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Ovarian Cancer

Jan 21
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Causes of Ovarian Cancer

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Causes

What are the causes of ovarian cancer?

Doctors cannot always explain why one woman develops ovarian cancer and another does not. However, women with certain risk factors may be more likely than others to develop ovarian cancer.

A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for ovarian cancer:

  • Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease.
  • Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer. If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
  • Age over 55: Most women are over age 55 when diagnosed with ovarian cancer.
  • <Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
  • <Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.

Having a risk factor does not mean that a woman will get ovarian cancer.

Most women who have risk factors do not get ovarian cancer. On the other hand, women who do get the disease often have no known risk factors, except for growing older.

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Jan 21
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About Ovarian Cancer

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The Ovary

The ovaries are part of a woman’s reproductive system. They are in the lower part of the body below the umbilicus area (pelvis).

Each ovary is about the size of an almond. The ovaries make the female hormones—estrogen and progesterone. The hormones control your menstrual cycle. As you get older and menopause approaches, the ovaries make less and less of these hormones and periods eventually stop altogether.

The ovaries also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus). When a woman goes through her “change of life” (menopause), her ovaries stop releasing eggs and make far lower levels of hormones.

About

What is Ovarian Cyst? Is Ovarian cyst a cancer?

An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue too. Most ovarian cysts are benign (not cancer). Most ovarian cysts go away with time.

Sometimes, a doctor will find a cyst that does not go away or that gets larger or it shows some solid components that may raise a suspicion of cancer. The doctor may order tests to make sure that the cyst is not cancer.

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Jan 21
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Surgery for Ovarian Cancer

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Treatment

What is the treatment for ovarian cancer?

Many years of treating cancer patients and testing treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. You will be advised on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread and your general health.

The most common treatment options for ovary cancer are surgery, and chemotherapy.

If your cancer hasn’t spread, you will almost certainly be offered surgery.

Surgery

Surgery For Ovarian Cancer

Though cancer surgeries are extensive and take longer hours; with advanced medical care, surgeries have become safer and better equipments are now available to perform surgeries. Improved techniques of anaesthesia and post-operative monitoring have significantly contributed to overall safety of surgical procedures for cancers.

Why is a chemotherapy port necessary?

If you are found suitable for the surgery, you will be usually admitted one or two days prior to the proposed date of surgery. There may be dietary restrictions and you may be given laxatives to evacuate your bowels prior to surgery. Your blood group will be checked and blood is usually reserved for all major abdominal surgeries. It is always a good idea to start with deep breathing exercises once you are admitted to the hospital.

Your doctor may summon a physiotherapist to assist you with the same. You will have most of your body parts shaved for the surgery. You will be given a consent form for your signature. The form would have details of the procedure to be performed on you by your treating surgeon. In case you have any doubts you should feel free to ask them to the surgical team.

The type of surgery you have depends on the stage of your cancer. But you are most likely to have your ovaries, fallopian tubes and womb removed. This is called a ‘total abdominal hysterectomy’ and ‘bilateral salpingo-oophorectomy’. You may hear your doctor call this operation TAH and BSO, for short. The surgeon will also remove a sheet of tissue from inside the abdomen. This tissue is called the omentum, so this part of the operation is called an ‘omentectomy’.

If your surgeon finds any cancer in your pelvis or abdomen during your operation, they will remove as much as possible. This is sometimes called ‘debulking’. The less cancer there is, the easier it is for chemotherapy to kill off any that is left behind.

In a small number of people who have ovarian cancer, the cancer may be attached to another organ, such as the rectum or the colon. If this happens in your case, the doctor may remove part of the attached organ with the intestine. If very evident on the CT scans your doctor should discuss this with you before the surgery. Sometimes the decision may have to be made during the surgery in which case the doctor will give you more information after the surgery.

Interval debulking surgery

If your surgeon thinks it is possible to remove all or most of your cancer, you will have surgery before your chemotherapy. But if it would be difficult for the surgeon to remove enough of the cancer, you may have chemotherapy first. Chemotherapy before surgery is called neo-adjuvant chemotherapy.

The chemotherapy may shrink the tumour so that it is then possible for the surgeon to remove it. You will have the rest of your chemotherapy after the operation. This operation is called interval debulking surgery.

You may also have interval debulking if you had surgery as your first treatment, before chemotherapy. You have this done if your surgeon couldn’t remove enough of the cancer during your first operation. So in this case, you have surgery first. Then you have some chemotherapy, followed by the second operation to remove the rest of the cancer.

