Ovarian cancer. Early diagnosis saves life: How to detect it?

Ovarian cancer is also known as ovarian cancer.

Any woman of any age can encounter ovarian cancer.

This disease affects a quarter of a million women worldwide every year. Early detection of the disease is important for successful treatment.

The ovaries are a paired oval-shaped organ located in a small pelvis. Every month in a woman's reproductive life, they produce an egg ready for fertilization and the female sex hormone estrogen.

How does cancer arise?

Cancer occurs when cells mutate and have a mistake in their DNA.

After the mutation, the cell grows and multiplies rapidly. More abnormal cells and a tumour are formed. The abnormal cells survive after the healthy cells die. They can invade surrounding tissues. Some of them may detach and travel elsewhere in the body. This is called metastasis.

Ovarian cancer is caused by cells in the ovary that suddenly start to grow and multiply. They form a cluster of cells - a tumour.

Tumours are divided according to their malignancy into

Malignant - Malignant tumors tend to grow rapidly and spread to the surrounding area. They invade healthy tissues and form other foci, metastasize. They can grow to large sizes and cause problems by their pressure on surrounding organs.

Benign - Non-malignant tumours (called 'false tumours') grow slowly and do not attack surrounding tissues. These are various formations such as a cyst, abscess, myoma. They can be large, filled with fluid, blood, pus. They are usually circumscribed. Surgery removes the entire lesion.

Semimalignant tumors - Their biological behavior is not clear. We don't know how they develop. They are tumors that are between benign and malignant.

The cause of ovarian cancer is not clear. Certain factors increase the risk of ovarian cancer.

It most often affects older women after the age of 50 and women after menopause.

A family history of inherited genetic disorders that includes a history of breast or ovarian cancer increases a woman's risk of ovarian cancer.

Healthy women have a lower risk compared to women with hereditary predispositions. The occurrence of breast cancer in the mother or sister before the age of 50 and the presence of bilateral breast and ovarian cancer in the family increases the risk. In this case, genetic testing is performed.

Other risk factors are

Reproductive factors - A higher number of ovulations taking place in the body also increases the risk. It is caused by early menstruation and late onset of menopause.

Ovarian tumors arising from surface cells (epithelial type) are attributed to the influence of estrogen.

Age - Ovarian cancer can occur at any age, but women after the age of 50 are more at risk.

Weight - Obesity increases the risk of cancer and other serious diseases.

Endometriosis - The endometrial lining occurs anywhere in the body and affects other organs near it.

Smoking

Taking certain fertility drugs or hormone treatments

Occurs more often in women who have never given birth or who gave birth to their first child after the age of 35.

Prevention

No method of prevention can prevent the development of ovarian cancer. There are ways to reduce the risk.

Low-hormone birth control pills taken for more than 5 years reduce the risk of ovarian cancer by up to 40%. But they increase other risks. Your doctor will recommend the most appropriate form of birth control pill for you.

Breastfeeding and pregnancy reduce the risk.

Removing the uterus reduces the risk of ovarian cancer.

Avoiding obesity, smoking and other risk factors reduces the risk.

A healthy lifestyle, intake of plenty of fruits and vegetables, without added sugars and fats reduces the risk.

A genetic counselor can be consulted if ovarian or breast cancer runs in the family. They will identify any gene mutation. Based on the results, they will consider subsequent removal of the ovaries to prevent cancer.

In the early stages of ovarian cancer, there may be few or no symptoms.

Therefore, it is very important to monitor and know your body. Regular check-ups with your gynaecologist once a year are most important.

In the early stages, symptoms may manifest as uncomfortable pressure in the lower abdomen. It is often attributed to premenstrual syndrome. Irritable bowel syndrome or frequent urination may occur.

In ovarian cancer, these symptoms do not subside. On the contrary, they persist and worsen.

Early symptoms include

• Abdominal and pelvic pain
• Unexpected vaginal bleeding
• Back pain
• Bloating and abdominal discomfort
• Indigestion, rapid onset of feeling full
• Frequent urination, sudden urge to urinate
• Disorders of defecation, diarrhoea, constipation

If any of these symptoms persist for more than 2 weeks, it is a good idea to see a doctor.

Other possible symptoms:

• Enlarged lymph nodes in the groin, neck, armpit or just above the collarbone
• Increased fatigue
• Dizziness
• Pain during intercourse
• Unappetite, feeling full after small amounts of food
• Irregular menstrual cycle
• Increase in abdominal girth
• Weight loss or gain, especially in the abdomen
• Vaginal discharge, colourless, white or bloody

The earlier cancer is diagnosed, the better the chance of a cure.

A woman often does not take ongoing symptoms seriously and seeks medical help late. Then treatment is no longer possible.

Diagnosing ovarian cancer is very difficult. Even with regular gynaecological examinations, it may not be detected at an early stage.

If symptoms have already appeared, it is necessary to undergo an examination by a doctor.

The basis of diagnosis is an assessment of the medical history and a gynaecological examination.

This is followed by a gynaecological ultrasound examination of the small pelvis and a transvaginal ultrasound examination. The doctor tries to catch deviations from normal.

Blood is drawn for blood tests and oncomarkers.

Other tests:

Chest X-ray

CT scan of the abdomen and pelvis

MRI of the abdomen and pelvis

A biopsy is often performed during surgery for ovarian cancer. It is used to determine the exact type of cancer. The biopsy itself is done when the diagnosis is unclear or for a large tumor. It is done to determine the correct chemotherapy and to shrink the tumor before surgery.

In the early stages, a woman may not have any visible symptoms. It is very difficult to detect ovarian cancer during a routine gynaecological examination. Sometimes it proceeds silently, without early symptoms.

Many women come to the doctor at an advanced stage of ovarian cancer. Until then, they have had no difficulties and have not paid attention to symptoms such as bloating or enlarged nodes.

The course of ovarian cancer can manifest itself in different ways.

As the tumor multiplies uncontrollably, invades healthy cells and metastasizes, unexplained abdominal pain, bloating, abdominal discomfort begin to appear. It is only at an advanced stage that the symptoms are most pronounced. At that time, there may already be cancer cells in the surrounding organs, especially in the uterus. This worsens the prognosis.

Once a tumour has been detected, a series of tests must be carried out to determine the type and stage of ovarian cancer.

During a biopsy, a sample of tumour tissue is taken. The tissue is carefully examined under a microscope. The type of tissue from which the cancer originated is distinguished by its appearance.

The types of ovarian cancer are distinguished as follows

• Epithelial- up to 90% of all ovarian cancers - serous, mucinous, endometrioid, clear cell carcinoma.
• Non-epithelial make up 10%.

The stage of the tumour is determined by the size of the tumour, by spread to the surrounding area and by lymph node involvement.

Staging

1. stage - The cancer is found only in the ovary.
2. stage - Cancer has affected one or both ovaries and has spread to the surrounding area.
3. stage - Cancer has affected one or both ovaries, the area above the pelvis or has spread to the lymph nodes.
4. stage - Cancer has affected distant organs (lungs, liver, brain).

Fertility preservation

Women who have overcome ovarian cancer at a young age have difficulty getting pregnant in the future. This may be due to cancer treatment, radiation, chemotherapy or surgical removal of the ovaries.

Current fertility preservation options include:

• Freezing the embryo, the fertilized egg
• Freezing an unfertilised egg
• Removal of only one ovary affected by cancer. The other healthy ovary is left