Ovarian Cancer, A Simple Guide To The Condition, Diagnosis, Treatment

Ovarian cancer is a malignant disease arising from the cells of the ovary.
It is the leading cause of death from gynecological cancer.
Epithelial cell tumors start from the cells on the surface of the ovaries.
These are the most common type of ovarian tumors.
Germ cell tumors start in the cells that produce the eggs.
They can either be benign or cancerous.
Causes:
a. Reproductive factors
The risk of epithelial ovarian cancer is increased in women who have not had children and possibly those with early menarche or late menopause.
Women who have been pregnant have a 50% decreased risk for developing ovarian cancer compared with nulliparous women.
Multiple pregnancies offer an increasingly protective effect.
Oral contraceptive use decreases the risk of ovarian cancer.
b. Genetic factors
Family history has an important role in the risk of developing ovarian cancer.
At least 2 syndromes of hereditary ovarian cancer are clearly identified, involving either
1. Disorders of the genes associated with breast cancer, BRCA1 and BRCA2, or
2. Genes within the Lynch II syndrome complex more rarely
Inheritance follows an autosomal dominant transmission.
Previous hormone therapy
Current users of hormones had incidence rate ratios for all ovarian cancers of 1.38 (95% confidence interval CI, 11.26-1.51) compared with women who never took hormone therapy.
Risk factors are
a. Increasing age.
b. Lifestyle.
Factors which increase the lifestyle risk include:
i. Smoking.
ii. Obesity.
There is evidence of increased risk in postmenopausal women who are overweight.
Presence of advanced ovarian cancer is often suspected on abdominal mass but can be confirmed only pathologically by removal of the ovaries or when disease is advanced, by sampling tissue or ascitic fluid.
Standard treatment is surgery (staging and optimal debulking) followed by adjuvant chemotherapy in most cases.
Even if optimal surgery is not possible, removing as much tumor as possible will provide significant palliation of symptoms.
Borderline lesions may be treated with conservative surgery.
In early disease, assessment of peritoneal cytology, hysterectomy, removal of ovaries and Fallopian tubes and infracolic omentectomy should be performed.
Management of early ovarian cancer in young women who desire future childbearing may be more conservative, i.e. a unilateral salpingo-oophorectomy and staging but the long-term safety is uncertain.
Treatment choice will depend on type of tumor and stage, and in partnership with the patient, who will need to be fully informed about prognosis.
Adjuvant platinum-based chemotherapy improves survival in early (Stage I/IIa) epithelial ovarian cancers
Chemotherapy is advised for all women with Stage II-IV disease following surgery.
New targeted treatments include:
Bavacizumab. This is a monoclonal antibody against vascular epithelial growth factor (VEGF).
This helps to prevent angiogenesis (the formation of new blood vessels), which is an important part of cancer growth.
Poly (ADP-ribose) polymerase (PARP) Inhibitors – e.g., olaparib.

TABLE OF CONTENT
Introduction
Chapter 1 Ovarian Cancer
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis and Prevention
Chapter 7 Summary
Epilogue