual promiscuity often leads to frequent abortions. Every abortion is a serious hormonal disruption of the whole female body. The consequences of abortion are infertility, chronic diseases of the uterus and other reproductive organs. Sexual promiscuity can also lead to various infectious diseases of the genital organs. Some of these diseases often increase the risk of ovarian cancer. Nulliparous women suffer from ovarian cancer more often than those who have children. (King, M., Marks, J. H., Mandell, J. B., 2003, p. 643-646).
Loophole 4: Unhealthy lifestyles
It is known that women, who smoke or drink alcohol, are much more susceptible to ovarian cancer. Cigarette smoking and alcohol consumption weaken their health and therefore they have a higher risk of cancer. “In recent years, it is possible to trace the appearance of different cosmetics and dietary supplements. They contain the hormonal stimulants, which are very harmful for the female body” (Kiani, F., Knutsen, S., Singh, P., Ursin, G., & Fraser, G., 2006, p.137-146). It is necessary to carefully use such stimulants. Before taking these pills, it is essential to consult your primary care physician or gynecologist. Women, who have menopause, should eat a balanced diet full of vitamins and other nutrients (Kiani, F., Knutsen, S., Singh, P., Ursin, G., & Fraser, G., 2006, p.137-146). Furthermore, personal hygiene is vital to good health. Remember that any chronic diseases, especially concerning the sexual organs, weaken the immune system and increases the risk of tumor development.
However, if diagnosed as having ovarian cancer don’t give up. Remember that timely access to a physician is the key to success. Tumors can be detected by the usual examination and then refined with the help of the ultrasound and analysis. If the disease is detected in an early stage, treatment will be more effective. In such a case, the doctor has the ability to combine surgical and medical treatment, without affecting the uterus and ovaries. Such patients can even get pregnant and give birth to a healthy baby. The later stages of ovarian cancer are characterized by more severe symptoms and can even lead to the complete removal of the ovaries, uterus and other organs affected by the tumor. Unfortunately, the survival rate of these patients is very low, and they often have relapse (McGuire, W.P., & Markman, M. (2003).
Conclusion
Taking the above-mentioned information into consideration, it is possible to draw a conclusion that ovarian cancer is often called the “silent killer” because clinically the first manifestations are associated with the spread of the tumor outside the ovary, and sometimes beyond the pelvis. Ovarian cancer can be divided into the following forms, such as primary, secondary, and metastatic. The most common symptoms for ovarian cancer are pain in the abdomen and lower back, accompanied with abdominal distention and ascites. However, these symptoms are typical for a number of benign ovarian tumors. Surgical treatment of ovarian cancer is considered to be the fundamental. The prevention of ovarian cancer is possible through the regular preventive examinations.
References
Cannistra, S.A. (2004). Cancer of the ovary. N. Engl. J. Med., 351 (24), 2519-29. doi: 10.1056/NEJMra041842 Goff, B. A., Mandel, L. S., Melancon, C. H., Muntz, H. G. (2004). Frequency of Symptoms of Ovarian Cancer in Women Presenting to Primary Care Clinics. American Medical Association, 291 (22), 2705-2712. Grilli, R., Apolone, G., Marsoni, S., Nicolucci, A., Zola, P., & Liberati, A. (1991). The Impact of Patient Management Guidelines on the Care of Breast, Colorectal, and Ovarian Cancer Patients in Italy. Medical Care, 29 (1), 50-63. Johannes, L. (2010, March 9). Test to Help Determine If Ovarian Masses Are Cancer. The Wall Street Journal. Retrieved from http://online.wsj.com/article/SB10001424052748704869304575109703066893506.html Jordan, S., Green, A., & Webb, P. (2006). Benign Epithelial Ovarian Tumours: Cancer Precursors or Markers for Ovarian Cancer Risk? Cancer Causes & Control, 17 (5), 623-632. Jordan, S. J., Purdie, D. M., Green, A. C., & Webb, P. M. (2004). Coffee, Tea and Caffeine and Risk of Epithelial Ovarian Cancer. Cancer Causes & Control, 15 (4), 359-365. Jordan, S. J., Siskind, V., Green, A. C., Whiteman, D. C., & Webb, P. M. (2010). Breastfeeding and Risk of Epithelial Ovarian Cancer. Cancer Causes & Control, 21 (1), 109-116. Kiani, F., Knutsen, S., Singh, P., Ursin, G., & Fraser, G. (2006). Dietary Risk Factors for Ovarian Cancer: The Adventist Health Study (United States). Cancer Causes & Control, 17 (2), 137-146. King, M., Marks, J. H., Mandell, J. B. (2003). Breast and Ovarian Cancer Risks Due to Inherited Mutations in BRCA1 and BRCA2. The New York Breast Cancer Study Group Science, New Series, 302 (5645), 643-646. Kuper, H., Cramer, D. W., & Titus-Ernstoff, L. (2002). Risk of Ovarian Cancer in the United States in Relation to Anthropometric Measures: Does the Association Depend on Menopausal Status? Cancer Causes & Control, 13 (5), 455-463. McGuire, W.P., & Markman, M. (2003). Primary ovarian cancer chemotherapy: current standards of care. Br. J. Cancer, 89 (3), 3-8. doi:10.1038/sj.bjc.6601494. Modugno, F., Moslehi, R., Ness, R. B., Nelson, D. B., Bell, S., Kant, J. A., Wheeler, J. E., Fishman, D., Karlan, B., Risch, J., Cramer, D. W., Dube, M., & Narod, S. A. (2003). Reproductive factors and ovarian cancer risk in Jewish BRCA1 and BRCA2 mutation carriers (United States). Cancer Cause and Control, 14, 439-446. Rossing, M. A., Tang, M. C., Flagg, E. W., Weiss, L. K., Wicklund,
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