The term ovarian cancer includes all malignant tumors of the ovary (ovary). In most cases, it is a so-called ovarian carcinoma, and more rarely scattered sites (metastases) of other cancers are found in the ovaries.
Diagnosis of ovarian cancer
Ovarian cancer is the second most common cancer of the reproductive organs in women after uterine cancer (endometrial cancer). Because there are usually no symptoms at the beginning, the diagnosis is often made at an advanced stage. Therefore, the prognosis for ovarian cancer is rather unfavorable compared with other cancers, because in many cases the tumor can already not be completely removed by surgery at the time of diagnosis.
Early stage: nonspecific signs
Usually, ovarian cancer does not cause any characteristic symptoms in the early stages. Any early symptoms that may occur can have a variety of other – often harmless – causes. For example, nonspecific symptoms of ovarian cancer include:
- Disorders of the menstrual cycle: bleeding in between, too frequent, too infrequent or absent menstrual bleeding.
- New-onset or unusually severe pain during menstruation or during the period of ovulation.
- Unusually heavy or prolonged menstrual bleeding
- Bleeding after menopause
- Lower abdominal pain
- Feeling of fullness or pressure in the lower abdomen
- Unexplained weight loss
- Fever
- Heavy night sweating
Ovarian cancer: symptoms in the late stages.
As a typical sign of advanced ovarian cancer often occurs a so-called abdominal dropsy (ascites). The reason for this is cancer cells that settle within the abdominal cavity and lead to an accumulation of fluid in the abdominal cavity due to, among other things, an obstruction of the lymphatic drainage. Patients usually first notice this as a growth in the circumference of the abdomen. If the cancer cells spread via the lymphatic vessels to the pleura, an accumulation of fluid (pleural effusion) may also occur there. This can then manifest itself as discomfort when breathing. If the tumor is so large that it presses on the surrounding organs, the following symptoms may occur:
- Diarrhea
- Constipation
- Flatulence
- Increased urination
- Urinary retention with flank pain
Masculinization in hormone-producing tumors.
Rare subsets of ovarian tumors can produce sex hormones, leading to specific symptoms: If the tumor produces the male sex hormone testosterone, this leads to masculinization (virilization or androgenization),which may be manifested by increased body hair growth, hair loss on the head, and a deeper voice. Another type of tumor produces the female sex hormone estrogen, causing thickening of the uterine lining. As a result, irregular, absent or increased menstrual periods and infertility may occur.
Differential diagnosis: other causes of symptoms
Many of the signs of ovarian cancer are nonspecific – meaning that a variety of other causes may also be causing the symptoms. For example, menstrual irregularities are much more often caused by an imbalance in hormones or by ovarian cysts. Endometriosis – a disease in which the lining of the uterus is found outside the uterus – is also a frequent cause of menstrual complaints. If menstruation is absent altogether, extrauterine pregnancy – a pregnancy in which the egg implants outside the uterine cavity – should also be considered. Behind lower abdominal pain in conjunction with fever, on the other hand, may also be ovarian inflammation.
Meigs syndrome in benign ovarian tumor.
Abdominal dropsy and a pleural effusion may indicate diseases of the lungs, liver, and heart, as well as various cancers. In rare cases, a benign ovarian tumor (ovarian fibroma) may also be the cause – the combination of symptoms is then called Meigs syndrome.
Age and gene mutations as risk factors
About one to two percent of all women develop ovarian cancer in their lifetime. Women after the age of 45 are usually affected – younger patients often have a mutation in a gene (BRCA1 or BRCA2), which significantly increases the risk of ovarian cancer.Since these mutated genes are hereditary, there may be an accumulation of ovarian cancer and other cancers – for example breast cancer – in the family. In addition, the following risk factors can promote the occurrence of ovarian cancer:
- Early first menstrual period (before the age of 12).
- Late last menstrual period (after the age of 50).
- Few or no pregnancies
- Drug stimulation of ovulation – for example, in the context of artificial insemination.
- Polycystic ovary syndrome (PCO syndrome).
- Lynch syndrome (HNPCC syndrome)
- Nicotine use
- Infertility
Because the occurrence of many ovulations in a lifetime (such as when a woman has her period for 40 years) can increase the risk of ovarian cancer, hormonal contraceptives such as birth control pills may have a protective effect by suppressing ovulation.
Ovarian cancer: diagnosis by ultrasound
If ovarian cancer is suspected, the gynecologist will first perform a physical examination with palpation of the abdomen after taking a medical history. This is usually followed by an ultrasound examination through the vagina. A CT scan or MRI, on the other hand, is usually performed only after the diagnosis is confirmed to plan surgery or to determine the stage of the tumor.
Surgical staging: specimen collection and therapy.
If a malignant tumor of the ovary cannot be excluded with certainty by ultrasound, a sample must be taken. This is usually done by surgery. The sample is sent to a pathologist while the operation is still in progress, who performs a microscopic examination and informs the surgical team of the result within a short time (frozen section). If ovarian cancer is actually present, the extent to which the tumor has spread and whether other organs have already been affected is examined during the same operation (staging). In many cases, the first step of treatment can then even take place and the tumor can be completely or partially excised.
Blood test not very informative
A blood test with determination of tumor markers – such as CA-125 or CA 15-3 – plays a rather minor role in the initial diagnosis. This is because these substances can be elevated in the blood in various diseases and therefore do not specifically indicate ovarian cancer. However, these blood levels can be helpful in follow-up examinations after therapy has begun or been completed by providing an indication of response to therapy or possible relapse.
