Ovarian Cancer: Symptoms, Causes and Treatment

Ovarian cancer symptoms often go unnoticed until the disease reaches an advanced stage. Approximately 80% of ovarian cancer cases are diagnosed only after reaching stage III or IV.

Although relatively uncommon, ovarian cancer often goes undetected because its signs and symptoms can be subtle and easily mistaken for less serious, more common conditions. Early-stage ovarian cancer symptoms typically include bloating, pelvic pain, frequent urination, and feeling full quickly after eating. Understanding these warning signs is crucial for early detection and improved treatment outcomes.

What is Ovarian Cancer?

Ovarian cancer develops when abnormal cells in the ovaries grow and multiply out of control. The ovaries are small, walnut-sized organs that produce eggs during a woman's reproductive years and are a crucial part of the female reproductive system. This malignancy can begin in various parts of the ovary or fallopian tubes, with several distinct types identified based on the cells where the cancer originates.

Symptoms of Ovarian Cancer

The warning signs of ovarian cancer are often subtle and easily confused with other conditions. Most patients experience symptoms only after the disease has progressed beyond the early stages, making detection challenging. Doctors often use the "BEACH" acronym to help women remember the most common symptoms:

• Bloating: Persistent abdominal swelling that doesn't subside
• Early satiety: Feeling full quickly after eating small amounts
• Abdominal pain: Pelvic or belly pain that may feel like cramping or pressure
• Changes: Alterations in bowel or bladder habits
• Heightened fatigue: Extreme tiredness without explanation
• Urinary symptoms: Frequent urination, a strong urge to urinate, urine leaks, or pressure in the bladder area
• Digestive disturbances: Constipation, diarrhoea, and indigestion

Moreover, several less obvious symptoms deserve attention:

• Back pain
• Pain during sexual intercourse
• Unexplained weight loss or gain
• Menstrual changes (irregular bleeding, heavier periods)
• Vaginal bleeding after menopause

Ovarian Cancer Causes and Risk Factors 

The exact cause of most ovarian cancers is still unclear. However, numerous factors can increase a woman's risk of developing this disease. These include:

• Genetic predisposition: Approximately 20-25% of ovarian cancers are linked to hereditary conditions. The most significant genetic risk comes from mutations in BRCA1 and BRCA2 genes, accounting for 65-85% of hereditary ovarian cancers. 
• Late first pregnancy (after 35), nulliparity (never having children), and infertility increase risk.
• Hormone replacement therapy (HRT) slightly increases risk, whereas oral contraceptive use provides protection.
• Lifestyle factors worth noting include obesity, which increases risk, especially for certain ovarian cancer types. 
• Smoking raises the risk of mucinous ovarian cancer specifically.
• Environmental exposures, including asbestos and possibly talcum powder, may increase risk, though evidence for talc remains inconclusive.

Diagnosis

• Blood Tests: The CA-125 blood test measures a protein often elevated in women with ovarian cancer. Unfortunately, this test has limitations - some women with ovarian cancer have normal CA-125 levels, whereas conditions like endometriosis can cause high readings without cancer being present. Because of these limitations, CA-125 testing is not recommended as a standalone screening tool for women at average risk.
• Imaging: Doctors commonly use:
  • CT scans: Help determine if cancer has spread to other organs
  • MRI scans: Particularly valuable for examining the brain and spinal cord where cancer might spread
  • PET scans & CT Scans: Helps to determine the stage of ovarian cancer 
  • Biopsy: A biopsy remains the only definitive way to diagnose ovarian cancer. This typically involves surgically removing tissue samples for laboratory examination. Most commonly, biopsies occur during:
  • Laparotomy: A surgical procedure opening the abdomen to examine organs
  • Laparoscopy: A less invasive option using a thin catheter with a camera inserted through small incisions

Ovarian Cancer Treatment

• Ovarian cancer surgery: Surgical intervention is the cornerstone of ovarian cancer treatment. For most women, this involves removing both ovaries, fallopian tubes, and the uterine cavity (total abdominal hysterectomy with bilateral salpingo-oophorectomy).
• Chemotherapy: Chemotherapy plays a crucial role either before or after surgery. It uses drugs that target fast-growing cells throughout the body. 
• For certain patients, heated chemotherapy may be administered directly into the abdomen during surgery (hyperthermic intraperitoneal chemotherapy or HIPEC).

