Ovarian cancer treatment
Ovarian cancer - is a malignant condition affecting female reproductive tissue. The disease can occur in the ovary (primary cancer) or metastasise from other tumours. Many treatment methods are effective for ovarian cancer, including surgery, chemo-, immuno-, target, proton and hormonal therapies, and interventional radiology (embolisation, ablation).
Ovarian cancer is an irregular, uncontrolled growth of malignant cells in the ovaries (part of the female sex organs). Therefore, there are different types of ovarian cancer (based on the microscopic structure):
- Epithelial tumours originate from the top cell layer. About 9 out of 10 tumours belong to this group.
- Germ cord-stromal tumours arise from the so-called supporting tissue.
- Germ cell tumours can already form in children and young women. This rare form of cancer arises from the egg cells that develop in the ovary.
The disease occurs due to the formation of a tumour directly in the ovary or the metastatic process from another organ. The danger of ovarian cancer lies in the absence of symptoms. Therefore it is crucial to detect cancer at an early stage.
An ovarian tumour (carcinoma) is one of the most aggressive malignant diseases of the female genital organs. It is the second most common malignancy of the female genital tract. The mean age at onset is 68 years, after which the incidence rates increase continuously. According to statistics, about one in 75 women will develop ovarian cancer during their lifetime.
What can be the cause of cancer in the ovaries?
Like almost every cancer, ovarian tumours occur because of genetic material changes. They cause normal body cells to turn into malignant ones that grow uncontrollably and destructively. Most genetic changes happen randomly throughout life, but some can also be inherited.
Research has identified factors that statistically increase the risk of developing cancer in the ovaries:
- Ovarian malignancy often affects women over the age of 50 after menopause. The malignant process develops against the background of hormonal changes in a woman's body.
- Women suffering from obesity are more likely to get oncological diseases of the genitourinary system. The disruption of the endocrine system explains it.
- A study shows that women who have not given birth to children are more prone to developing ovarian cancer. The illness can also appear in women who refuse to breastfeed their children.
- Taking drugs containing estrogen without progesterone in the climacteric period is a risk factor. At the same time, drugs containing both hormonal elements reduce the chances of the disease.
- Genetic predisposition: the risk increases by 10% if a blood relative has developed cancer.
- Women who have suffered or are struggling with breast cancer are at particular risk.
- Early puberty.
However, there are cases when cancer develops in a woman without the listed trigger factors - each situation is individual. But if certain factors can provoke ovarian cancer, regular consultations and ultrasound examinations are worth undergoing. In addition, there are designed check-ups or special cancer screening programs for females.
Symptoms related to ovarian malignancy
The cancer process in the ovaries does not have pronounced symptoms and is often diagnosed in the last stages. And those signs are often attributed to problems with the digestive tract or mild malaise. As a result, cancer advances due to an incorrect diagnosis.
Manifestations begin to appear gradually with the stage of development and spread of the tumour. Women can note the following signs:
- Unclear abdominal pain;
- Persistent urination;
- Changes in bowel movements;
- Increasing abdominal circumference or difficulty breathing due to accumulation of water in the abdomen (ascites);
- Unclear weight loss.
The following symptoms of late-stage carcinoma formation are uterine bleeding, increased abdomen volume, and frequent urination urges.
Doctors consider many complaints from patients, and typical sufferings might be: heaviness in the lower abdomen, nausea, vomiting, and diarrhoea alternating with constipation. The stomach increases because of fluid accumulation in the abdominal cavity (ascites). Ascites can develop over several months (accompanied by flatulence, abdominal pain, heaviness), or they can appear suddenly. A large volume of fluid causes shortness of breath when walking and difficulty bending the trunk. In addition, there are signals of respiratory and cardiovascular insufficiency and swelling of the lower extremities.
How do healthcare providers diagnose cancer in the ovaries?
Gynaecologists usually carry out physical examinations for ovarian tumour diagnosis. The doctor palpates the abdominal wall from the outside and the inside via the vagina. In addition, the internal sex organs are examined using a tubular instrument (speculum).
Ultrasound through the vagina (vaginal ultrasound) helps to examine ovaries for any noticeable changes. A doctor inserts a special rod-shaped ultrasound probe into the vagina. Transvaginal ultrasound is usually painless. In addition to ultrasound, doctors perform imaging procedures to look inside the body.
- Computed tomography (CT) uses X-rays to detect metastases of bones and soft tissues making 3D images layer by layer.
- Magnetic resonance imaging (MRI) uses radio waves and a large magnet to make a clear image of the whole body and projects it on the screen. MRI helps to identify cancer in the ovaries and distance metastases.
- Positron emission tomography (PET) is more accurate than CT for diagnosing ovarian cancer and metastases using a radioactive tracer.
Diagnostic laparoscopy is a surgery performed through tiny incisions in the abdomen with the help of a particular camera (laparoscope) and instruments. Laparoscopy allows it to see ovaries from the inside and take tissue samples.
Gynaecologists can get tissue for further investigations during the operation or via needle aspiration biopsy. A histological examination helps to examine suspected cells in the laboratory for their biological properties. So the specialists can determine whether the tumour is benign or malignant and what biological subtype it is. Only the histological analysis confirms the cancer diagnosis and stages of the malignant process:
- Stage I - is localised ovarian damage.
- Stage II - malignant process affects the uterus and surrounding tissues.
- Stage III - spreading of cancer cells in the lymph nodes.
- Stage IV - metastases to distant organs.
