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Ovarian Cancer

Compared to other gynecological cancers, early ovarian cancers give almost no symptoms. Routine ultrasound examinations play a major role in the diagnosis of ovarian cancer, where early diagnosis is important. Gynecology and Obstetrics Department and Oncology Specialists of Uniqacare provided information about ovarian cancer.

What is ovarian cancer?


Epithelial cells form the main structure of the ovaries, which have many different cells in their tissues. Ovarian cancer may occur as a result of uncontrolled division and proliferation in epithelial cells or cells of the embryonic period. 80 percent of ovarian cancers, which are mostly seen after menopause, occur in the epithelial tissue. Embryonic tumors are seen in 60 percent of ovarian cancers seen under the age of 20.


What are the symptoms of ovarian cancer?


Ovarian cancer symptoms often do not show themselves much. Although most of the symptoms related to ovarian cancer are specific to the patient, there are no typical findings. As symptoms of ovarian cancer, it can also be said as a symptom of many diseases; abdominal pain, bloating and stomach disorders can be listed. In the advanced stages, the biggest symptom of ovarian cancer is a palpable mass in the abdomen, a feeling of downward pressure, fluid accumulation in the abdomen, abdominal swelling, urinary and intestinal complaints due to pressure on the surrounding organs.


​Hormone imbalances can be seen in some types of ovarian cancer. As a result, menstrual irregularities, hair growth due to increased male hormone secretion, male pattern hair loss can be seen. Most ovarian cancer complaints are about abdominal swelling. 


We can list the general symptoms of ovarian cancer as follows;


Change in bowel habits, especially the appearance of constipation,

Change in bladder habits, the need to urinate frequently,

Loss of appetite or feeling full quicklyvaginal bleeding,weight loss,

Feeling of pressure and bloating in the abdomen,

Fullness or pain in the groin,Prolonged indigestion, gas or nausea.


What are the causes of ovarian cancer?


Although the causes of ovarian cancer are not known very clearly, it can be mentioned that some risk factors cause this disease. Genetic, environmental and hormonal factors can be shown among the causes of ovarian cancer. 


We can list the causes of ovarian cancer as follows;


Those with a family history of breast or ovarian cancer are at increased risk. In recent years, changes in some genes have led to an increased risk of ovarian cancer.

The risk of ovarian cancer increases in those who use drugs that increase ovulation.

The use of birth control pills reduces the risk of ovarian cancer.

The risk of ovarian cancer is higher in those who have never been pregnant. The risk is reduced in those who have given birth.


How is ovarian cancer diagnosed?


Early diagnosis of ovarian cancer is very important as in all other cancers. It is recommended that women do not delay their annual routine gynecological controls for early diagnosis. A palpable mass in a gynecology examination or a mass seen in the ovaries during an ultrasound gives the chance to intervene early in cancer. 


Not every cyst in the ovaries is cancer. Most of the cysts seen especially in women of reproductive age are simple and harmless cysts. These cysts, which disappear on their own over time, do not carry the risk of cancer. For this reason, it is determined whether the cysts monitored on ultrasound by the specialist doctor are harmful or do not have any negative effects on the body. In addition, all kinds of cysts in menopausal women and premenstrual young girls are open to the risk of tumor. It should definitely be evaluated from this point of view.​


In the advanced stages of ovarian cysts and masses with tumor characteristics, tumor markers are checked in the blood. Some tumor markers (especially CA 125) are elevated in some types of ovarian tumors. However, high levels of CA125 and other tumor markers do not always indicate that the mass is cancer, and low tumor markers do not exclude cancer. Apart from tumor markers, Doppler ultrasonography can also help differentiate benign and malignant tumors by showing blood flow changes. All these methods are helper methods. None of them is sufficient to make a definitive diagnosis. To perform surgery in cases that cannot be differentiated from cysts and masses that are thought to be tumoral (whether benign or malignant) and pathological findings during surgery. Taking a sample biopsy provides a definitive diagnosis.


​In the presence of a cyst, if tumor markers and Doppler examinations are normal, there is no finding suggesting a tumor with ultrasound and examination, and if the cyst is smaller than 8 cm, it can be followed for a while. If there is no shrinkage or disappearance during follow-up, surgery is preferred.


How is ovarian cancer treated?


Ovarian cancer treatment is surgical, and not only the uterus and ovaries, but also all tissues that are likely to be retained in the body are removed. After surgery, chemotherapy is applied. Surgery is used in all stages of ovarian cancer. In the treatment of ovarian cancer, if the removal of the mass carries the risk of damaging vital organs, it is aimed to reduce the mass with chemotherapy first. Then, the cancerous masses and tissues are intervened with the principle of surgical method. After ovarian cancer surgery, chemotherapy may not be needed if the cancer does not spread throughout the body. If ovarian cancer spreads, chemotherapy or radiotherapy should be applied. Although chemotherapy varies according to the stage of the disease, 6-9 cycles are applied after the operation.​


New treatment alternatives in ovarian cancer are now being applied frequently in our country. Treatments with targeted agents increase the likelihood of cure, prolong survival, and provide significant symptomatic relief. In the treatment of ovarian cancers, great attention is paid to the protection of reproduction. Especially in germ cell ovarian cancers and borderline type ovarian cancers seen at an early age, only the cancerous tissue or cancerous ovary is removed, and it is possible to get pregnant by protecting the uterus and opposite ovary.


