JULIENNE PUCAN BSN III D

OVARIAN CANCER

I. DEFINITION

 Ovarian cancer has a high recurrence rate. After recurrence, the cancer is treatable
but no longer curable. If this occurs, the patient may deny symptoms at first or
express feelings of anger and grief. The family is often fearful of the outcome.
Provide encouragement and support during this difficult time and help the patient
and her family work through their grief and prepare for death

A. Types of ovarian cancer

The type of cell where the cancer begins determines the type of ovarian cancer you
have and helps your doctor determine which treatments are best for you. Ovarian cancer types
include: (MayoClinic)

 Epithelial ovarian cancer. This type is the most common. It includes several

subtypes, including serous carcinoma and mucinous carcinoma.
 Stromal tumors. These rare tumors are usually diagnosed at an earlier stage
than other ovarian cancers.
 Germ cell tumors. These rare ovarian cancers tend to occur at a younger age.

The ovaries are made up of three types of cells. Each cell can develop into a different
type of tumor: (healthline)

 Epithelial tumors form in the layer of tissue on the outside of the ovaries.

About 90 percent of ovarian cancers are epithelial tumors.

 Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian

cancers are stromal tumors.

 Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare.

B. Stages of ovarian cancer

The stage refers to how far the cancer has spread. (MedicalNewsToday)

  Localized: Cancer cells affect only the ovaries or fallopian tubes and have not
spread elsewhere.
 Regional: Cancer has spread to nearby organs, such as the uterus.
 Distant: Cancer is present elsewhere in the body. It now affects other organs,
such as the lungs or liver.

According to Healthline

Stage 1

 Stage 1A.The cancer is limited, or localized, to one ovary.

 Stage 1B. The cancer is in both ovaries.
 Stage 1C. There are also cancer cells on the outside of the ovary.

Stage 2. In stage 2, the tumor has spread to other pelvic structures

 Stage 2A. The cancer has spread to the uterus or fallopian tubes.

 Stage 2B. The cancer has spread to the bladder or rectum.

Stage 3

 Stage 3A. The cancer has spread microscopically beyond the pelvis to the lining
of the abdomen and the lymph nodes in the abdomen.
 Stage 3B. The cancer cells have spread beyond the pelvis to the lining of the
abdomen and are visible to naked eye but measure less than 2 cm.
 Stage 3C. Deposits of cancer at least 3/4 of an inch are seen on the abdomen or
outside the spleen or liver. However, the cancer isn’t inside the spleen or liver

Stage 4. In stage 4, the tumor has metastasized, or spread, beyond the pelvis, abdomen,
and lymph nodes to the liver or lungs.

 In stage 4A, the cancerous cells are in the fluid around the lungs.
 In stage 4B, the most advanced stage, the cells have reached the inside of the
spleen or liver or even other distant organs like the skin or brain.

II. INCIDENCE

According to Healthline
Survival rate

The survival rate is the percentage of women who survive a certain number of years at a
given stage of diagnosis. The relative survival rate also takes into account the expected rate
of death for people without cancer.

Epithelial ovarian cancer is the most common type of ovarian cancer. Survival rates may
differ based on the type of ovarian cancer, the progression of the cancer, and continuing
advancements in treatments.

The American Cancer Society uses information from the SEER database that the National
Cancer Institute (NCI) maintains to estimate the relative survival rate for this type of ovarian
cancer.

5-year relative survival rates for ovarian cancer

Invasive epithelial ovarian cancer

Stages 5-year relative survival rate

Localized 92%

Regional 76%

Distant 30%

All stages 47%

Ovarian stromal tumors

Stages 5-year relative survival rate

Localized 98%

Regional 89%

Distant 54%

All stages 88%

 Germ cell tumors of the ovary
Stages 5-year relative survival rate

Localized 98%

Regional 94%

Distant 74%

All stages 93%

According to the National Cancer Institute (NCI), there are over 22,000 cases of ovarian cancer
and almost 14,000 deaths from the condition each year. The vast majority of the cases are EOC and are
found at stage 3 or later, meaning the cancer has spread beyond the pelvis or to the lymph nodes. This is
mostly due to the lack of definite symptoms and signs at the early stages of cancer growth. Around 1.2%
of women will be diagnosed with cancer of the ovary at some point in life, thus, it is relatively rare. The
median age of diagnosis is 63. However, approximately 25% of cases are diagnosed between ages 35
and 54. Caucasian women have the highest rate of diagnosis.

