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Ovarian Cancer

American women have approximately a 1 in 78 chance of developing ovarian cancer in their lifetimes; over the past two decades, the rate of its diagnosis has been gradually dropping.

American women have approximately a 1 in 78 chance of developing ovarian cancer in their lifetimes; over the past two decades, the rate of its diagnosis has been gradually dropping.

Overview

Ovarian cancer is the fifth deadliest cancer in women, and generally develops in women 63 and older. A woman has a 1 in 108 chance of dying of the disease in her lifetime1https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html#written_by.

To look for ovarian cancer, doctors will often measure levels of a protein known as CA-125 in the blood, because women with the disease often have high levels of it2https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html. However, studies have shown the test to have a high false positive rate as well as poor specificity values and sensitivity3https://jcp.bmj.com/content/58/3/308.short.

Symptoms

Early on, ovarian cancer is often asymptomatic. Advanced ovarian cancer could present symptoms including4https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941:

  • Pelvic discomfort
  • Changes in bowel habits
  • Frequent urination
  • Abdominal swelling or bloating
  • Weight loss
  • Feeling full quickly when eating

If you are having any of the above symptoms you need to talk to a doctor about the appropriate diagnostic work up. The Ezra scan is a screening test for asymptomatic individuals and it is not designed to diagnose existing or suspected cancers.

Causes

It is difficult for researchers to pinpoint precisely what causes ovarian cancer, though they do know that ovarian cancer originates in genetic changes, or mutations, found in the DNA of normal ovarian cells. These mutations can cause cells to quickly multiple and form a tumor, or mass, of atypical cells, which will thrive while healthy cells die. If left untreated, a mass can invade surrounding tissue and pieces eventually break off from the original tumor, metastasizing to other body parts.

Some risk factors that may increase one’s likelihood of developing ovarian cancer are5https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941:

  • A family history of the disease
  • Estrogen hormone replacement therapy
  • Older age
  • Beginning menstruation early
  • Starting menopause later
  • Certain inherited gene mutations

A small number of ovarian cancer cases are linked to genetic mutations that are inherited from our parents. The most well-known of these genetic mutations are BRCA1 and BRCA2, also known as the “breast cancer genes,” because they also increase one’s risk of developing breast cancer6https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941.

Detection

The best way to catch ovarian cancer early is to get regular checkups. These generally involve pelvic exams, during which your doctor will feel your ovaries for any abnormalities7https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html.

In addition to the aforementioned unreliable CA-125 blood test8https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html, another major test for ovarian cancer is the transvaginal ultrasound (TVUS). That exam can find an ovarian tumor, but cannot assess whether or not it is cancerous or benign9https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html. Doctors sometimes scan for ovarian cancer using CT scans, which expose you to radiation10https://www.fda.gov/radiation-emitting-products/medical-x-ray-imaging/what-are-radiation-risks-ct and cannot show small tumors11https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/how-diagnosed.html. They can also look for abnormalities on MRIs12https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/how-diagnosed.html, and the results have been promising: a 2017 meta-analysis showed that diffusion-weighted MRI has a high diagnostic ability in the detection of ovarian cancer13https://insights.ovid.com/crossref?an=00005792-201705120-00006. This makes it a safe and reliable screening method for the disease.

Diagnosis

Upon diagnosis, doctors assign ovarian cancer a stage ranging from I to IV based on whether or not it has spread beyond the ovaries. Assigning cancers a stage helps doctors assess how serious each case is, as well as allows them to plan the best treatment approach for each patient. Ovarian cancer is often staged using the TNM system:

  • T is for tumor: has the cancer spread beyond the fallopian tube or ovary? Has it reached nearby organs, like the bladder or uterus?
  • N is for lymph nodes: has the cancer spread to the lymph nodes around the aorta or in the pelvis?
  • M is for metastasis: has the cancer metastasized to fluid around the lungs, or distant organs like the bones or liver?

(Source)

When you are diagnosed, your doctor will also perform tests to analyze what type of ovarian cancer you have. The type of ovarian cancer one has is determined by the type of cell where it originates:

  • Epithelial tumors make up about 90% of all ovarian cancers, and begin in the thin tissue layer surrounding the ovaries.
  • Germ cell tumors originate in egg-producing cells are rare, and are generally found in younger women.
  • Stromal tumors make up about 7% of all ovarian cancers, and are often diagnosed at an earlier stage than other types of ovarian cancers. These tumors originate in ovarian tissue harboring cells that make hormones.

(Source)

Treatment

The best treatment for ovarian cancer depends on the nature of the disease and how far it has spread. Treatment options often include a combination of chemotherapy and surgery, but can also involve targeted therapy14https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/diagnosis-treatment/drc-20375946

Please consult with a physician on treatment options as necessary.

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