Ovarian cancer is a malignant tumor affecting the ovaries. It may be of the primary character, when the main center is located in the ovarian tissues. It may also be of secondary character with the center in any part of the body. Carcinoma (70 percent of all malignant tumors), germ cell and stromal tumors of the genital tract as well as other less frequent variations are the primary group. Metastatic tumors of the ovaries appear frequently enough: when the tumors of endometrium are observed, tumors of the breast, colon, stomach and cervical cancer.
Prevalence & Survival rate
Ovarian cancer is the fifth according to frequency of deaths caused by cancer in women, the leading cause of deaths caused by malignant gynecologic tumors and the second according to frequency of tumors in gynecology. Every year at least 225 thousand cases of ovarian cancer are registered and about 140 thousand end up lethally. In 75 percent of cases, the ovarian cancer is diagnosed on late stages. Even the modern diagnostics appears to be not successful enough. Five-year survival during the third stage is about 24 percent and 4.6 percent during the fourth stage.
As in the cases with other cancer tumors, the causes are not completely studied. However, it is believed that ovarian cancer affects mainly nulliparous women (those, who had never given birth). Also there is an opinion that the ovarian cancer may be prevented by taking oral contraceptives. Without a doubt, the ovarian cancer (as well as other types of cancer) may be inherited from one of the parents. Also the risk for women with breast cancer is twice higher. According to other opinion the pathology may be caused by consumption of food rich in animal fats. The gonadotropic hyperstimulation, uterine fibroids, chronic encysted inflammatory processes , early and late menopause, uterus bleeding during post menopause-are should also be attributed to risk factors.
Stages of the disease
- IA – one of the ovaries is affected, no ascites;
- IB –both ovaries are affected, no ascites;
- IC – the appearance of a tumor on the surface of the ovary (s), ascites;
- II – the disease is spread to the smaller pelvis;
- IIA – the uterus or the fallopian tubes are damaged;
- IIB –other pelvic tissues are damaged;
- IIC – tumor on the surface of the ovary (s), ascites.
- III – applies to the peritoneum, there are metastases in the liver and other organs within the abdominal cavity, the inguinal lymph nodes are damaged.
- IIIA – spreading to the pelvis, dissermination of the peritoneum is observed.
- IIIB – metastases above to 2 cm in diameter may be observed.
- IIIC – Metastasis larger than 2 cm in diameter with the involvement of retroperitoneal and inguinal nodes appear.
- IV – distant metastases take place.
Mainly ovarian cancer proceeds without any symptoms during the first stage. Besides that first symptoms (increased stomach) are very often considered adnexitis ( inflammation of the ovaries) Tumor is gradually spread over the abdominal cavity affecting the omentum and causing the fluid accumulation (ascites). Also to one of the first symptoms should be carried nagging pain in the lower abdomen. The pain is usually similar to pain that occurs in cases of ovarian inflammation.
The ways of diagnosing the ovarian cancer
The ovarian cancer may be suspected during the examination of the stomach at gynecology. If the cancer is suspected the biopsy of the abdominal cavity is performed and the fluid is analyzed for the presence of the tumor cells. The biopsy in developed European countries is not recommended as it may lead to sieving of the tumor. That is why the final diagnosis may be made only during surgery and according to result of the analyses of the samples taken during the post surgical period. For cancer diagnosis and valuation of the metastatic damage the ultra sound diagnostics of the abdominal cavity and smaller pelvis are performed. In accompany to that the computer tomography of the chest as well as CT scan or the MRI of the abdominal cavity are performed. But the most informative way of diagnosing is a histological examination of the ovary. Such an examination allows to figure out the nature and the structure of the tumor. According to results the oncologist forms the treatment tactics and makes prognosis.
The main methods of cancer treatment are the surgery and chemotherapy. If the surgery is performed on the early stage of the decease only damaged ovary may be removed. In more difficult cases depending on the level of the damage the uterus and omentum could be removed. Chemotherapy is usually based on combining of the medicines (Cisplatin or Carboplatin, Cyclophosphamide, Taxol etc)
Transplantation of the ovary
Due to the fact that some women are diagnosed with ovarian cancer at reproductive age after treatment some of them might want to have children. The successful pregnancy after the removal of the ovaries and recovery from cancer is possible only if the not damaged tissue was cryopreserved and transplanted back. The research in that area was performed by Danish scientists led by Annette Jensen from Rigshospitalet Copenhagen. The Danish project of cryopreservation and transplanting of the ovaries which started in 2000 was traced. Since that tissues samples taken from almost 800 women, 41 out of which were chosen for participation. According to results 30 percent of women got pregnant successfully both natural way and with the help of IVF. The average age at the moment of transplantation was 33 years. Altogether 14 children were born during the research.
National cancer society (USA) with reference to the National Cancer Institute and SEER data base published the statistics of survival based on the research since 2004 till 2010.
5-year survival rate according to the stage:
- I 90%
- IA 94%
- IB 92%
- IC 85%
- II 70%
- IIA 78%
- IIB 73%
- III 39%
- IIIA 59%
- IIIB 52%
- IIIC 39%
- IV 17%
The death is usually caused by development of ascites, bone metastases, lungs, liver and brain, as well as violation intestinal permeability or depletion.