III. RISK FACTORS

Factors that can increase your risk of ovarian cancer include:

Older age. The risk of ovarian cancer increases as you age. It's most often diagnosed in older
adults.

Inherited gene changes. A small percentage of ovarian cancers are caused by genes changes
you inherit from your parents. The genes that increase the risk of ovarian cancer
include BRCA1 and BRCA2. These genes also increase the risk of breast cancer.

Several other gene changes are known to increase the risk of ovarian cancer, including gene
changes associated with Lynch syndrome and the genes BRIP1, RAD51C and RAD51D.

Family history of ovarian cancer. If you have blood relatives who have been diagnosed with
ovarian cancer, you may have an increased risk of the disease.

Being overweight or obese. Being overweight or obese increases the risk of ovarian cancer.
 Postmenopausal hormone replacement therapy. Taking hormone replacement therapy to
control menopause signs and symptoms may increase the risk of ovarian cancer.

Endometriosis. Endometriosis is an often painful disorder in which tissue similar to the

tissue that lines the inside of your uterus grows outside your uterus.

Age when menstruation started and ended. Beginning menstruation at an early age or

starting menopause at a later age, or both, may increase the risk of ovarian cancer.

Never having been pregnant. If you've never been pregnant, you may have an increased
risk of ovarian cancer.

According to Medical News Today

Breast cancer. People with a history of breast cancer seem to have a higher chance of
ovarian cancer. This may be due to changes in the BRCA gene. For this reason, some people
with breast cancer who test positive for this gene mutation may opt to have an
oophorectomy, or surgery to remove the ovaries, as preventive therapy.

Hormone therapy. Undergoing hormone replacement therapy (HRT)

after menopause appears to increase the risk of ovarian cancer. The longer a person uses
HRT, the higher the risk. However, the risk appears to fall after treatment stops.

Obesity and overweight. Ovarian cancer is more common in people with a body mass index
(BMI) of over 30

Gynecologic surgery. Having surgery to remove the uterus, called a hysterectomy, may
reduce the risk of ovarian cancer by one-third.

Risk for transgender people

Some studies suggest that having high levels of androgen may increase the risk of
ovarian cancer. This may be a concern for transgender men who use hormone treatment in
their transition. A study Trusted Source from 2017 notes that having the ovaries removed
may lower the risk, but the authors urge people to be aware that ovarian cancer remains a
possibility.

According to Medicinet

Risk factors are related to two major categories: menstrual cycles (ovulation) and family
history.

 The more a woman ovulates (cycles) over her lifetime, the higher her risk of ovarian cancer.
Thus starting her period (menarche) at a younger age, ending her periods ( menopause) at a late
age, and never getting pregnant (nulliparity) are all risk factors.
 Up to 25% of ovarian cancers are related to family cancer syndromes. Because of this, current
guidelines suggest that all women with ovarian cancer should undergo testing for BRCA1 and
 BRCA2 gene changes (mutations). These gene mutations can affect males as well as females. If a
patient is positive for one of these, then her siblings and her children can be tested as well.

BRCA1 and BRCA2 are genes that have been identified with hereditary cancer risk.

