Ovarian Cancer

Ovarian cancer is a major health concern for women globally. In India, ovarian cancer is the 3rd most prevalent cancer, followed by breast and cervical cancer, and each year, approximately 60,000 new cases are diagnosed. This cancer is responsible for around 35,000 deaths in India annually. Unfortunately, 70% of ovarian cancer cases in our country are diagnosed when the cancer has advanced to stage 3 or 4, which significantly reduces the success rate of the treatment methods.

Considering the health risks and lower survival rate of ovarian cancer, spreading awareness about the disease is critical. Here, you will learn all about ovarian cancer, its symptoms, causes, risk factors, diagnosis, and treatment options in detail.

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What is ovarian cancer?

Ovarian cancer is a type of cancer that originates in the different types of cells present in the ovaries (a female reproductive organ where eggs form). Normally, new cells form to replace the dying cells. However, sometimes, cells divide uncontrollably until they form a lump, known as a tumor. This tumor can be benign (non-cancerous) or malignant (cancerous). While a benign tumor causes health problems, it doesn’t spread to the healthy tissues. Unlike a benign tumor, the cancerous tumor can spread to healthy tissues and become life-threatening.

Though ovarian cancer is a very serious condition, it doesn’t exhibit clear symptoms until later stages. Due to this, it is often called a silent killer. Generally, ovarian cancer develops in women after menopause, but it can also develop in younger women due to certain reasons. As the cancerous tumor grows and spreads to the pelvis and abdomen, it can be fatal. That’s why doctors usually recommend getting tested at regular intervals to detect ovarian cancer at an early stage when the tumor is confined within the ovary, thereby, increasing the chances of successful treatment and survival.

Types of Ovarian Cancer

Ovarian cancer is a very complex disease and has various types with different characteristics, prognosis, and treatment methods. The most common types of ovarian cancer are explained below:

Epithelial Ovarian Cancer

Around 90% of cases of ovarian cancer are epithelial ovarian cancer. It originates from the epithelial cells that cover the ovary. It is further categorized into the following subtypes:

  • Serous Carcinoma
  • Mucinous Carcinoma
  • Endometrioid Carcinoma
  • Clear Cell Carcinoma

All these types of epithelial ovarian cancers progress rapidly and are often diagnosed at advanced stages due to a lack of clear symptoms. The symptoms become apparent when the cancer has spread to the pelvis, abdomen, and other reproductive organs.

Germ Cell Ovarian Cancer

Around 5% of ovarian cancer are germ cell tumors that originate from the ova, the cells that produce eggs in the ovaries. These cancerous tumors occur in young women and girls and have various subtypes, including dysgerminoma, yolk sac tumor (endodermal sinus tumor), teratoma, and choriocarcinoma.

Germ cell ovarian cancer is very difficult to diagnose because its symptoms resemble the normal menstrual cycle and puberty onset. In the early stages, it can also be mistaken for a benign ovarian cyst. The good thing is that in most cases, germ-cell ovarian cancer responds well to chemotherapy, making the prognosis better.

Stromal Ovarian Cancer

Stromal tumor accounts for 1-2% of all ovarian cancers and as the name suggests, it originates from stromal cells, which are responsible for the production of estrogen and progesterone hormones and the connective tissue cells that hold the ovary together. The subtypes of stromal ovarian cancer include granulosa cell tumor and sertoli-leydig cell tumor.

As stromal ovarian cancer causes hormonal imbalance, which makes it comparatively easier to detect in early stages, thereby, improving the prognosis.

Besides these types, there are several rare types of ovarian cancer as well, such as small cell carcinoma, primary peritoneal carcinoma, and ovarian carcinoma which are aggressive forms of cancer.

Who gets ovarian cancer?

Typically, ovarian cancer develops in postmenopausal women, but it can develop in younger women too due to certain factors. The general population who are prone to ovarian cancer includes the following:

  • Women who are over the age of 50 and aren’t actively menstruating.
  • Younger women who have a genetic predisposition for certain types of cancers, such as germ cell tumors.
  • Women who have inherited genetic mutations, i.e., BRCA1 and BRCA2, and other conditions such as Lynch syndrome.
  • Women who’ve never had a full-term pregnancy or taken certain fertility treatments(assisted reproductive technologies).
  • Women who experience early onset of menstruation or have late menopause (after age 50).
  • Women who get hormone replacement therapies for an extended period.
  • Women who have endometriosis or have a history of breast cancer.

Along with these, lifestyle and environmental factors also play a major role in determining who can get ovarian cancer.

Stages of Ovarian Cancer

Ovarian cancer is classified into 4 stages that indicate the extent of growth of the cancerous tumor and how far it has spread. Staging of the cancer is important to determine the most effective treatment plan for the cancer and get an insight into the prognosis. The four stages of ovarian cancer are explained below:

Stage I: Ovarian Cancer in the Ovaries

At this stage, the cancerous tumor is confined within the ovary and the capsule that covers the ovary may or may not be intact. Stage 1 ovarian cancer is further divided into three sub-stages:

  • Stage IA: Cancer cells are present in one ovary only and have not spread to any other organ.
  • Stage IB: Cancer cells are present in both ovaries, but the tumor is still confined within the ovaries and hasn't spread to the other organs.
  • Stage IC: The cancer cells are present in both ovaries and any of the following incidents are applicable:
    • IC1: The ovarian capsule is ruptured during surgical removal.
    • IC2: The capsule has ruptured before the surgery and there is a tumor on the ovarian surface.
    • IC3: Cancer cells are found in the fluid-filled in the abdominal cavity.

Stage II: Ovarian Cancer in the Pelvic Region

At stage 2, ovarian cancer starts to spread from the ovaries to the pelvic organs and is classified into 2 sub-stages:

  • Stage IIA: Cancer has spread to the uterus and/or fallopian tubes.
  • Stage IIB: Cancer has spread beyond the reproductive system, i.e., bladder, sigmoid colon, or rectum.

Stage III: Ovarian Cancer Spread to the Abdomen

At stage III, the cancer has started to spread to the abdominal cavity and/or lymph nodes. This stage is also further classified into the following sub-stages:

  • Stage IIIA: Again classified into 2 sub-stages, IIIA1- where the cancer has spread to the retroperitoneal lymph nodes, and IIIA2- where the cancer has spread to the peritoneum (lining of the abdominal cavity) but is only visible under a microscope.
  • Stage IIIB: Cancer has spread to the peritoneum and the tumor is visible with a diameter of 2 cm or less. Lymph nodes may also be involved at this stage.
  • Stage IIIC: The tumors in the peritoneum are larger than 2 cm in diameter and the cancer has spread to the liver and spleen.

Stage IV: Ovarian Cancer Metastasis

This is the most severe stage of ovarian cancer where the cancer has spread to distant parts of the body. It is divided into the following sub-stages:

  • Stage IVA: Cancer is found in the fluid in the lungs (pleural effusion).
  • Stage IVB: Cancer has spread to the liver, lungs, lymph nodes in the groin region, and inside the spleen.

It can be derived from the stages that the best prognosis for ovarian cancer treatment is at stage I when the cancer is confined to the ovaries. As the cancer progresses and invades the surrounding tissues, it has a negative impact on the treatment’s outcome. And the worst case scenario would be stage IV ovarian cancer where the cancer has invaded several major organs.