Ovarian cancer occurs in women, especially after the age of 45, in the form of tumors that develop in one or both ovaries. In most of the cases, it arises from the outer lining of the ovary called epithelium. Sometimes, it occurs from the egg cells (germ cell tumor). Ovaries are that part of the female reproductive system, which release ova or eggs and also produce essential hormones like estrogen, testosterone, and progesterone. Due to a process called metastasis, the tumors caused by malignancy intrude the neighboring organs or lymph nodes. They may enter the bloodstream and spread to other body organs.
It is difficult to diagnose ovarian cancer, as the observable symptoms occur quite late in the disease. Initially, the symptoms are not noticeable until the tumors grow and apply pressure to other organs in the abdomen. This leads to diagnostic delays, resulting in a late metastatic ovarian cancer and poor prognosis. Some of the late symptoms of the disease include menstrual irregularity, pelvic pain or pressure, abdominal swelling or bloating, abnormal pubertal development, urinary frequency, ascites, diarrhea, and nausea.
Staging of a cancer helps the doctor to know how far the disease has spread. For this purpose, samples of tissues are taken from different parts of the pelvis and abdomen, and examined under intense observation. The staging should be accurate, as the prognosis and treatment are often decided according to it.
There are four stages in ovarian cancer:
- Stage 1: Only the ovaries are affected.
- Stage 2: The disease spreads outside the ovaries and enters the pelvis.
- Stage 3: It spreads outside the pelvis, into the abdominal cavity, and is also detected in the lymph nodes in the upper abdomen, groin, or behind the womb.
- Stage 4: Stage 4 is the final stage. The patients display parenchymal liver metastases and extra-abdominal metastases at this level. Liver and lungs are the most common areas where the cancer spreads. The spleen may also get affected, while some patients exhibit metastases of the brain.
When the patient reaches the final stage which is most advanced and dangerous, the treatment begins with a surgery that includes hysterectomy (surgical uterus removal) and chemotherapy. Though it is difficult to eradicate the cancer completely, both optimal cytoreductive surgery and platinum-based chemotherapy prolong the time till its recurrence and increase chances of overall survival. In cytoreductive surgery, the physicians try to remove most of the malignancy from the patient's body by reducing the number of affected cells.
Clinical studies have shown that the patients who had undergone this surgery, benefited from prolonged duration of survival and lesser chances of recurrence. Chemotherapy is usually performed after the surgery and consists of paclitaxel and a platinum compound administered every 3 weeks for 6 - 8 cycles. This treatment is considered to be best for patients who have reached the advanced stage of ovarian cancer.
Though the purpose of treatment for stage 4 ovarian cancer is to increase the patient's chances of cure and survival, there are a variety of factors that influence a patient's decision regarding the treatment. Along with that, the key factor for surviving this disease is to have a positive, upbeat attitude towards the situation.