Ovarian Cancer

Ovarian cancer develops in the ovaries, fallopian tubes, or peritoneum (the lining of the abdomen). It’s often called a “silent killer” because symptoms are vague and typically appear at advanced stages. Here’s a comprehensive overview:

1. Types of Ovarian Cancer

• • Epithelial Ovarian Cancer (EOC)
    • ~90% of cases.Arises from cells covering the ovary. Subtypes:
      • High-Grade Serous Carcinoma (HGSC): Most common (70-80%), aggressive, often linked to BRCA
      • Endometrioid, Clear Cell, Mucinous: Less common, varied aggressiveness.
      • Low-Grade Serous: Rare, slower-growing.
    • Germ Cell Tumors
      • ~5% of cases.Develop from egg-producing cells. It often affects younger women (teens/20s). Usually curable.
    • Stromal Tumors
      • ~5% of cases.Arise from hormone-producing cells (e.g., granulosa cell tumors). Can cause estrogen/testosterone excess.

1. 2. Symptoms (Often Subtle & Late-Stage)

• • • Early:Bloating, pelvic/abdominal pain, feeling full quickly, urinary urgency.
    • Advanced:Weight loss, fatigue, changes in bowel habits, ascites (fluid buildup), shortness of breath.
    • Key Insight:Symptoms persist >2 weeks and worsen. “E.A.T.”          mnemonic: Bloating, Eating less/fullness, Abdominal pain, Toilet changes.

3. Risk Factors

• • Age:Highest risk in women >50; peak incidence in 60s-70s.
  • Genetics:
    • *BRCA1/BRCA2* mutations (↑ risk of HGSC).
    • Lynch syndrome(↑ risk of endometrioid/clear cell).
  • Reproductive History:
    • ↑ Risk: Nulliparity (no pregnancies), early menstruation, late menopause.
    • ↓ Risk: Oral contraceptive use, multiple pregnancies, breastfeeding.
  • Endometriosis:↑ Risk for clear cell/endometrioid subtypes.
  • Family History:Ovarian, breast, or colorectal cancer.
  • Obesity:Linked to poorer outcomes.

4. Diagnosis

• • Pelvic Exam:May detect masses (limited sensitivity).
  • Imaging:
    • Transvaginal Ultrasound (TVUS):First-line for ovarian masses.
    • CT/MRI/PET-CT:Staging, metastasis detection.
  • Blood Tests:
    • CA-125:Elevated in 80% of advanced EOC (but not specific; can rise in endometriosis, menstruation).
    • HE4, ROMA Score:Complementary biomarkers.
  • Biopsy/Surgery:
    • Definitive diagnosis via tissue biopsy (often during surgery).
    • Staging laparotomy: Assesses spread (critical for treatment planning).

5. Treatment

• • Surgery (“Debulking”):
    • Goal: Remove all visible tumor (“optimal cytoreduction”).
    • Includes hysterectomy, omentectomy, and lymph node removal.
  • Chemotherapy:
    • First-line: Carboplatin + Paclitaxel (IV or IV + intraperitoneal).
    • Neoadjuvant chemo: Shrinks tumors before surgery (for advanced/unresectable cases).
  • Targeted Therapies:
    • PARP Inhibitors (Olaparib, Niraparib): Maintenance therapy for BRCA-mutated or HRD+ tumors.
    • Bevacizumab (Anti-VEGF): Inhibits blood vessel growth.
  • Hormone Therapy: For stromal/low-grade tumors (e.g., aromatase inhibitors).
  • Immunotherapy & Clinical Trials: Emerging role (e.g., checkpoint inhibitors).

6. Prognosis

• • 5-Year Survival:
    • Stage I: ~90%
    • Stage III: ~40%
    • Stage IV: ~20%
  • Key Factors:Stage, tumor subtype, residual disease post-surgery, BRCA

7. Prevention & Early Detection

• • High-Risk Women:
    • BRCA+: Risk-reducing salpingo-oophorectomy (removal of ovaries/tubes).
    • Regular TVUS + CA-125 (though screening not proven effective for average-risk women).
  • General: Birth control pills reduce risk by 30-50% with long-term use.