Ovarian Cancer

Definition: What Is Ovarian Cancer

Ovarian cancer is a malignant tumor disease that originates from the cells of the ovaries. Approximately 8000 women are diagnosed with ovarian cancer every year. After cervical cancer, ovarian cancer is the second most common genital tumor in women.

The prognosis for ovarian cancer is significantly worse because tumors of the ovaries are often discovered late and are very aggressive. Principally, ovarian cancer can occur at any age, although the probability increases significantly with age.

Causes and Risk Factors: Why Does Ovarian Cancer Develop?

A specific cause has not yet been identified. However, there seems to be an individual, familial predisposition. Various gene changes (mutations) are more common in tumor patients with ovarian cancer. Some of them are also more common in breast cancer (BRCA1, BRCA2). Familial ovarian cancer usually occurs ten years earlier than the average age of 60 in Germany.

Another risk factor is the number of ovulations. The more ovulations a woman has, the higher the risk. Thus, a low number of pregnancies and the infrequent use of the pill lead to an increased incidence of ovarian cancer. Eating habits and being overweight can also favor the development of ovarian cancer.

The Symptoms: How Can Ovarian Cancer Be Noticed?

Unfortunately, ovarian cancer is a type of cancer that develops symptoms very late. Since the abdominal cavity offers a lot of space for the tumor to spread, symptoms usually only occur when both ovaries and other organs are already affected, and the tumor is about 10cm large.

The first symptoms can be slight abdominal pain and vaginal bleeding. Later, when the peritoneum, pelvic organs up to the diaphragm are involved, constipation, pain during a bowel movement, feeling of fullness, nausea, back pain, and problems with urination may occur.

Water retention in the abdominal cavity (ascites) also occurs more frequently and can lead to a bulging, painful abdomen. If cancer cells also spread to the lungs (lung metastases), this can also lead to fluid accumulation and breathing difficulties.

As the tumor can exhaust the body enormously, sufferers are often emaciated despite a bulging abdomen, which is particularly noticeable in the face (facies ovarica).

Diagnosis: How Is Ovarian Cancer Diagnosed?

Tumors (elevations) on the ovaries are often noticed during the ultrasound examination by the gynecologist. These are usually harmless fluid-filled bladders (cysts), which may be subject to hormonal fluctuations. In rare cases, it can be a malignant tumor of the ovaries, ovarian carcinoma.

The patient interview and the physical examination by the gynecologist usually do not indicate ovarian cancer until the late stage (e.g., by a palpable tumor). Earlier stages are often discovered by a transvaginal ultrasound examination (ultrasound examination through the vagina).

In rare cases, a CT examination or an MRI scan is also carried out. The final confirmation of the diagnosis is made by laparoscopy with removal and later examination of the tissue.

Treatment: How Is Ovarian Cancer Treated?

The primary therapy is always surgery. The aim of the To be able to visually assess the various organs up to the diaphragm, a large longitudinal incision must be made in the midline of the abdomen. Laparoscopic surgery is only considered in the case of early-stage ovarian cancer is.

First, a biopsy of the tumor is examined by a pathologist. Only if the suspicion of ovarian carcinoma is confirmed, the surgery where the ovaries and uterus are removed will be continued. The omentum and parts of the peritoneum are also removed.

Then all organs, lymph nodes, and the diaphragm are examined in detail and, if possible, all other visible tumor parts are removed. It may be necessary to remove the spleen, parts of the bladder, and the intestines as well. During these often difficult operations there is close cooperation between gynecologists, surgeons, urologists, and the intensive care unit.

The more parts of the tumor can be removed, the greater the chance of recovery through subsequent chemotherapy. The chemotherapy, which usually lasts four months, is intended to kill off remaining tumor cells.

Ovarian carcinomas, which are classified as early stages, must also be intensively examined during surgery, as in 40% of cases a greater spread of the tumor is discovered during surgery.

The possibility of a fertility preserving surgery (if you wish to have a child) is only possible in the earliest stage, when the ovarian carcinoma is limited to one ovary. The complete surgery will be carried out after completed family planning.

Treatment of Relapse

Unfortunately, ovarian cancer tends to reappear even after complete removal of the tumor. Then further surgery, chemotherapy or antibody therapy may be necessary to relief the symptoms and prolong the lifetime. A cure after a relapse is rare.

Chances of Recovery: What Is the Prognosis for Ovarian Cancer?

In recent years, despite innovations in medical research, the cure rates for ovarian cancer have not improved much because of the late diagnosis of this type of cancer. In about 75% of cases, ovarian cancer has already spread to other organs by the time it is discovered.

The prognosis depends strongly on the stage of the tumor and the patient's state of health. The 5-year survival rate is at best 80% and decreases to as low as 10% as the tumor spreads.

After macroscopic tumor-free surgery, the chances of recovery should be 60%. In the higher stages, a relapse or progression of the tumor under therapy is expected in 65% of cases.

Since the known tumor markers are not specific for ovarian cancer, they cannot be used for early detection, but they are used in tumor aftercare to detect relapses soon and possibly treat them.

For more detailed information regarding therapy options and the course of the disease, please contact your gynecologist in confidence.

Why Should I Be Treated by a Specialist for Ovarian Cancer?

Patients who have ovarian tumors want the best medical care. Therefore, the patient is wondering where to find the best clinic for ovarian cancer.

Since this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor’s experience. The more patients with ovarian cancer a doctor treats and operates on, the more experienced he becomes in his specialty.

Gynecologists and gynecological clinics with a focus on gynecological oncology have great experience in the treatment of ovarian cancer. They are usually certified as gynecological cancer centre and/or breast cancer center, which guarantees optimal and up-to-date diagnostics and therapy. Many centers also participate in studies to develop new surgical procedures and therapeutic methods in the fight ovarian cancer.

Sources:

• www.awmf.org/leitlinien/detail/ll/032-035OL.html
• www.nds-krebsgesellschaft.de/bilder/pdf/123.pdf
• Stauber, Manfred; Weyerstahl, Thomas (2007): Gynäkologie und Geburtshilfe. 3., aktualisierte Auflage. Stuttgart: Georg Thieme (Duale Reihe).
• Keck, Christoph; Denschlag, Dominik; Tempfer, Clemens (2004): Facharztprüfung Gynäkologie und Geburtshilfe. 1000 kommentierte Prüfungsfragen ; 6 Tabellen. Stuttgart: Thieme.