 BRCA1 and BRCA2 increase a woman's risk of breast cancer, for example. When compared with
the general population risk (1.3% of women will develop ovarian cancer), women with BRCA1
and BRCA2 genetic mutations have a 35%-70% (BRCA1) or 10%-30% (BRCA2) chance of
developing ovarian cancer in their lifetime.
 Lynch syndrome (typically colon and uterine cancer), Li-Fraumeni syndrome, and Cowden's
syndrome are other conditions associated with an increased risk of ovarian cancer but are less
common.
IV. SIGNS AND SYMPTOMS

When ovarian cancer first develops, it might not cause any noticeable symptoms. When
ovarian cancer symptoms happen, they're usually attributed to other, more common
conditions. (MayoClinic)

Signs and symptoms of ovarian cancer may include:

 Abdominal bloating or swelling

 Quickly feeling full when eating
 Weight loss
 Discomfort in the pelvic area
 Fatigue
 Back pain
 Changes in bowel habits, such as constipation
 A frequent need to urinate
The early symptoms include: (healthline)
 abdominal bloating, pressure, and pain
 abnormal fullness after eating
 difficulty eating
 an increase in urination
 an increased urge to urinate
V. COMPLICATIONS

According to Marks, J. and Marron (2020)

Surgery for ovarian cancer can lead to complications, such as

 Infection You have a higher risk of developing an infection after surgery. Symptoms

may include fever, chills, sweats, cough, shivering, or swelling or redness around the
incision
  Vaginal bleeding After your procedure, you might experience some vaginal
bleeding, similar to a light period, typically for a few days to a few weeks
 Blood clots You may be at risk for developing a blood clot in your pelvis or legs. To
help prevent this, your medical team will encourage you to get up and walk around
as soon as possible after your operation. You may also be given injections to thin
your blood or be asked to wear special stockings
 Bleeding in the abdomen or pelvis You’ll likely lose some blood during surgery, and
there’s a small chance you could bleed internally afterward
 Leg swelling If your surgeon removes your lymph nodes, you may experience fluid
buildup in your legs or, rarely, in your genital area. Tell your doctor if this occurs.
 Bladder or bowel issues When surgeons operate on the pelvis or abdominal area,
there’s a risk of damaging the bladder or bowel.
 Colostomy bag or catheter During an ovarian cancer debulking surgery (a technique
to remove as much of the tumor as possible), your surgeon may remove part of the
colon or bladder. Afterward, you may need to wear a colostomy bag to collect stool
or a catheter to remove urine. These fixes are usually temporary. (3)
 Infertility If you have surgery to remove both your ovaries, you won’t be able to  get
pregnant. Your doctor can tell you about possible ways to preserve your fertility or
other options.
 Early menopause Having your ovaries removed during surgery results
in menopause if you haven’t already gone through it.

Complications From Radiation Therapy

Side effects are usually temporary and improve after treatment stops. They may include
skin changes, fatigue, nausea, vomiting, diarrhea, or vaginal irritation. Radiation that’s directed
at the pelvic area may also lead to infertility.

Complications From Targeted Therapy

The therapy can cause side effects such as nausea, diarrhea, vomiting, dizziness, fatigue,
loss of appetite, weight gain, taste changes, confusion, or pain affecting the muscles, joints, or
belly. Anemia, heart problems, and abnormal liver tests are some possible complications
associated with targeted drugs. Rarely, some of these medicines can lead to a blood cancer,
such as myelodysplastic syndrome or acute myeloid leukemia.

Common Complications From Ovarian Cancer

 Some common complications of advanced ovarian cancer include:

 Fatigue or weakness in one study, 75 percent of women reported this

symptom.
 Nausea, vomiting, or constipation these are common gastrointestinal side
effects.
 Edema Excess fluid buildup in body tissues can cause swelling in the legs or
pelvic area.
 Anemia Low blood cell counts can be caused by the cancer itself.
 Ascites These are collections of fluid in the abdominal cavity that are caused by
the cancer. Symptoms of ascites may include swelling, bloating, shortness of
breath, indigestion, loss of appetite, or worsened fatigue.
 Bowel or bladder obstruction large tumors may block the intestines or bladder.
This can lead to pain and discomfort, and may require corrective procedures.
 Pleural effusion Pleural effusion is a buildup of fluid between the thin
membranes that line the lungs and the inside of the chest cavity. It can cause
breathing difficulties and other symptoms.
 Nutrition issues If you can’t eat on your own because of the side effects of
cancer or you’re malnourished, you may receive parenteral nutrition, which
involves getting your requirements intravenously

