Ovarian Cancer – Symptoms, Diagnosis, and Treatment of Ovarian Carcinoma

The ovaries are connected to the uterus via the fallopian tubes. They are attached by ligaments, which hold them in place. Like the uterus, the fallopian tubes, and the vagina, the ovaries are part of the female internal reproductive organs.

Among the essential functions of the ovaries is the production of female sex hormones:

• estrogens,
• progestogens, and
• androgens.

These hormones are responsible for maintaining the menstrual cycle. In addition, the ovaries produce eggs, which are released into the fallopian tubes during ovulation. From there, they travel to the uterus. If they are fertilized by a sperm during this time, a fetus develops and the woman becomes pregnant.

The ovaries change their position and size during the menstrual cycle. However, they have relatively plenty of space in the abdominal cavity. Therefore, their increase in size and change in position during the cycle do not interfere with other organs.

This is also why ovarian tumors often go unnoticed for a long time. In most cases, they do not cause symptoms until they have reached an advanced stage.

The exact cause of ovarian cancer is not yet fully understood. However, several risk factors are known that may increase the likelihood of developing ovarian cancer. These include, among others

• advanced age,
• harmful environmental factors,
• unhealthy dietary habits,
• being overweight,
• childlessness and infertility, as well as
• the use of hormone replacement therapy after menopause.

In addition, genetic factors appear to be responsible for about 10 percent of all cases of ovarian cancer. In these cases, mutations are present in the so-called breast cancer genes BRCA1 (on chromosome 17) and BRCA2 (on chromosome 13). These genes also increase the risk of developing breast cancer. If mutations in these genes are present, cases of ovarian cancer and breast cancer occur more frequently within a family.

Ovarian cancer is the second most common cancer of the female reproductive organs after breast cancer.

According to the Robert Koch Institute, between 7,000 and 8,000 women in Germany are newly diagnosed with ovarian cancer each year. This corresponds to an annual incidence rate of 11 new cases per 100,000 female residents.

Overall, the risk for women of developing ovarian cancer at some point in their lives is 1.5 percent. It most commonly affects older women who have gone through menopause. In about 50 percent of ovarian cancer cases, both ovaries are affected by malignant tumors.

In about 70 percent of cases, ovarian cancer is not detected until the disease is already at an advanced stage. This is partly because ovarian cancer typically does not cause any early symptoms at the outset.

Another reason is that the symptoms, which usually do not appear until the advanced stage, tend to be nonspecific in nature. This means they can also occur with many other, harmless conditions. Furthermore, there are currently no reliable screening tests for ovarian cancer.

The nonspecific symptoms that may occur in the advanced stages of ovarian cancer include, among others

• pain in the lower abdomen,
• frequent urge to urinate, and
• gastrointestinal symptoms such as
  • indigestion,
  • bloating, and
  • constipation.

In addition, affected women often feel tired, exhausted, and lack energy. Other possible symptoms include

• bleeding outside of the menstrual cycle or after menopause,
• unexplained weight loss, and
• an increase in waist circumference without weight gain, caused by an increased accumulation of fluid in the abdominal cavity (ascites).

The location of the uterus and ovaries in the body © SciePro | AdobeStock

Ovarian cancer is staged according to the FIGO classification (International Federation of Gynecology and Obstetrics). There are four tumor stages:

• FIGO I: The ovarian cancer has affected only the ovarian tissue. Either one ovary or both ovaries may be affected.
• FIGO II: The ovarian cancer has already spread within the pelvis.
• FIGO III: The ovarian tumor has already metastasized to the peritoneum or lymph nodes.
• FIGO IV: The tumor tissue has already spread outside the abdominal cavity, for example, in the form of distant metastases.

A preliminary diagnosis of “ovarian cancer” is usually made following nonspecific symptoms, particularly when a gynecological examination is also performed as part of the evaluation.

If ovarian cancer is suspected, the doctor will conduct further tests to

• determine the size,
• extent,
• location, and
• nature

of the ovarian tumor. This may include, among other things, an ultrasound examination of the abdominal region (abdominal ultrasound) and the vagina (vaginal ultrasound). A CT scan may also be performed.

However, a definitive diagnosis can only be made during surgery, when tumor tissue is removed. The tissue is then examined under a microscope by a pathologist to check for malignant cancer cells.

Ovarian cancer is treated by gynecologists specializing in gynecologic oncology.

Surgery and chemotherapy are the two main treatment options available for ovarian cancer. Which one is used depends on the stage of the disease. In most cases, however, treatment consists of a combination of both approaches.

During surgery, the tumor is first removed as completely as possible. This usually involves

• both ovaries,
• the uterus,
• the fallopian tubes,
• a portion of the peritoneum,
• the appendix, and
• lymph nodes in the pelvis and along the abdominal aorta

are removed.

The surgery often needs to be supplemented with chemotherapy, even if all tumor tissue has been removed. In cases of advanced ovarian cancer, chemotherapy is often supplemented with antibody therapy using the active ingredient bevacizumab. The antibody therapy is intended to prevent any remaining cancer cells from forming new blood vessels. A tumor, too, requires a blood supply.

Following treatment for ovarian cancer, regular follow-up examinations are important. They serve to detect a possible recurrence—that is, the reappearance of ovarian cancer—as early as possible.

These follow-up examinations should

• quarterly during the first three years after completion of therapy,
• every six months for the following two years, and
• annually thereafter

. The follow-up examination typically includes a physical examination of the abdomen and genital area, as well as an ultrasound of the abdominal and pelvic organs. In addition, the doctor will ask about any possible symptoms. Whether tumor marker testing is appropriate must be decided on a case-by-case basis.

The topic of ovarian cancer demonstrates that, depending on the type and stage of the disease, the course of the illness can vary greatly; this is why the diagnosis of ovarian cancer is crucial for women with the disease. Structured treatment and targeted therapy are particularly necessary for advanced ovarian cancer, for women with ovarian cancer, and for patients with advanced ovarian cancer, since ovarian cancer is often detected at a late stage and frequently remains asymptomatic for a long time.

When it comes to ovarian cancer, symptoms of ovarian cancer, signs of ovarian cancer, and indications of ovarian cancer play a central role, as ovarian cancer arises, develops, and occurs without typical symptoms being noticeable, particularly in the early stages or in early-stage ovarian cancer. Various factors that promote ovarian cancer or are causes of ovarian cancer contribute to its development, although the exact causes of ovarian cancer are not yet fully understood, and ovarian cancer often causes only nonspecific symptoms at first.

Depending on the situation, treatment may include surgery for ovarian cancer, supplemented by diagnosis and treatment in accordance with the patient guideline on ovarian cancer and the recommendations of the Consortium for Familial Breast and Ovarian Cancer, particularly in cases of breast or ovarian cancer.