What is Ovarian (Ovary) Cancer, Its Symptoms, and Treatment

Ovarian cancer is a type of tumor that occurs due to the uncontrolled growth and proliferation of cells in the ovarian or fallopian tube tissue. Ovarian cancer, also known as ovary cancer, is among the most common cancers faced by women worldwide. Diagnosing it can sometimes be difficult because symptoms often develop in the later stages. This can prevent early detection. Commonly experienced symptoms of ovarian cancer can include pelvic pain, abdominal pain, bloating, abnormal bleeding, or vaginal discharge. The goal of ovarian cancer treatment is to remove the tumor from the body. Treatment methods include surgery, chemotherapy, targeted therapy, and radiotherapy.

What is Ovarian (Ovary) Cancer?

The female reproductive system consists of the vulva, vagina, uterus, fallopian tubes, and ovaries. There are two ovaries located on either side of the body. The ovaries of women who have reached childbearing age produce one egg each month. Additionally, the ovaries are responsible for the production of estrogen and progesterone hormones. Cancer is a disease in which cells in the body divide abnormally and uncontrollably. Although cancer can spread to other areas of the body, it is usually named according to the location where it began.

Ovarian cancer is a disease that can form in the ovaries, fallopian tubes, or relevant sections of the peritoneum. The cancer begins in the ovaries and can spread to other tissues or organs if not detected early. Early diagnosis is therefore very important. Ovarian cancer can occur in one or both of the ovaries. This type of cancer mostly affects women over 50 years old and those in the postmenopausal period. It is known to be the 8th most common cancer among women worldwide.

What Are the Symptoms of Ovarian Cancer?

Ovarian cancer often does not have obvious symptoms. However, women diagnosed with cancer commonly present similar complaints when seeking medical advice. If these symptoms occur frequently (12 times or more per month), it is essential to consult a doctor. The symptoms of ovarian cancer can be listed as follows:

• Pelvic pain and abdominal pain
• Back pain
• Discomfort, indigestion, and bloating
• Changes in eating habits
• Early satiety
• Loss of appetite
• Unintentional weight loss
• Vaginal bleeding after menopause
• Vaginal discharge
• Abnormal bleeding
• Diarrhea and constipation
• Increase in abdominal size
• Frequent urination and urgency to urinate
• Fatigue and exhaustion

What Causes Ovarian Cancer?

Ovarian disease is generally seen in older women. Some patients are in the postmenopausal period. It is most commonly observed in women aged 60-64. Approximately 10-15% of ovarian cancers occur due to hereditary reasons. Additionally, it is less common in women who have had multiple pregnancies, are breastfeeding, give birth at an older age, use birth control pills, or have had their tubes tied. Factors that increase the risk of ovarian cancer include:

• Having gone through menopause
• Being diagnosed with endometriosis (chocolate cyst)
• Not having had children or not having been pregnant
• A family history of ovarian or breast cancer in close relatives
• Mutations in the BRCA genes
• Obesity
• Having previously undergone radiation therapy for cancer
• Early onset of menstruation or late onset of menopause

Stages of Ovarian Cancer

The stages of ovarian cancer indicate the extent of the disease's spread in the body. Ovarian cancers are surgically staged. The stage of cancer helps in forming the treatment plan and affects how the patient responds to the treatment procedures. The success rate of treatment is high in cancers that can be diagnosed in the early stages, while it is low in advanced-stage cancers. Ovarian cancer has four stages:

• Stage I: The tumor is present only in the ovary, fallopian tube, or both tissues.
• Stage II: The tumors have spread to the pelvic, uterus, and abdominal tissues.
• Stage III: The tumor has spread to the lymph nodes and the upper part of the abdomen.
• Stage IV: The tumor has spread to organs far from the ovaries, such as the lungs, liver, and spleen.

How is Ovarian Cancer Diagnosed?

