Ovarian Cancer Signs and Symptoms

Ovarian cancer (ovarian cancer) is a malignant growth on one or both ovaries. It is the sixth most common cancer of the woman.

                                      Ovarian cancer is the sixth most common cancer in women.

Every woman has two ovaries. They are located on both sides of the uterus in the pelvis and consist of the ovarian cortex and the ovarian cord. In the ovaries, the germ cells mature. Most ovarian cancer is from the cortex, more rarely from the medulla or germ cells.
The ovarian cancer penetrates the ovarian capsule, it spreads throughout the abdominal cavity and covers the peritoneum with daughter tumors (metastases). In addition, the ovarian cancer can remove metastases via the lymphatics into the lymph nodes as well as through the bloodstreams in the liver, lungs, brain and bones. Conversely, metastases of other cancers, such as those of gastric cancer, can settle in the ovaries.
According to the International Association of Gynecology and Obstetrics (FIGO), ovarian cancer is divided into four tumor stages depending on its location and extent:
  • FIGO I The tumor is limited to the ovaries .
  • FIGO II The tumor detects other small pelvic organs such as the uterus .
  • FIGO III Malignant tumor cells infest the peritoneum outside the small pelvis or lymph nodes.
  • FIGO IV The tumor scatters into other organs such as the liver (distant metastases).
Causes of ovarian cancer
The causes of ovarian cancer (ovarian cancer) are still unclear. However, certain risk factors seem to favor ovarian cancer:
• Genetic factors - Up to ten percent of cases of ovarian cancer are familial. Women of affected families are also more likely to develop breast cancer (hereditary breast and ovarian cancer).
• Multiple ovulations - women who have had multiple pregnancies or who have been taking the birth control pill for many years are less likely to develop ovarian cancer. Both during pregnancy and by taking the pill, ovulation stops. This seems to have a protective effect. On the other hand, women who have had many ovulations (early first and late last period, no pregnancies, no pill intake) have a higher risk.
• higher age
• Fat and meat-rich diet

• Pollutants such as asbestos and talcum talc, and sometimes asbestos-like fibers, are found in some medical and perfumed body powders. Women who use such a body powder in the genital area, become more likely to ovarian cancer.

Symptoms of ovarian cancer
Since ovarian cancer (ovarian carcinoma) does not cause any typical symptoms at the beginning, in two-thirds of cases it is only discovered in advanced stages (FIGO III / IV).
Many affected women feel tired and exhausted for no apparent reason. In rare cases, menopausal women surprisingly get bleeding again. In younger women, bleeding between the actual period (intermenstrual bleeding) may be a first sign. If the growing tumor displaces neighboring organs such as the intestine or the bladder, affected women may suffer from diarrhea , constipation or frequent urination. In addition, some women report a feeling of pressure and heaviness in the pelvis, often also of abdominal and back pain. Since tumor-related fluid in the abdomen can accumulate (ascites), often increases the waist circumference. At the same time many sick women lose weight.
The individual complaints are quite unspecific on the whole, which means that they can hide other, sometimes harmless illnesses behind them. Only a doctor can clarify this.

Diagnosis of ovarian cancer
First evidence of ovarian cancer (ovarian cancer), the doctor from the detailed survey of the woman on the history of the disease (history) and to win the current complaints. If additionally enlarged, solid ovaries are palpated during the subsequent gynecological examination, the suspected ovarian cancer can be further substantiated. By means of an ultrasound examination by the vagina (transvaginal sonography), the gynecologist depicts the female reproductive organs. A suspicious tumor can also be detected and displayed here. In order to estimate the further spread of the tumor, an additional ultrasound via the abdominal wall and computed tomography of the abdomen and pelvis are possible.

Proof only by operation
However, the ovarian cancer can only be definitively detected through surgery. The surgeon uses an abdominal incision to remove the affected ovary and tumor and examines it under the microscope. When it comes to ovarian cancer, numerous tissue samples (biopsies) are taken from the entire abdominal area, which are also examined microscopically and provide information about the extent of the tumor. The detection of distant metastases may require further examinations such as computed tomography of certain body regions.
Before therapy, tumor markers such as CA-125 are measured in the blood of sick women. Tumor markers are sugar-protein compounds that are released by cancer cells. They often increase with the growth of a tumor. However, since they can also occur in benign diseases, they are not likely to help diagnose cancer. However, after the malignant tumor has been removed, it often falls off and, in the event of a new rise, gives an important indication that the tumor is growing again.

Treatment of ovarian cancer

The therapy depends mainly on the tumor stage. Ovarian cancer (ovarian cancer) is mainly used for surgery and subsequent chemotherapy.

The ovarian cancer and all its visible dislocations (metastases) are removed. Since ovarian cancer (ovarian cancer) is often already advanced in the discovery, in addition usually both ovaries, the fallopian tubes and the uterus are removed. It is followed by adjacent lymph nodes, the cecum and parts of the peritoneum, including the large mesh, a fold of the peritoneum filled with fatty and connective tissue. If other organs are affected, they too - if possible - are partially or completely removed.
If the tumor is confined to an ovary, only the affected ovary needs to be removed. Women who have not yet completed family planning can be enabled to have a later pregnancy.

In most cases, the operation is followed by chemotherapy. Chemotherapy destroys residual remains of the tumor and the smallest secondary tumors, and it delays the tumor's growth.
Ovarian cancer can be treated very well with platinum and taxane chemotherapeutics, such as carboplatin and paclitaxel. These substances interfere with cell metabolism or cell division. They are particularly strong on fast-growing tumors. To a certain extent, they also affect healthy tissue. Women often suffer from hair loss, vomiting, diarrhea or sensory disturbances during therapy. The blood formation can be disturbed.
At early stages of the tumor, carboplatin alone is used in advanced stages in combination with paclitaxel for six cycles.

Ovarian cancer (ovarian cancer) also responds to radiation. Since radiotherapy has some disadvantages compared to chemotherapy, it is used less frequently today.

Hormone therapy

Only when all chemotherapeutic options have been exhausted can hormone therapy make sense. The achievements are limited so far. For example, anti-estrogens such as tamoxifen are used. Anti-estrogens block the docking sites for estrogens that ovarian cancer (ovarian cancer) often carries on its surface.
Immunotherapeutic approaches
Currently, the use of special antibodies is being investigated, which are either directed against the tumor itself or cause an immune reaction of our body against ovarian cancer (ovarian carcinoma). The results are promising and suggest that future therapy will be complemented by immunotherapy.
Course of ovarian cancer
The course of ovarian cancer depends on the tumor stage and the type of tumor. Up to 90 percent of women with ovarian cancer (ovarian cancer) in the first stage survive with therapy for the next five years. By contrast, when ovarian cancer is only discovered in its fourth stage, only eleven percent of women survive the next five years. On the other hand, the success of the operation plays an important role in the course. The more tumor tissue is removed, the higher the chances of survival of the diseased woman. Even a younger age and a good state of health have a positive effect.
When the therapy is completed, about two thirds of women experience a so-called relapse, which means that the ovarian cancer recurs. Aftercare therefore plays a particularly important role. In the first three years the follow-up examination takes place every three months, from the fourth year all six months and from the sixth year every twelve months.

Prevent ovarian cancer

The ovarian cancer (ovarian carcinoma) can not be effectively prevented until today. A general check-up is not recommended. A lower risk of developing ovarian cancer seems to result from a long-term use of the anti-baby pill.
With genetic risk of ovarian cancer (ovarian cancer), both ovaries can be removed as soon as family planning is complete. However, this is not a standard procedure, but is only after detailed and individual counseling of the woman in question.

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