VI. PATHOPHYSIOLOGY

Ovarian cancer is the leading cause of death from female reproductive cancers, but it is
not the most common type of cancer. Most ovarian cancers are epithelial tumors that grow
on the surface of the ovaries. These tumors grow rapidly, spread quickly, and are often
bilateral. Tumor cells spread by direct extension into nearby organs and through blood and
lymph circulation to distant sites (McCance et al., 2014). Free-floating cancer cells also
spread through the abdomen to seed new sites, usually accompanied by ascites (abdominal
fluid). Ovarian cancer seems to be disordered growth in response to excessive exposure to
estrogen. This would explain the protective effects of pregnancies and oral contraceptive
use, both of which interrupt the monthly estrogen exposure. Women who have had tubal
ligation, used oral contraception, and breast-fed their children have less risk for having the
disease (ACS, 2017b). The incidence increases in women older than 50 years, and most are
diagnosed after menopause. Family history accounts for a small percentage of cases. These
women carry BCRA1 or BCRA2 genetic mutations. Of these, some choose to have an elective
bilateral salpingo-oophorectomy (BSO) (removal of both ovaries and fallopian tubes) to
prevent ovarian cancer.

VII. PROGNOSIS
 Although the 5-year survival rate for ovarian cancer has improved significantly in the
past 30 years, the prognosis for ovarian cancer remains poor overall, with a 48.6% 5-year
relative survival rate. The prognosis of ovarian cancer is closely related to the stage at
diagnosis, as determined according to the staging system developed by the International
Federation of Gynecology and Obstetrics (FIGO).

VIII. DIAGNOSTIC PROCEDURES

According to Medical News Today

If routine screening or symptoms suggest that a person may have ovarian cancer, a doctor
will typically: ask the person about their personal and family medical history and carry out a
pelvic examination

They may also recommend:

Blood tests: These tests will check for high levels of a marker called CA-125.

Imaging tests: Examples include a transvaginal ultrasound, an MRI scan, or a CT scan.

Laparoscopy: A healthcare professional will insert a thin tube with a camera attached
through a small hole in the abdomen, to see the ovaries and perhaps take a tissue sample
for a biopsy.

Biopsy: This involves the microscopic examination of a tissue sample.

Only a biopsy can confirm that a person has cancer. A healthcare professional may do this as
part of the initial assessment or following surgery to remove a tumor.

IX. MANAGEMENT

Treatment will depend on many factors, including:

- the type, stage, and grade of the cancer

- the individual’s age and overall health
- their personal preferences
- accessibility and affordability of treatment
 Surgery: The choice will depend on the type of cancer and how far it has spread. Surgical
options include a hysterectomy, removing one or both ovaries, and removing affected
lymph nodes. A doctor will discuss suitable options with the individual.

Chemotherapy: These drugs aim to kill cancer cells. If a person takes chemotherapy drugs

by mouth or as an injection or infusion, they will affect the whole body. Another option is
intraperitoneal chemotherapy. In this case, a tube delivers the drug directly to the body area
affected by cancer. Chemotherapy can have widespread adverse effects, especially if it
affects the whole body.

Targeted therapy: Some treatments target specific cells that help promote cancer growth.
Examples include monoclonal antibody therapy and angiongenesis inhibitors. Targeted
therapy aims to limit the adverse effects by targeting specific functions.

Radiation therapy: This technique uses X-rays to kills cancer cells. One way to do this is by
introducing a radioactive liquid into the peritoneum. This may help people with advanced
ovarian cancer.

Immunotherapy (biotherapy): This aims to boost the immune system’s ability to defend the
body against cancer. Vaccine therapy involves injecting substances that will find and kill a
tumor. It may help people with advanced ovarian cancer.