You will be transferred to the Intensive care unit after the surgery. Your recovery will depend on the magnitude of surgery performed. After the operation, the patient is usually monitored in the ICU for 48 to 72 hrs and the overall hospital stay (if no complications) is usually between 10–14 days. Your pain and discomfort will be taken care of by the anaesthetic team. You will be given pain-killers and an intravenous infusion (drip) to replace your body’s fluids until you are able to drink and eat again after a few days.

You will also have a naso-gastric (NG) tube in place. This is a thin tube that passes down your nose into your stomach or small intestine and allows any fluids to be removed so that you don’t feel sick. It is usually taken out within 48 hours. Sometimes a small tube (catheter) is put into the bladder to drain your urine into a collecting bag.

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed the nurses will encourage you to do regular leg movements and deep breathing exercises. You will be seen by a physiotherapist who can help you to do the exercises.

Drinking and eating after surgery.

After an anaesthetic, the movement of the bowel slows down and usually takes about 72 hours to get back to normal. After about 48-72 hours you will probably be ready to start taking small sips of water, however your doctors will tell you when it is appropriate for you to start drinking some fluids. This will be gradually increased after a couple of days until you are able to eat a light diet.

Going home.

You will probably be ready to go home in about 10-14 days after your operation and once your stitches have been removed. If deemed appropriate your doctor may send you home with stitches and call you later to remove the stitches. By and large you should be able to climb several flights of stairs after your discharge from the hospital and you will be given diet instructions.

Before you leave hospital you will be given an appointment for a post-operative check-up at the outpatient clinic.

Diet after ovarian surgery.

There is no restriction on the type of food you eat after an ovarian surgery and you should be able to eat all that you did before surgery.

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Jan 21
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Test for Ovarian Cancer

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Tests

What is the treatment for ovarian cancer?

This section lists common tests. It is not necessary for all the tests to be performed and your doctor will select the tests that will provide maximum information about the tumor/ disease.

If you have a symptom that suggests ovarian cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests.

Physical examination

Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumors or an abnormal build up of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.

Pelvic examination

Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size.

Blood tests

Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer, however, the CA-125 test is not used alone to diagnose ovarian cancer.

Ultrasound

Ultrasound scans are very important in the diagnosis of ovarian cancer.

They are done in two ways. In an abdominal scan, the ultrasound specialist passes a hand-held device called a transducer over your pelvic area. This is used to build up pictures of your organs. The pictures can be seen on a screen.

Sometimes the ovaries may not be seen well by an abdominal ultrasound and the device may be inserted into the vagina (transvaginal ultrasound) for a better view of the ovaries.

Biopsy

A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound/ CT scan, your doctor may suggest open surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen.

Surgery is usually needed to diagnose ovarian cancer. Although most women have a open surgery for diagnosis, some women have a procedure known as laparoscopy. The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen.

Laparoscopy may be used to remove a small bit of tissue, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.

A pathologist uses a microscope to look for cancer cells in the tissue or fluid depending on which the further treatment may be decided by your doctor.

Computerised tomography (CT) scan

A CT scan is a type of x-ray that gives a picture of organs and other structures (including any tumours) in your body. It is used to see more details of a cancer and its relation to the surrounding organs in your body.

It also gives information related to cancer spread into the lymph nodes, liver or lungs.

Magnetic resonance imaging (MRI)

This test is like a CT scan, but it uses magnetism instead of x-rays to build up pictures of the organs in your abdomen. Like a CT scan, MRI is painless and the magnetism is harmless.

MRI scan may be more informative in cases of low rectal cancers.

Positron emission tomography (PET) scan

This test is combined with a CT scan by injecting a radioactive material in the body to highlight all areas where the tumor has or can spread.

This test may be used to build up more information after an MRI or CT scan. PET scan is not necessary for all patients. Your doctor will decide if you need to undergo this scan.

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Jan 21
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Symptoms of Ovarian Cancer

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Symptoms

What are the common symptoms of ovarian cancer?

The early symptoms of ovarian cancer are vague and can include:

  • Discomfort in the abdomen or a bloated feeling or pressure.
  • There may be a change in bowel habits and flatulence (wind).
  • Indigestion can also occur and sometimes problems with the kidneys or bladder.
  • Some women have abnormal vaginal bleeding.
  • Occasionally pain is the first sign of ovarian cancer.
  • Sometimes ovarian cancer is found unexpectedly, for example during a scan for other reasons.

As the cancer grows, the abdomen can become bigger. This is due to the cancer or a build-up of fluid called ascites, which is caused by the cancer. Women may also lose weight in spite of having a bigger abdomen.

If you have not been diagnosed with ovarian cancer and are just looking through this site, please be aware that many of these symptoms occur without any serious disease being present. However, if you have any of the symptoms for more than two weeks, see your doctor for a check-up.

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