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What is ovarian cancer?
The term "ovarian cancer" includes several different types of cancer that all arise from
cells of the ovary.
Most commonly, tumors arise from the epithelium, or lining cells, of the ovary.
These include epithelial ovarian (from the cells on the surface of the ovary), fallopian
tube, and primary peritoneal (the lining inside the abdomen that coats many abdominal structures)
cancer.
These are all considered to be one disease process.
There is also an entity called ovarian low malignant potential tumor; these tumors have
some of the microscopic features of a cancer, but tend not to spread like typical cancers.
Signs and symptoms.
Early ovarian cancer causes minimal, nonspecific, or no symptoms.
The patient may feel an abdominal mass.
Most cases are diagnosed in an advanced stage.
Epithelial ovarian cancer presents with a wide variety of vague and nonspecific symptoms,
including the following: Bloating; abdominal distention or discomfort.
Pressure effects on the bladder and rectum.
Constipation.
Vaginal bleeding.
Indigestion and acid reflux.
Shortness of breath.
Tiredness.
Weight loss.
Early satiety.
Symptoms independently associated with the presence of ovarian cancer include pelvic
and abdominal pain, increased abdominal size and bloating, and difficulty eating or feeling
full.
Symptoms associated with later-stage disease include gastrointestinal symptoms such as
nausea and vomiting, constipation, and diarrhea.
Presentation with swelling of a leg due to venous thrombosis is not uncommon.
Paraneoplastic syndromes due to tumor-mediated factors lead to various presentations.
Causes of ovarian cancer.
It's not clear what causes ovarian cancer.
In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells.
Cancer cells quickly multiply, forming a mass (tumor).
They can invade nearby tissues and break off from an initial tumor to spread elsewhere
in the body (metastasize).
Types of ovarian cancer.
The type of cell where the cancer begins determines the type of ovarian cancer you have.
Ovarian cancer types include:
1.
Epithelial tumors, which begin in the thin layer of tissue that covers the outside of
the ovaries.
About 90 percent of ovarian cancers are epithelial tumors.
2.
Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells.
These tumors are usually diagnosed at an earlier stage than other ovarian tumors.
About 7 percent of ovarian tumors are stromal.
3.
Germ cell tumors, which begin in the egg-producing cells.
These rare ovarian cancers tend to occur in younger women.
Management / Treatment.
Standard treatment for women with ovarian cancer involves aggressive debulking surgery
and chemotherapy.
The aim of cytoreductive surgery is to confirm the diagnosis, define the extent of disease,
and resect all visible tumor.
Neoadjuvant chemotherapy is increasingly used.
1.
Surgery.
The type of procedure depends on whether or not disease is visible outside the ovaries.
When no disease is visible outside the ovaries, or no lesion greater than 2 cm is present
outside of the pelvis, the patient requires formal surgical staging, including peritoneal
cytology, multiple peritoneal biopsies, omentectomy, pelvic and para-aortic lymph node sampling,
and biopsies of the diaphragmatic peritoneum.
If visible disease is noted, aggressive surgical debulking, with the intent to remove all visible
disease should be undertaken.
If the surgeon determines that optimal debulking is not possible, then neoadjuvant chemotherapy
should be considered.
For patients with stage IV disease, surgery should be individualized on the basis of presentation.
2.
Chemotherapy.
Postoperative chemotherapy is indicated in all patients with ovarian cancer, except those
who have surgical-pathologic stage I disease with low-risk characteristics.
Standard postoperative chemotherapy for ovarian cancer is combination therapy with a platinum
compound and a taxane (eg, carboplatin and paclitaxel).
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