Cancer is understood when the cells of some specific tissue of an individual’s body begin to grow in an uncontrolled, disorderly and invasive way, generating repercussions at a systemic level in the medium or long term, even being able to invade other nearby or distant organs (metastasis).

The ovarian cancer in many countries in America and Europe is among one of the most common types of gynecologic cancer origin, being in some regions the third or even the second most common. In many cases, due to the difficult to pinpoint and nonspecific initial symptoms, it is estimated that two-thirds of patients have advanced disease at the time of diagnosis.

There are risk factors that can increase the chances of suffering from ovarian cancer such as the family genetic factor, reproductive factors such as nulliparity and pharmacological factors such as the use of some ovulation inducers. There are also protective factors, such as oral contraceptives, that prevent ovulation put the ovaries on relative rest.


Symptoms of ovarian cancer

The course of the disease is usually insidious or even silent in the early stages, meaning that women are more likely to have symptoms when the disease is in advanced stages.

However, in some cases early-stage ovarian cancer may present some nonspecific symptoms, such as pelvic distention or pain, menstrual abnormalities, etc., but they hardly lead to ovarian oncological pathology. Among other symptoms that may occur we have:

  • Feeling full after eating.
  • Urinary symptoms (burning when urinating and difficulty urinating).
  • Tiredness and weakness
  • Lumbar and pelvic pain
  • Abdominal pain triggered after sexual intercourse.
  • Menstrual changes
  • Weightloss.
  • Constipation or even intestinal obstruction in cases where the ovarian mass compresses and occludes part of the intestinal lumen.

These symptoms tend to be persistent and progressive, worsening in the advanced stages of the disease.

Ovarian Cancer Types and Stages

Mainly, three types of ovarian cancer can be established according to their histological composition: epithelial (which corresponds to the most frequent), germ cell and stroma.

The stage refers to a way of describing the extent of the cancer lesion, which allows the medical team to jointly plan the most appropriate treatments without the need for procedures that for staging have not shown significant improvement in disease elimination could pose greater risks.

Usually, the stage of cancer is assigned using the FIGO (International Federation of Gynecology and Obstetrics) system. They are grouped into four stages, ranging from localized unilateral or bilateral, ovarian or fallopian tube involvement, without findings of peritoneal implants, to stage IV that includes metastases to pelvic or extra-abdominal organs, such as the lung or brain.

Ovarian Cancer Treatment

Treatment of ovarian cancer will depend on the stage at which the disease is detected. The main objective is the  removal  (excision)  full  of visible disease, or at least reduced to the maximum possible with less residual disease 1cm.

The traditional approach is based on three aspects: surgery, chemotherapy and radiotherapy, which has been shown to significantly improve the survival of patients suffering from this disease.

In the case that surgery is indicated as a treatment, it will not only consist of the removal of the ovaries and uterus, but also includes a series of additional steps to ensure optimal debulking (complete removal of the tumor), such as appendectomy. (remove appendix), lymphadenectomy (removal of pelvic nodes), peritoneal biopsy, and omentectomy (omentum removal). Depending on whether any segment of the intestine, bladder, spleen or liver is compromised, an additional surgical approach may be required.

The  chemotherapy treatment in some cases of ovarian cancer indicated prior to surgery, known as neoadjuvant chemotherapy, which aims to reduce tumor size and facilitate the surgical approach.

After surgery, it is also usually necessary to use cycles of chemotherapy and radiotherapy that increase the chances of remission of the disease. In some cancer centers, intraperitoneal administration of chemotherapy is also performed postoperatively in cases in which it has been possible to perform an optimal initial surgery, which for some authors achieves good results.

Finally, it is always important that one of the factors on which the success of the treatment will depend is early diagnosis, being less invasive and of greater recovery and survival, not being a guarantee, especially in advanced stages, that the treatments so far known allow 100% elimination of the disease, having of course special variations according to the particular characteristics of the patient and the type of cancer.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses. He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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