In medical practice, it is noted that people whose malignant tumours were detected at an early stage have a better chance of recovery. Since during this period, there is an opportunity to entirely remove the cancerous tumour and conduct chemotherapy to destroy all cancer cells. But the main problem is that most often, ovarian cancer in a woman's body is asymptomatic, and it is not always possible to determine the disease. Therefore, the only way to diagnose ovarian cancer early is to undergo an annual preventive examination (check-ups) with a gynaecologist and conduct ultrasound scans.
Treatment overview for ovarian cancer
Ovarian cancer treatment tactics are developed by specialists in related specialities for each patient individually after a comprehensive examination. The following specialities can be involved in the process: gynaecologist, oncologist, surgeon, radiation oncologist, interventional radiologist, etc.
Surgery is the basis of treatment for cancer in ovaries. The operation aims to eradicate the tumour. For this purpose, ovaries, fallopian tubes, the uterus, the sizeable abdominal mesh, and parts of the peritoneum are usually removed. The different extent of the operation depends on the cancer type. If only one ovary is affected and the tumour is minimal and not very aggressive, fertility-preserving surgery is an option for those who desire to have children.
The alternative and less invasive option is Robot-assisted da Vinci ovarian surgery, a surgical technique using the robotic system. The benefits are that the operation is carried out without conventional incisions and does not need a prolonged postoperative period. Unfortunately, only a small number of patients can qualify for such a method.
Patients with advanced ovarian cancer usually receive additional chemotherapy after the operation. Healthcare providers also offer chemotherapy to patients with early ovarian cancer, the systemic introduction of drugs (so-called cytostatics) to slow down cell growth or cell division. In addition, there are more specific types of chemotherapy for the treatment of distant metastases:
- Transarterial chemoembolisation (TACE) - is the injection of chemo drugs into the tumour's vessel. And the blockage of this artery kills metastatic cells quickly.
- Transarterial chemoperfusion (TACP) - is the introduction of antitumour drugs into the arteries feeding the malignant neoplasm.
Immunotherapy is furthermore an effective method in the treatment of ovarian cancer. Immuno drugs activate the patient's immune system against foreign malignant body cells.
Hormonal therapy is an additional therapy for cancer in the ovaries. It uses drugs to block or decrease hormones like estrogen because female sex hormones cause tumour cell growth and development in the ovaries.
Target therapy is a treatment with drugs that block the growth and spread of cancer cells. It is possible by acting on specific molecules involved in developing ovarian cancer. This treatment can be much more effective as it targets particular molecules within the malignant neoplasm in the ovaries.
Radiotherapy is a systemic use of radiation to destroy cancerous cells in ovaries and distant metastasis. A more precise radiotherapy method is proton therapy, which treats ovarian cancer with the help of high-powered energy. It has minimal effect on surrounding tissues but is much more powerful and precise than conventional radiotherapy.
Numerous targeted treatment exists within the interventional radiology field. It tried to substitute a surgical treatment when an operation is impossible or helps during the primary systemic therapy. Ablation therapy is an example of locally targeted ovarian cancer treatment. A doctor can also use different kinds: radio waves (radiofrequency ablation, RFA), microwaves (microwave ablation), or alcohol (ethanol ablation).
What can patients with ovarian cancer expect?
The earlier the ovarian cancer is diagnosed, the better prognosis for a patient. Unfortunately, most women are not identified until the neoplasm is advanced. About 3 of 4 ovarian tumours are not discovered until stage III or IV. Those patients usually have a less favourable prognosis. The survival rate in the early stages is 88-90% for five years, but in the later stages, the forecast is less optimistic - 10-20%.
Is cancer in the ovaries curable?
In most cases, surgery treatment cures ovarian cancer. In the early stages, it is possible to preserve reproductive function. Additionally, chemotherapy and radiation therapy prevent cancer cells from metastasising to other organs.
Does ovarian cancer spread to the peritoneum?
There are three ways of spreading malignant cells from the ovaries to other organs: peritoneal fluid, lymphatic vessels, and blood. The most characteristic is spread through the peritoneal fluid, as a result of which metastases are very often found in the peritoneum.
Is bleeding a sign of ovarian cancer?
Menstrual problems and bleeding disorders are alarm signals for ovarian cancer. Bleeding between periods and especially bleeding after menopause is widespread sign of ovarian cancer.
Why might ovarian cancer treatment abroad be better?
Scientific research in oncology abroad allows for raising the level of medicine in this area. Highly qualified foreign specialists have a higher level of training and experience. In addition, modern equipment and the latest approved drugs (chemo, target, radionuclides and medicine for immunotherapy) are available in clinics abroad.
Can an ovarian cyst turn into cancer?
Ovarian cysts are fluid-filled cavities that form in or on the ovary. Such cysts are relatively common. Most of them are benign. However, malignant (cancerous) cysts are more likely to occur in women over 40.
Where can I get Ovarian cancer treatment?
What are the best clinics for Ovarian cancer treatment?
Who are the best doctors for Ovarian cancer?
Prof. Dr. med Harald-Robert Bruch, MSc, PhD from Oncological and Haematological Praxis Clinic Bonn
Prof. Dr. med. Florian Bassermann from University Hospital rechts der Isar Munich
Prof. Dr. med. Marion Kiechle from University Hospital rechts der Isar Munich
Prof. Dr. med. Sven Mahner from University Hospital Ludwig-Maximilians Munich
Dr. med. Christopher Kobagk from Park Clinic Weissensee Berlin