Ovarian cancer

Poem – on cancer 

I lift my eyes

I see me

A tear falls

This can’t be

The person in the mirror

She is different

Her skin pale, eyes sad

She looks back at me

Her eyes of sorrow show the emotion

It’s almost like she knows me,

Remember me;

Wonders where I have been

Why do you look different? She asks

Without a world spoken

A poem on Cancer Dane Stewart 1812

The term “Ovarian Cancer” includes several different types of cancer, that all arise from cells of the ovary. Most commonly, tumours arise from the epithelium, or lining cells, of the ovary. These include epithelial ovarian (from the cells on the surface of the ovary), fallopian tube and primary peritoneal (the lining inside the abdomen that coats many abdominal structures) cancer.

These are all considered to be one disease process. There is also an entity called ovarian low malignant potential tumour these tumours have some of the microscopic features of a cancer

but tend not to spread like typical cancer.

Internationally, the incidence ranges from 3.1 cases per 1,000 women in Nigeria to 21 cases per 100,000 in other African countries.

Epithelial ovarian cancer occurs most commonly in white women in industrialised countries.

African women have low risk of ovarian cancer, but medical practitioners are not sure if it could be due to difficulty in diagnosis.

There are many types of ovarian cancer. Some types of ovarian cancer are extremely rare and require specialised treatment.

We have epithelial ovarian cancer, germ cell ovarian cancer, stromal ovarian cancer, primary peritoneal ovarian cancer.

The causes of ovarian cancer are unknown, but the risk factors include age, reproductive history, having endometriosis, lifestyle factors, hormonal factors.

Some factors may reduce the risk of developing ovarian cancer. These include having children, breastfeeding, using the combined oral contraceptive pill for several years and having your fallopian tubes tied – tubal ligation.

It is not clear what causes ovarian cancer. In general cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Cancer cells quickly multiply, forming a mass (tumour). They can invade nearby tissues and break off from an initial tumour to spread disorder.

The symptoms of ovarian cancer include, bloating, pelvic or abdominal pain, trouble eating or feeling of fullness quickly, feeling the need to urinate urgently or often.

Other symptoms of ovarian cancer can include fatigue, stomach upset or heartburn, back pain, pain during sex, constipation and menstrual changes.

If above symptoms persist or continue for more than 2 weeks, it is recommended that the woman consult a gynaecologist.

Your gynaecologist may suspect that you have ovarian cancer after taking your medical history and doing a physical examination. To confirm the diagnosis your doctor will arrange special tests. These tests may also be used to “stage”, and “grade” the cancer and to help plan the treatment.

Physical examination allows the doctor to look for any signs of ovarian cancer. During a physical examination, the doctor may do a pelvic (gynaecologist) examination to feel the uterus and ovaries and look at the vagina and cervix.

Your doctor may also do the abdominal examination to feel for lumps or enlargement of organs such as the liver.

Imaging studies allow tissues, organs and bones to be looked at in more detail, using x-rays, ultrasounds, CT scans, MRI or bone scans. Your doctor can get a picture of the size of the tumour  and see if it has spread. These tests are usually painless and do not require an anaesthetic.

A trans-vaginal ultrasound may be done to diagnose ovarian cancer. A trans-vaginal ultrasound uses sound waves to form a picture of the vagina, uterus, fallopian tubes and ovaries. A small probe is inserted into the vagina to look for dark Dee or dense areas on the image that may be cancer.

Blood is taken and studied to see if different types of blood cells are normal in number and appearance. The results show how well your organs are working and may suggest whether you have cancer and if it has spread.

The blood may also be tested for body chemicals called tumour markers. For ovarian cancer the blood may be tested for several tumour markers including CA 125.

CA-125 is a substance found in ovarian cancer cells and in some normal tissues. If the CA-125 level is high there is a higher chance of ovarian cancer and some other conditions. CA-125 can also help tell whether the cancer has spread or not.

A biopsy is usually necessary to make a definite diagnosis of cancer. Cells are removed from the body and checked under a microscope. If the cells are cancerous, they may be studied further to see how fast they are growing and how different they look from normal cells.

For ovarian cancer, your doctor may choose to examine and take samples of tissues or fluid from the abdomen. This may be done by laparoscopy or laparotomy

Complications of ovarian cancer may include torsion, rupture, infections.  Complication Dee of ovarian cancer treatment may include bone marrow depression, infection.

Once a definite diagnosis of cancer has been made, the cancer is given a stage and a grade.

This information helps you and your team doctors to choose the treatment option for you.

The cancer stage describes the tumour size and tells whether it has spread.

A grade is given based on how the cancer cells look and behave compared to the normal cells.

Treatment options for ovarian disease vary, depending on the stage of the cancer, and are assessed taking into account the following variables, tumour size, tumour position, degree of spread and patients physical condition.

Until recently treatment options for ovarian cancer were limited to surgery and chemotherapy. However in 2011, the European Commission (EC) announced the approval of a biological therapy in combination with standard chemotherapy (carboplatin and paclitaxel), as initial treatment for advanced stages of ovarian cancer.

   Surgery is used to remove as much of the tumour as possible. This is known as debulking surgery or cytoreduction. Patient most commonly have both ovaries removed (bilateral oophorectomy), and a hysterectomy (removal of the uterus),

   In young women who wish to remain fertile, only the affected ovary is removed and the uterus is left in place.

In patients diagnosed with early disease, surgery alone is usually sufficient.

You cannot control some things that put you at risk, to prevent ovarian cancer, such as your family history or inheriting gene changes. But you can make some personal choices that lower your risk of all cancers and other diseases.

Eat a healthy diet with plenty of fruits, vegetables and whole grains. Use of oral contraceptives, especially for more than 10 years. Previous pregnancy helps lower risk of ovarian cancer. You must breastfeed your children.

You can use micro-aspiring daily to prevent blood clots and infarcts around your arteries.

Be active. Talk with your doctor about what kinds of activity and how much activity would be good for you.

Always be medically guided.

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