Fertility preservation

Possible fertility preservation options include:

 Embryo freezing. This involves freezing a fertilized egg.

 Oocyte freezing. This procedure involves freezing an unfertilized egg.
 Surgery to preserve fertility. In some cases, surgery that only removes one ovary
and keeps the healthy ovary can be done. This is usually only possible in early stage
ovarian cancer.
 Ovarian tissue preservation. This involves removing and freezing ovarian tissue for
future use.
 Ovarian suppression. This involves taking hormones to suppress ovarian function
temporarily.
X. TRENDS AND ISSUES
According to Healthline

Ovarian cancer research and studies

New treatments for ovarian cancer are studied each year.

Researchers are also exploring new ways to treat platinum-resistant ovarian cancer.

When platinum resistance occurs, standard first-line chemotherapy drugs like carboplatin
and cisplatin are ineffective.

The future of PARP inhibitors will be in identifying what other drugs can be used in
combination with them to treat tumors that show unique characteristics.

Recently, some promising therapies have started clinical trials such as a potential
vaccine against recurrent ovarian cancers that express the survivin protein.

In May 2020, clinical trial results Trusted Source were published for a potential new
antibody-drug conjugate (ADC) to treat platinum-resistant ovarian cancer.

New targeted therapies are being studied, including the antibody navicixizumab, the
ATR inhibitor AZD6738, and the Wee1 inhibitor adavosertib. All have shown signs of anti-
tumor activity.

Gene therapies Trusted Source target a person’s genes to treat or cure disease. In 2020,
a phase III trial for the gene therapy VB-111 (ofranergene obadenovec) continued with
promising results.

In 2018, the FDA fast-tracked a protein therapy called AVB-S6-500 for platinum-resistant

ovarian cancer. This aims to prevent tumor growth and cancer spread by blocking a key
molecular pathway.

An ongoing clinical trial combining immunotherapy (which helps a person’s immune

system fight cancer) with existing approved therapies has shown promise.

A 2019 study Trusted Source examined targeted treatments for those with

more advanced stages of this cancer.
 Ovarian cancer treatment primarily focuses on surgery to remove the ovaries and uterus
and chemotherapy. As a result, some women will experience menopause symptoms.

A 2015 article looked at intraperitoneal (IP) chemotherapy. This study found that those
who received IP therapy had a median survival rate of 61.8 months. This was an
improvement as compared to 51.4 months for those who received standard chemotherapy.

XI. PREVENTION

There's no sure way to prevent ovarian cancer. But there may be ways to reduce your risk:

(MayoClinic)

 Consider taking birth control pills. Ask your doctor whether birth control pills (oral
contraceptives) may be right for you. Taking birth control pills reduces the risk of
ovarian cancer. But these medications do have risks, so discuss whether the benefits
outweigh those risks based on your situation.
 Discuss your risk factors with your doctor. If you have a family history of breast and
ovarian cancers, bring this up with your doctor. Your doctor can determine what this
may mean for your own risk of cancer. You may be referred to a genetic counselor
who can help you decide whether genetic testing may be right for you. If you're
found to have a gene change that increases your risk of ovarian cancer, you may
consider surgery to remove your ovaries to prevent cancer.

References

Ovarian cancer - Symptoms and causes. (2021, August 31). Mayo Clinic. Retrieved from
https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

Pietrangelo, A. (2020, September 8). What are the Early Signs of Ovarian Cancer and How Do You Detect
Them? Healthline. Retrieved from https://www.healthline.com/health/cancer/ovarian-cancer-early-
signs#stages

Ovarian Cancer Symptoms, Types, Stages, Treatment & Survival Rate. (2021, June 24). MedicineNet.
Retrieved from https://www.medicinenet.com/ovarian_cancer/article.htm
Marks, J., & Marron, T. U., MD PhD. (2020, May 4). Complications of Ovarian Cancer: How It Affects Your
Body | Everyday Health. EverydayHealth.Com. retrieved from
https://www.everydayhealth.com/ovarian-cancer/complications/