The ovaries are a pair of organs of the female reproductive system, one on each side of the uterus. The ovaries are connected to the uterus through the fallopian tubes. The egg formed in one of the ovaries each month is fertilized in the fallopian tube, and from there it is embedded in the inner lining of the uterus, that is, the endometrium, resulting in pregnancy.
Types of ovarian cancer
The first treatment option in ovarian cancer is to perform surgery whenever possible and surgically
There are several different types of ovarian cancer and subtypes of each type:
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Epithelial ovarian cancers
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Serous-type ovarian cancers (This is the most common type of ovarian cancer)
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Mucinous-type ovarian cancers
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Clear cell type ovarian cancers
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Ovarian cancers with mixed cell type
- Carcinosarcomas
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Ovarian cancers arising from sex cord stroma
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Ovarian granulosa cell cancers
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Sertoli-Leydig cell ovarian cancers
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Ovarian cancers arising from yolk-sac cells
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Ovarian cancers arising from non-specific stroma
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Ovarian cancers arising from the germ (reproductive) cell
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Gonadoblastomas
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Dysgerminomas
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Embryonic carcinomas
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Poly-embryomas
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Mixed type germ cell tumors
Ovarian cancer most commonly develops from ovarian epithelium, fallopian tube epithelium or peritoneal epithelium (primary peritoneal cancer). Since they do not cause many complaints, they are usually diagnosed in advanced stages. About two-thirds of all ovarian cancers are diagnosed when they reach an advanced stage. The most common complaints in ovarian cancer are as follows:
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Feeling of bloating in the abdomen
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Early satiety
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A palpable swelling or mass in the abdomen
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Abdominal, groin or low back pain
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Nausea, vomiting
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Difficulty breathing , early fatigue
Fluid collection in the abdomen is observed in advanced stages of ovarian cancer. It is the excess fluid collected in the abdomen that causes a significant part of the complaints.
Planning the treatment in ovarian cancer
The diagnosis is usually made by physical examination, blood tests and imaging methods. Before deciding on treatment options, a detailed examination and research should be done.
In advanced disease, sometimes the general condition of the patient may be poor or medically unsuitable for surgery. In this case, after the diagnosis is made by biopsy taken from the abdomen, after 2 or 3 cycles of chemotherapy, the disease can be reduced and the general condition of the patient is expected to improve, surgery can be planned.
Deciding on the type of treatment in ovarian cancer
Before deciding on the type of treatment, some blood tests and imaging methods will be requested by your doctor. Imaging methods may include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET/CT).
Familial breast-ovarian cancer and genetic testing
Approximately 10% of epithelial ovarian cancer cases show some familial gene mutations. These genes are BRCA-1 and BRCA-2 genes. Demonstrating the presence of these mutations is important both when deciding on the treatment modality and for revealing the increased risk of breast and ovarian cancer in other family members. There are some tumor markers that are frequently used in controls. The most commonly used tumor marker is the CA-125 test. Approximately three-quarters of epithelial ovarian cancers have elevated CA-125 levels at the time of diagnosis. Gradual increases in CA-125 levels, which are observed at low levels after treatment, may indicate that the disease is recurring. Tumor markers are also available and your doctor may refer to their use.
Ovarian cancer treatment
Surgery:
In surgery, the uterus, tubes and opposite ovary are removed along with the mass originating from the ovary. In addition, all visible tumor foci should be removed. For this, some organs may need to be removed. The most frequently removed organs can be counted as the tumor parts of the large and small intestines, spleen or liver surface. If the disease is at an early stage and there is no visible tumor in other organs, biopsies are taken from the peritoneum, called the peritoneum, within the surgical staging procedure, and the omentum, which is the fatty tissue in the anterior abdominal region, is removed. Then, lymph nodes in the pelvic and para-aortic regions are also taken and sent to pathology, and it is checked whether there is disease spread in these regions. The staging process is very important because if the uterus and ovaries are removed after this procedure, the patient does not have a chance to become pregnant again. In early stage cancers and non-epithelial types, there is a possibility that fertility can be preserved even in the case of advanced disease. You should definitely talk to your doctor about situations where fertility can be preserved.
Ovarian Cancer Stages
Stage 1:
The cancer is limited to one or both ovaries. There is no visible tumor outside the ovary.