Beyond these main approaches, several additional treatments exist:

Targeted therapy focuses on specific vulnerabilities in cancer cells. Doctors test tumour samples to determine which targeted drugs might work best for each patient.

When to See a Doctor

Contact your doctor immediately if you notice:

• Persistent bloating or swelling in your abdomen that doesn't go away
• Unusual lumps or pain in your abdominal area
• Pelvic discomfort that recurs or worsens over time
• Feeling full quickly after eating small amounts
• Changes in bathroom habits, including frequent urination
• Unexplained vaginal bleeding, primarily after menopause

Prevention

Birth control pills offer significant protection when used for extended periods. Women who take oral contraceptives containing oestrogen and progesterone for five or more years experience a lower chance of developing ovarian cancer, with protection lasting years after discontinuation. 

Pregnancy and breastfeeding offer natural protection. 

Maintaining a recommended body weight through regular exercise and balanced nutrition helps lower cancer risk overall. 

Reducing alcohol intake and avoiding smoking further enhance these protective measures.
For women at high genetic risk due to BRCA mutations or Lynch syndrome, doctors may recommend risk-reducing surgery after childbearing is complete.

Conclusion

Ovarian cancer is one of the most challenging cancers to detect early, though awareness of its symptoms can significantly improve outcomes. Women should pay close attention to persistent bloating, early satiety, abdominal pain, and changes in bowel habits - remembered through the BEACH acronym.

Regular medical check-ups become essential, particularly for women over 50 or those with a family history of ovarian cancer. Though no guaranteed prevention exists, several strategies help reduce risk. Birth control pills, pregnancy, breastfeeding, and maintaining a healthy lifestyle offer some protection against this disease.

FAQs

1. What are the stages of ovarian cancer?

Ovarian cancer stagings are:

• Stage I means cancer remains confined to one or both ovaries.
• Stage II indicates cancer has spread to nearby pelvic organs like the uterus or fallopian tubes.
• Stage III means cancer has spread outside the pelvis into the nearby structures of the abdominal cavity or abdominal lymph nodes.
• In Stage IV, cancer has reached distant organs such as the lungs or liver.

2. What questions should I ask my doctor?

Consider asking these essential questions when meeting with your doctor:

• "What type and stage of ovarian cancer do I have?"
• "What treatments do you recommend and why?"
• "What side effects should I expect?"
• "What symptoms require immediate medical attention?"
• "How quickly must we begin treatment?"

3. How do you detect ovarian cancer early?

Doctors typically use several approaches:

• Pelvic examination to check for abnormal growths
• Ultrasound (USG abdimin & pelvis) to examine ovaries
• CA-125 blood test to measure protein levels often elevated in ovarian cancer
• Additional imaging tests (CT scan, MRI, PET scan)

4. How to check for ovarian cancer at home?

You cannot definitively check for ovarian cancer at home. Instead, monitor your body for persistent symptoms lasting more than two weeks. 

5. Is ovarian cancer painful?

Ovarian cancer often causes pain, typically described as a constant ache or dull pain in the lower abdomen. 

6. Who is at high risk for ovarian cancer?

Women at the highest risk include those who are:

• Middle-aged or older (most cases diagnosed in women 63+ years)
• Carriers of genetic mutations like BRCA1/2 or Lynch syndrome
• Those with close relatives who had ovarian cancer
• Women of Eastern European or Ashkenazi Jewish background
• Those with previous breast, uterine or colorectal cancer