Ovarian Cancer

Overview

• Course and prognosis of the disease: Usually very good only with identifiable tumors in the ovarian region; in the last stage and in case of metastasis (infection of organs outside the abdominal cavity) the chances of recovery drop significantly
• Treatment: Operation to remove ovaries, fallopian tubes, uterus, large abdominal cavity, if necessary bowel, appendix or lymph nodes; chemotherapy, rarely radiotherapy
• Causes and risk factors: Largely unknown; Increased risk due to genetic factors, predisposition, many female cycles, certain environmental influences; Risk is lower through birth control and pregnancy
• Diagnostics: Abdominal scan, ultrasound, computer and/or magnetic resonance imaging, cystoscopy or rectal examination, blood test, tissue sample.

What is Ovarian Cancer?

Ovarian cancer (ovarian carcinoma) is a cancerous (malignant) tumor of the ovaries. They are located to the left and right of the uterus and have a relatively large area – because their position and size change slightly during the female cycle. A tumor in the ovary therefore usually only causes symptoms at an advanced stage and is detected late in about 75 percent of cases. In up to 50 percent of cases, the cancer has spread to both ovaries.

Doctors distinguish between different types of tumors in ovarian cancer, depending on the tissue cells in which the tumor forms.

Epithelial tumors make up the majority of tumors in ovarian cancer and originate from cells in the top layer (epithelium) of cells in the ovaries. An example is Brenner’s tumor, which is mostly benign and affects postmenopausal women. This tumor is rarely malignant. Other forms such as serous cystadenocarcinomas or mucinous carcinomas are clearly malignant.

Sex cord stromal tumors form a group of different tumors that develop from embryonic sex cords or cells of the sex glands (gonads). There are benign and malignant forms. The group of pure stromal tumors is predominantly benign.

Pure sex cord tumors include, for example, granulosa cell tumors (GCTs), which are considered less malignant. The group of mixed sex cord stromal tumors includes Sertoli-leydig cell tumors and the sex cord stromal tumor NOS. They cannot be assigned precisely according to tissue changes.

Germ cell tumors originate directly from germ cells (egg cells) and develop during childhood or adolescence. The most common benign tumor in this group is mature teratoma, while dysgerminoma is the most common malignant germ cell tumor.

Malignant ovarian cancer rapidly forms secondary ulcers called metastases. They mainly spread into the abdominal cavity and peritoneum. Liver, lungs The pleura or lymph nodes are sometimes also affected through the blood and lymphatic system.

Ovarian Cancer Stages

The disease progresses in four stages, divided according to the FIGO classification (Fédération Internationale de Gynécologie et d’Obstétrique):

• FIGO I: Early stage. Ovarian cancer affects only the ovarian tissue (one or both ovaries are affected).
• FIGO II: The tumor has already spread to the pelvis.
• FIGO III: Cancer has spread to the peritoneum (peritoneal carcinosis) or lymph nodes.
• FIGO IV: Very advanced stage. Tumor tissue is already outside the abdominal cavity (e.g. distant metastases in the lungs that reach there via the bloodstream or lymphatic system).

Another internationally used stage classification is based on the TNM system (Tumor Nodus Metastases), which classifies the extent of the tumor, as well as the involvement of lymph nodes (nodus) and the presence of secondary tumors. It is consistent with the FIGO classification, so only one of the two systems is usually present in the diagnosis.

Ovarian cancer mostly affects older women after menopause. According to the Robert Koch Institute (RKI), the average age of onset is 69 years. Ovarian cancer rarely occurs before the age of 40. Ovarian cancer is the second most common cancer of the female genital organs after breast cancer. The risk of developing a malignant tumor in the ovaries is 1.3 percent (one in 76 women is affected).

Other ovarian tumors

Tumors also occur in the ovaries that are not caused by degeneration of ovarian cells, such as female tumors of other cancers. This includes krukenberg tumor, which occurs as a secondary tumor of stomach cancer.

How does ovarian cancer progress?

In most cases, the tumor develops unnoticed without any early symptoms, making it difficult to tell how fast ovarian cancer is growing. This type of tumor is usually only diagnosed at an advanced stage.

Disease confined to the ovaries has a very good prognosis – on average, patients live 15 years or more after diagnosis. However, if metastases have also developed in the abdominal cavity, the chances of recovery are greatly reduced. Complete recovery is possible if the tumor tissue has been completely removed by surgery without the cancerous tissue spreading metastases. Therefore, the earlier a tumor is detected, the better.

If the cancer has already spread to the abdomen, the chances of recovery are poor. In the final stages, ovarian cancer has often spread throughout the body. Organs outside the abdominal cavity, such as the liver and lungs, also contain metastases. The average life expectancy at this stage is only 14 months. In patients with advanced ovarian cancer, the disease often comes back after treatment is completed.

Overall, ovarian cancer has the worst prognosis of all gynecologic cancers.

What is ovarian cancer treatment?

Ovarian cancer treatment mainly consists of two procedures: surgery and chemotherapy. Usually the doctor will treat the patient with a combination of both. Which treatment method is used depends on the stage of the tumor.

Ovarian Cancer Surgery

The chances of surviving ovarian cancer largely depend on the complete removal of the tumor: the ovary (usually both), uterus, fallopian tubes and the large abdominal mesh are therefore usually removed by the doctor. In the case of early diagnosis or clear unilateral tumor involvement, surgery is not absolutely necessary. If the tumor has already spread, it may be necessary to remove additional parts of the peritoneum, parts of the intestine, appendix or lymph nodes. If sections of the intestine have to be removed, those affected are usually given an artificial intestinal outlet (stoma).

The operation also serves diagnostic purposes. The doctor has the opportunity to search the entire abdomen for metastases. For example, if there are markedly enlarged lymph nodes, tissue samples are usually taken for further examination.

Ovarian Cancer Chemotherapy

Chemotherapy is usually given after surgery. Treatment is aimed at preventing further development of tumor foci that have not been removed or not completely removed. The drugs (cytostatics) either affect the whole body or can be given specifically to the abdominal cavity. They kill cancer cells. The most effective against ovarian cancer are platinum-containing substances such as carboplatin, which are administered in combination with other drugs such as paclitaxel.

There are additional drugs that specifically disrupt certain characteristics of the tumor and thus support chemotherapy. For example, substances that suppress the formation of new blood vessels disrupt the supply of oxygen and nutrients to the tumor, slowing its growth.

If an ovarian tumor is detected very early, chemotherapy may not be necessary. Chemotherapy alone is usually successful in patients whose doctors will not operate because of their poor health. Doctors use radiotherapy only in exceptional cases.