Stage 1A: Cancer is limited to one ovary. The ovarian capsule is intact, there is no cancer on the ovary, and there are no cancer cells in the abdominal washing fluid
Stage 1B: Cancer is in both ovaries. The ovarian capsule is intact, there is no cancer on the ovary, and there are no cancer cells in the abdominal washing fluid.
Stage 1C: Cancer is in one or both ovaries, but
Stage 1C1: the ovarian capsule has burst during surgery.
Stage 1C2: The ovarian capsule is tumor-invaded before surgery
Stage 1C3: There are tumor cells in the abdominal washing fluid.
Stage 2:
Cancer is limited to organs in the pelvis. It has not protruded beyond the pelvis
Stage 2A: There are tumoral structures on the uterus, on the tubes
Stage 2B: R Tumor over pelvic organs other than the uterus, ovaries, and tubes
Stage 3:
The cancer has spread outside the pelvis, but is limited to the organs inside the abdomen. The only site of tumor spread outside the pelvis is the lymph nodes
Stage 3A1(i): tumoral spread in the lymph node ≤10 mm
Stage 3A1(ii): tumoral spread in the lymph node <10 mm
p>Stage 3A2: There is microscopic tumor spread outside the pelvis
Stage 3B: There is visible tumor spread outside the pelvis, but the largest tumor diameter is<2 cm
Stage 3C: The largest diameter of tumor foci outside the pelvis is >2 cm
Stage 4: Tumor spread within distant organs
Stage 4A: Presence of tumor cells in the fluid in the lung membrane
Stage 4B: There is tumor in distant organs such as liver and spleen. Or tumor spread in distant lymph nodes outside the abdomen
Chemotherapy Process After Surgery
Chemotherapy is drugs given to kill cancer cells. Classical chemotherapy drugs kill all rapidly proliferating cells in the body. In the presence of cancer, since cancer cells are the cells that multiply the fastest in our body, chemotherapy kills cancer cells the most, but also affects organs and systems that contain cells that play a role in the normal functioning of the body and that naturally need to multiply rapidly. Chief among these are bone marrow cells that multiply rapidly and form blood elements. The reason for the decrease in blood values and suppression of immunity after chemotherapy is the decrease in the production of blood and immune cells in the bone marrow due to chemotherapy. Another system most affected by chemotherapy is the intestines. Epithelial cells lining the inner surface of the intestines need to proliferate faster than other tissues. For this reason, chemotherapy-induced nausea, vomiting and diarrhea may be observed.
In ovarian cancer, chemotherapy is usually given after surgery in almost all stages except for Stage 1A.
Your doctor will ask you for some blood tests and tests during and after chemotherapy. will ask for display methods. According to the results of these, you will have information about your response to treatment.
Patients who are not suitable for surgery
After 2 or 3 cycles of chemotherapy (this is called neo adjuvant chemotherapy), the general condition of the patients improves and surgery is required. When they become appropriate, surgery can be planned.
Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can be applied during surgery after neo-adjuvant chemotherapy. In this application, a special system is set up and after all the tumoral foci that can be seen after the surgery are cleaned, chemotherapy solution heated to 42-43 degrees Celsius is administered into the abdomen and circulation is provided at low pressure for an average of 60-90 minutes. The purpose of this procedure is to destroy invisible tumoral foci that may have been left behind after surgery with high-temperature chemotherapy drugs.
Life after ovarian cancer treatment
A long-term follow-up period begins for long patients after the chemotherapy period given after ovarian cancer surgery has passed.
Follow-up intervals are every 3 months for 2 years after the end of treatment. It is every 6 months between 2-5 years and once a year after 5 years. If suspicious findings are detected during the follow-up, the frequency of follow-up can be changed.
When you come to follow-up, your doctor will firstly question your symptoms and complaints. Next comes a detailed physical examination. Physical examination includes examination of the whole body systemically, as well as the surgical site and genital areas. Vaginal examination is an integral part of the physical examination.
Relapse of the Disease
The return of the disease after treatment is called recurrence or relapse. If one or more of the following occur during follow-up, disease recurrence may be suspected and more detailed examinations can be performed to confirm the diagnosis. p>
Detection of a newly formed mass in the imaging methods requested in the follow-ups
The presence of signs and symptoms suggestive of ovarian cancer recurrence. (nausea, vomiting, accumulation of fluid in the abdomen, rapid weight loss, constipation, gradual
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