Ovarian cancer (ovarian tumor)

Ovarian cancer is a malignant tumour (carcinoma) of the ovary. The tumour tends to form metastases, preferably in the abdominal cavity.

Ovarian cancer (ovarian tumour or ovarian carcinoma) can affect either one or both ovaries. Initially, the tumour does not cause any symptoms, which is why it is only diagnosed at a very late stage and by chance. The main risk group are women after menopause. Before the age of 40, the development of an ovarian tumour is rare.

Ovarian cancer is a malignant change in the tissue that affects the female reproductive organs. In Germany, there are about 100,000 new cases every year. Thus, ovarian carcinoma ranks fifth in the frequency of cancers in women.

An exception to the ovarian tumour is the so-called borderline tumour. This tissue alteration cannot be precisely classified as "benign" or "malignant" and thus occupies an intermediate position. After some time, these tumours can nevertheless degenerate and develop into a malignant ovarian tumour.

The exact cause of ovarian cancer is still unclear. However, it can be assumed that, like other types of cancer, it is caused by degenerate cells that grow uncontrollably. Later on, these degenerated cells can spread to the surrounding tissue, constrict organs, blood and lymph vessels and form metastases.

Another risk factor is a family history of cancer caused by genetic changes (mutation of the BRCA gene). This gene mutation also increases the risk of developing breast cancer.

The use of hormonal contraceptives and pregnancy minimise the risk of ovarian cancer.

Initially, ovarian cancer does not cause any symptoms. If there are already metastases in the abdominal cavity, there may be an increased abdominal girth and an indefinable feeling of pressure in the lower abdomen. In some cases this feeling occurs in combination with nausea.

If the peritoneum is already affected (peritoneal carcinoma), the body usually produces an excessive amount of water (ascites), which causes the abdomen to swell. In most cases, ovarian cancer is discovered too late and by chance. This often happens in the course of a lower abdominal examination or because the growing tumours exert pressure on the bladder or intestines.

If ovarian cancer is suspected, the diagnosis is initially made on the basis of a gynaecological examination, during which the ovaries in particular are palpated. This is followed by additional examinations:

• With the help of an ultrasound examination (sonography), it is often possible to tell whether a benign or malignant tumour is present - A computer tomography (CT) or magnetic resonance tomography (MRT) can provide information about how far the disease has already spread.
• So-called tumour markers are measured by means of a blood sample.
• A cystoscopy and a rectoscopy are necessary if it is suspected that the tumour has already spread to the bladder or rectum.
• A definite diagnosis of ovarian cancer can only be made by surgery or by taking a tissue sample (biopsy). A biopsy can be done by surgery through an abdominal incision (laparotomy) or a laparoscopy.

Ovarian cancer is treated with surgery and possibly with chemotherapy. Which therapy is used depends on the stage of the tumour.

In most cases, surgery is used. The aim of the operation is to remove as much of the cancerous tissue as possible. Depending on the stage of the tumour, it may be necessary to remove either an ovary, the fallopian tubes, the uterus, the large abdominal network, parts of the peritoneum and possibly also the lymph nodes on the large vessels.

Further treatment usually consists of chemotherapy, which is intended to prevent any tumour foci that may still be present from spreading further. The drugs usually have an effect on the entire body (systemic) or they are administered directly into the abdominal cavity (intraperitoneal chemotherapy).

If surgery is not possible due to poor health, success can also be achieved by chemotherapy alone. In rare cases, radiotherapy is used.

If ovarian cancer recurs, hormone therapy may be considered.

Experiments currently underway will determine whether immunotherapy with antibodies will provide new therapeutic approaches.

In order to detect ovarian cancer in its early stages, it is important to attend regular examinations by a gynaecologist. To be on the safe side, a vaginal ultrasound can be used. In general, the earlier ovarian cancer is detected, the better the chances of cure.

The best prospects for a complete cure are when all the tumour tissue has been removed and no metastases have yet formed.

A major danger with ovarian cancer is that it often grows unnoticed and is only detected late. This can be the case when it has already spread throughout the abdominal cavity. Once this advanced stage is present, there is little chance of cure.

Unfortunately, diagnosis often comes late because there are no typical symptoms and there is no routine examination for early detection. At this stage, the main goal is to alleviate the symptoms and improve the quality of life.