Ovarian cancer is the most common and difficult to treat cancer among women’s cancers. 1 or 2 out of every 100 women develop ovarian cancer during their lifetime. Ovarian cancer is usually very advanced when diagnosed, and therefore the treatment process is more difficult than many types of women’s cancer. For this reason, as with all other cancers, early detection is very important in terms of treatment success. Ovarian cancer, which accounts for 4% of all cancers seen among women, can occur at any age, as it can be seen more after menopause.
Epithelial cells form the main structure of the ovaries, which have many different cells in their tissue. Ovarian cancer can occur as a result of uncontrolled division and proliferation that occurs in epithelial cells or embryonic cells. 80 percent of ovarian cancers, mostly seen after menopause, occur in epithelial tissue. Embryonic tumors are observed in 60 percent of ovarian cancers under the age of 20.
Although the causes of ovarian cancer are not very clear, it can be mentioned that some risk factors cause this disease. Genetic, environmental and hormonal factors can be cited among the causes of ovarian cancer. Causes of ovarian cancer;
• The risk increases in those with breast or ovarian cancer in their family.
• In recent years, changes in some genes have led to increased risk of ovarian cancer.
• The risk of ovarian cancer increases in those who take ovulation-enhancing drugs.
• The use of birth control pills reduces the risk of ovarian cancer.
• The risk of ovarian cancer is higher in those who have never conceived. In those who give birth, the risk is reduced.
Symptoms of ovarian cancer often do not manifest themselves much. Although most of the symptoms associated with ovarian cancer are specific to the patient, they do not have typical signs. As symptoms of ovarian cancer, it can also be said as a symptom of many diseases; abdominal pain, bloating, and stomach ailments can be listed.
In advanced stages of ovarian cancer, there is a mass in the abdomen, a feeling of downward pressure, accumulation of fluid in the abdomen, abdominal swelling, urine and intestinal complaints due to pressure on surrounding organs.
Hormone disorders may occur in some types of ovarian cancer. Depending on this, menstrual irregularities, pubescence with increased secretion of male hormone, male-type hair loss can be observed. Most ovarian cancer complaints are related to abdominal swelling.
We can list the most common symptoms of ovarian cancer;
• Change in bowel habits, especially the appearance of constipation,
• Change in bladder habits, the need for frequent urination,
• Loss of appetite or feeling satiety quickly,
• Vaginal bleeding,
• Weight loss,
• Feeling of pressure and bloating in the abdomen,
• Fullness or pain in the groin,
• Long-term indigestion, gas or nausea.
Early diagnosis of ovarian cancer is very important, as with all other cancers. For early diagnosis, women are advised not to disrupt annual routine gynecological checks. A mass that is addressed during a gynecological examination or masses seen in the ovaries during ultrasound give the chance to intervene in cancer early.
Not every cyst in the ovaries means cancer. Most cysts, especially in women of reproductive age, are simple and harmless cysts. These cysts, which disappear on their own over time, do not carry a risk of cancer. For this reason, it is determined whether the cysts monitored by the specialist doctor on ultrasound are harmful or do not contain any negative properties for the body. In addition, all types of cysts in menopausal women and young girls before menstruation are open to the risk of tumors. It must be evaluated from this point of view.
In advanced stages of ovarian cyst and masses with tumor characteristics, tumor markers in the blood are looked at. Some tumor markers (especially CA 125) are high in some types of ovarian tumors. However, the height of CA125 and other tumor markers does not always indicate that the mass is cancer, and a low level of tumor markers does not rule out cancer. Apart from tumor markers, doppler ultrasonography can also help in the separation of benign and malignant tumors by showing changes in blood flow. All these methods are auxiliary methods. None of them is enough to make a definitive diagnosis. In cases where cysts and masses that are thought to be tumoral (whether benign or malignant) cannot be distinguished, surgery and a pathological biopsy sample during surgery provide a definitive diagnosis.
If tumor markers and doppler examinations in the presence of a cyst are normal, ultrasound and examination may follow for some time if there are no signs suggesting that it is tumoral, and if the cyst is less than 8 cm. If there is no reduction or loss during follow-up, surgery is preferred.
The response of ovarian cancer to treatment is directly related to how far the tumor has spread. Ovarian cancer can be eliminated by 80-90 percent when diagnosed at an early stage and with appropriate treatments. In advanced stage diagnosed ovarian cancer, the recovery rate is 40-50 percent. After ovarian cancer surgery and chemotherapy, it should be checked regularly for the possibility of recurrence of the disease.
It is very important at what stage it is diagnosed in the treatment of ovarian cancer. It is necessary to know if the cancer has spread from your ovary to around and surrounding organs. In ovarian cancer, staging is determined depending on the degree of cancer spread.
Stage 1: the cancer is in one or both ovaries, but only in the ovary.
Stage 1a: cancer is limited in one ovary and inside the ovary.
Stage 1b: the cancer is in both ovaries, but is still limited within the ovaries.
Stage 1c: the cancer is in one or two ovaries, but the ovary has also gone beyond its limit. A tumor cyst on the ovary exploded, or cancer cells were found in the fluid inside the abdomen.
Stage 2: The Cancer has spread to other organs in the area called the pelvis and surrounded by the pelvis bones.
Stage 2a: the cancer has spread to the uterus, tubes, or both.
Stage 2b: the cancer has spread to the bladder or large intestine.
Stage 2c: cancer has made any of the spreads in 2a and 2b. In addition, the cancer has also gone beyond the ovarian boundary, a tumor cyst on the ovary has burst, or cancer cells have been found in the fluid inside the abdomen.
Stage 3: the cancer has spread to the abdomen or held the lymph nodes.
Stage 3a: cancer cells have spread into the abdomen, but are in small enough foci to be seen only under a microscope.
Stage 3b: cancer cells have spread into the abdomen, but their size is less than 2 centimeters.
Stage 3c: cancer cells have spread into the abdomen and are larger than 2 centimeters or have also spread to the lymph nodes, or these two conditions are present.
Stage 4: the cancer has also spread to the liver, lungs, or other distant organs.
The treatment of ovarian cancer is surgical, and not only the uterus and ovaries, but all tissues that are likely to be retained in the body are removed. After surgical treatment, chemotherapy is applied. In all stages of ovarian cancer, the surgical method is used. If removing a mass in the treatment of ovarian cancer carries a risk of damage to vital organs, it is first aimed to reduce the mass with chemotherapy. Then the surgical method is first intervened in the cancerous mass and tissues. After ovarian cancer surgery, chemotherapy may not be necessary if the cancer does not spread throughout the body. If ovarian cancer has spread, chemotherapy or radiation therapy should be applied. 6-9 treatments are applied after surgery, with chemotherapy changing depending on the stage of the disease.
New treatment alternatives for ovarian cancer have now begun to be applied frequently in our country. Treatments with targeted agents increase the likelihood of curing, prolong survival and provide significant symptomatic relief. Care is taken to protect reproduction in the treatment of ovarian cancer. Especially in early germ cell ovarian cancer and borderline ovarian cancer, only cancerous tissue or cancerous ovary is removed and the uterus and counter-ovary are protected, making it possible to conceive.