Ovarian cancers that occur in women generally appear as types that develop in epithelial tissue. In the early stages of the disease, there are often no noticeable symptoms. However, patients may experience symptoms such as pain, discomfort, and swelling in the abdominal and groin areas. In some cases, swollen lymph nodes may be noticed in the groin, armpits, neck, and just above the collarbone. The initial investigations for diagnosing ovarian cancer typically include physical examination, imaging methods, and blood tests. A definitive diagnosis is made through pathology reports of samples taken after surgery. Recently, genetic tests have also been used to obtain information about cancer risk and disease progression, as well as to adapt to new treatments. Genetic counseling is recommended based on the results. The diagnostic methods for ovarian cancer can be briefly described as follows:

• Physical Examination: If ovarian cancer is suspected, a pelvic examination may be performed by a specialist based on the symptoms. During the examination, any abnormal growth, swelling, or enlarged organs are assessed.
• Imaging Tests: Imaging methods such as pelvic ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) can be used during the diagnosis stage. These methods aim to obtain images of the abdomen and pelvis.
• Blood Tests: The CA-125 substance is sought in blood tests. Elevated CA-125 levels in the patient's blood may indicate cancer. However, this is not a definitive diagnostic method, as CA-125 levels can be normal even if cancer is present or may be higher in non-cancerous conditions. Therefore, physicians may prefer to use other diagnostic methods alongside blood tests.
• Surgical Evaluation: Ovarian cancer can be diagnosed during surgical intervention. Abnormal growths and cystic structures can be removed during this procedure.
• Laparoscopy: Laparoscopy is a surgical intervention. The surgeon makes a small incision in the patient's abdomen and places a camera called a laparoscope, attached to a thin tube, inside this incision. Biopsy samples may be taken for cancer staging purposes, and in some cases, tumors causing ovarian cancers may be removed.
• Genetic Testing: Blood samples may be tested to identify genetic changes that increase the likelihood of ovarian cancer. It is determined whether there are genetic changes in the patient's DNA. If changes are present, discussions with physicians are conducted to establish a treatment plan.

How is Ovarian Cancer Treated?

The cornerstone of early-stage ovarian cancer treatment is surgery. In advanced-stage or high-risk ovarian cancer patients, surgery and chemotherapy may be used together, or chemotherapy may be administered alone or in combination with other treatments. In some cases, targeted therapy may be preferred. The treatment of ovarian cancer progresses differently at various stages:

Surgery: The most important step in the treatment of ovarian cancer is surgery. Surgical management is the first step in managing cancers at all stages except for those in the final stage. The goal of surgery is to remove all cancerous foci present in the abdomen. If this goal cannot be achieved, the tumor size in the abdomen should be reduced to 1 cm or less.

Chemotherapy: Chemotherapy, also known as cytotoxic or systemic treatment, is the most important step accompanying surgery in ovarian cancer treatment. For successful treatment, both surgery and chemotherapy are necessary. Almost all ovarian cancer patients receive chemotherapy after surgery; otherwise, the cancer may recur rapidly. Chemotherapy administered after the surgical operation is called adjuvant chemotherapy.

Targeted Therapies: Recently, drug therapies that provide targeted treatment are frequently used in ovarian cancer. This treatment aims to recognize and attack cancer cells, as well as alter their ability to grow and divide.

Hormone Therapy: Ovarian cancers use certain hormones to grow, and hormone therapy works by blocking these hormones, thereby slowing down or stopping the growth of cancerous tissues.

Cancer, regardless of its location, is a serious health issue that requires treatment. If you have persistent and frequently recurring symptoms of ovarian cancer, it is highly recommended to consult a healthcare professional. During the diagnostic phase, specialists will employ various methods to conduct a comprehensive health screening. Once a diagnosis is made, the appropriate treatment procedure determined by the physician can begin. This process can be long and exhausting, but among the supportive factors for treatment is the patient’s mental health. Seeking psychological counseling, if needed, can also be beneficial during the treatment process.