Celebrating Ovarian Cancer Day

I HOPE I find you well and in good health.

Cancer is a disease in which abnormal cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later.

May 8 is Ovarian Cancer Day. Ovarian cancer is a group of diseases that originate in the ovaries, or in the related areas of the fallopian tubes and the pelvis.

Women have two ovaries that are located in the pelvis, one on each side of the uterus, each the shape of an almond (egg yolk). The ovaries make female hormones (oestrogen and progesterone) and produce eggs.

Women have two fallopian tubes that are a pair of long, slender tubes on each side of the uterus. Eggs pass from the ovaries through the fallopian tubes to the uterus.

The peritoneum is the tissue lining that covers organs in the abdomen. Early cancers of the ovary rarely produce symptoms unless an ovarian accident (pain, bleeding or rupture) occurs.

Most women present with the symptoms when the disease has spread across the peritoneum, thus, 75 percent of women present late.

Factors that can increase your risk of ovarian cancer include: Older age; ovarian cancer can occur at any age but is most common in women aged 50 to 60 years.

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

Incessant ovulation: each ovulation causes minor trauma to the surface of the ovary. The more trauma, the higher the chance of cancer developing.

Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2).

These genes also increase the risk of breast cancer. Other gene mutations, including those associated with Lynch syndrome (bowel cancer), are known to increase the risk of ovarian cancer.

People with two or more close relatives with ovarian cancer have an increased risk of the disease.

Oestrogen hormone replacement therapy, especially with long-term use and in large doses also increases the risk as well as fertility drugs stimulating ovulation, eg clomiphene citrate or gonadotropins used in “test tube babies’’.

The majority of patients present with advanced disease as the symptoms take time to show and so prognosis and survival remain poor.
Signs and symptoms of ovarian cancer may include:

Abdominal bloating or swelling, quickly feeling full when eating,weight loss,discomfort in the pelvis area, changes in bowel habits,such as constipation and frequent need to urinate.

The most common ovarian cancers arise from the thin layer of tissue that covers the outside of the ovaries, epithelial tumours. Stromal tumours begin in the ovarian tissue that contains hormone-producing cells while germ cell tumours, which begin in the egg-producing cells. These rare ovarian cancers tend to occur at a younger age. There’s no sure way to prevent ovarian cancer. But there may be ways to reduce your risk:

Having given birth.

Breastfeeding.

Some studies suggest that women who breastfeed for a year or more may have a reduced risk of developing ovarian and breast cancer.
Consider taking birth control pills. Ask your doctor whether birth control pills may be right for you. Women who use oral contraceptives may have a reduced risk of ovarian cancer. Having had a tubal ligation (getting your tubes tied), both ovaries removed, or a hysterectomy (an operation in which the uterus, and sometimes the cervix, is removed).

The diagnosis is made after a pelvic exam by the doctor who may order imaging tests of the abdomen and pelvis to help determine size and structure of ovaries. Imaging may include ultrasound scanning and CT scan of the abdomen and pelvis. Your doctor might also test your blood for tumour markers that indicate ovarian cancer.

For example, a cancer antigen (CA) 125 test can detect a protein that’s often found on the surface of ovarian cancer cells. These tests can’t tell your doctor whether you have cancer, but may give clues about your diagnosis and prognosis. Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer.

The aim should be for surgery to be as conservative as possible. Formal staging with laparotomy and washings should be performed. It is often possible to remove achieving complete remission. The majority of women will have a recurrence. The cancer can spread when ovarian cancers breach the capsule (outer boarder) of the ovary, they are able to spread across the abdominal cavity, typically surfaces, such as the diaphragm, bowel and its fatty covering called omentum.

Lymphatic spread: to para-aortic and pelvic lymph nodes. Haematogenous spread (via blood): occurs late to lungs and liver. The lack of symptoms does not necessarily mean lack of disease this is why it is important to have regular checks with your doctor. Let us remember to be vigilant and curb the spread of Covid-19.

Dr Tatenda Simango can be contacted on [email protected] or follow him on Facebook@ 9th Avenue Surgery.

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