FREQUENTLY ASKED QUESTIONS ABOUT OVARIAN CANCER

What are the stages of ovarian cancer?


In the treatment of ovarian cancer, it is very important at what stage it is diagnosed. It is necessary to know whether the cancer has spread from your ovary to its surroundings and to the surrounding organs. The staging of ovarian cancers is determined by the extent of spread of the cancer.


Stage 1: The cancer is in one or both ovaries, but only in the ovary.

Stage 1a: The cancer is confined to one ovary and within the ovary.

Stage 1b: The cancer is in both ovaries, but is still confined to the ovaries.

Stage 1c: Cancer is in one or both ovaries, but it has also spread beyond the ovarian border. A tumoral cyst on the ovary has burst, or cancer cells have been found in the fluid in the abdomen.

Stage 2: The cancer has spread to other organs in the area called the pelvis and surrounded by the pelvis.

Stage 2a: The cancer has spread to the uterus, fallopian tubes, or both.

Stage 2b: The cancer has spread to the bladder or large intestine.

Stage 2c: Cancer has had any of the spreads in 2a and 2b. In addition, the cancer has spread beyond the ovarian border, a tumoral cyst on the ovary has burst, or cancer cells have been found in the fluid in the abdomen.

Stage 3: The cancer has spread to the abdomen or has involved the lymph nodes.

Stage 3a: Cancer cells have spread to the abdomen, but are in foci so small that they can only be seen under a microscope.

Stage 3b: Cancer cells have spread to the abdomen but are less than 2 centimeters in size.

Stage 3c: Cancer cells have spread to the abdomen and are larger than 2 centimeters, or have spread to the lymph nodes, or both conditions are present.

Stage 4: The cancer has spread to the liver, lungs or other distant organs.


What is the importance of early diagnosis in ovarian cancer?


The response of ovarian cancer to treatment is directly related to how far the tumor has spread. When ovarian cancer is diagnosed at an early stage and with appropriate treatments, 80-90 percent of it can be eliminated. The cure rate for ovarian cancers diagnosed in advanced stages is 40-50 percent. After ovarian cancer surgery and chemotherapy, it should be checked regularly for the possibility of recurrence of the disease.


Is ovarian cancer deadly?


Ovarian cancer is a very important disease that can be seen at any age, seriously threatening women's health and life. Ovarian cancer is the most lethal of female genital organ cancers. Compared to other gynecological cancers, early diagnosis of ovarian cancers can be made very late, as they do not show any preliminary symptoms. Therefore, routine gynecological USG is important in early diagnosis.


Is there a high risk of ovarian cancer after menopause?


Ovarian cancer is divided into two depending on the type of tissue it originates from. The type of the disease, the probability of its occurrence and the age of onset vary. People who have never given birth and have a family history of breast and ovarian cancer are at increased risk of developing the disease. However, the most important risk factor is considered to be advanced age. Estrogen hormone support alone, especially after menopause, is among the factors that trigger ovarian cancer.


What is CA 125?


CA125 is a protein found on the surface of most ovarian cancer cells. It can be significantly higher in the blood of women with ovarian cancer. Small amounts of this protein can also be produced in some other cancers.


What is CA 125 in ovarian cancer?


Values ​​between 0 and 35 are normal in the CA 125 test. If there is a figure between 35-50, this patient should be under control. Ovarian cancer is suspected at values ​​above 50. However, CA 125 may not be high in every ovarian cancer.


Where does ovarian cancer metastasize?


Ovarian cancer can spread to various organs in advanced stages. In the treatment, it is necessary to know whether it spreads around the ovary and to the surrounding organs. The most important feature of this cancer is the spread to the intra-abdominal organs. Patients are usually diagnosed at an advanced stage because of the spread to the abdominal organs in a short time. Ovarian cancer can spread to the small and large intestines. It can also metastasize to the peritoneum, pelvis, lung and liver.


Can ovarian cancer be confused with other diseases?


Since symptoms such as digestive complaints, pain in the groin area and constipation can be seen in ovarian cancer, patients may lose time to gastroenterology or internal medicine services to see if there is a problem in the digestive system. Sometimes the diagnosis can be made by these doctors. If there is a digestive system problem in the advanced age group, it should be applied to the gynecology department.


Is ovarian cancer surgery open?


If there is fluid collection in the abdomen and tumor spread in the advanced stage, open surgery is performed. In some cases, the prevalence can be observed by laparoscopy, while if there is no large prevalence, tumors seen in the same session can be removed. Or, in these patients, laparoscopic or robotic surgery can remove the uterus, ovaries, and lymph nodes, as well as appendicitis in the needy group. Chemotherapy is planned according to the pathology.

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