Should we be concerned about Epithelial Ovarian Cancer?

Have you ever heard of Epithelial Ovarian Cancer? The name may sound a bit complicated, but it is a type of ovarian cancer that is common among women. Let's talk about it simply, in a way that you can understand. Because it is very important to be aware of things like this.

What is Epithelial Ovarian Cancer?

Simply put, epithelial ovarian cancer is the most common type of ovarian cancer. This cancer develops in the thin outer covering of the ovary, called epithelial tissue. Think of it like a thin membrane that surrounds the ovary.

Not only that, but sometimes this cancer can also develop in the lining of the fallopian tubes or even in the peritoneum, the tissue that covers the organs in the abdomen. Doctors also include fallopian tube cancer and primary peritoneal cancers in the same category as epithelial ovarian cancer because the symptoms and treatments for these conditions are very similar.

How common is this cancer?

Ovarian cancer is the second most common gynecological cancer, after uterine/endometrial cancer. The average woman has a 1 in 78 chance of developing ovarian cancer in her lifetime.

In 2021 alone, more than 21,400 people were diagnosed with ovarian cancer. Nine out of ten of these are reported as epithelial ovarian cancer. This cancer is particularly common among women over the age of 65.

What are the types of epithelial ovarian cancer?

About three-quarters of epithelial ovarian cancers are high-grade serous ovarian carcinomas (HGSOC). "High-grade" means that these cancer cells grow and spread more quickly than "low-grade" cancers.

Medical experts believe that this type of HGSOC grows slowly at first, but it can take up to six and a half years for it to spread from the fallopian tubes to the ovaries. But once it reaches the ovaries, it spreads very quickly. It often affects the lining of the abdominal cavity (peritoneum) and other parts of the body. About 70% of HGSOC patients are diagnosed with the disease at stage 3 or 4. This means that the cancer has spread beyond the original tumor and is now metastatic cancer.

There are other less common types of epithelial ovarian cancer:

• Endometrioid carcinoma: This type is more common in people with endometriosis. It affects the lining of the uterus (endometrium). It responds better to chemotherapy than some other types.
• Low-grade serous ovarian carcinoma (LGSOC): This is a slow-growing cancer. It occurs in relatively young women (between 45 and 57 years of age). It accounts for about 10% of epithelial ovarian cancers. The disease is often advanced when diagnosed, and it does not respond well to chemotherapy. Although low-grade cancers grow slowly, they are less likely to become high-grade cancers.
• Mucinous carcinoma: These tumors are different from other types and respond well to treatment. They are usually large (about 8 inches or 20 centimeters). They often affect only the ovaries.
• Ovarian clear cell carcinoma (OCCC): Asian women and those with endometriosis are at higher risk of developing this cancer. The disease is often advanced when diagnosed. It does not respond well to chemotherapy.
• Primary squamous cell carcinoma (SCC) of the ovary: This type of SCC usually develops from benign/noncancerous conditions. For example, it can develop from ovarian cysts, endometriosis, or Brenner tumors (solid, abnormal growths in the ovaries). If caught early, it responds well to treatment.

What causes epithelial ovarian cancer?

In fact, the exact cause of most cancers, including epithelial ovarian cancer, is still unknown. However, new research suggests that most ovarian cancers actually start in cells at the ends of the fallopian tubes. They then spread to the ovaries.

What are the risk factors for developing this cancer?

More than half of those diagnosed with ovarian cancer are over the age of 65 and have gone through menopause, which means their menstrual cycle has stopped.

Some factors may increase the risk of developing ovarian cancer. They are:

• If someone in your family has had ovarian cancer, breast cancer, or colorectal/colon cancer.
• If you have inherited a change (mutation) in the BRCA gene.
• If you have inherited a gene linked to familial cancer syndromes, such as Lynch syndrome.
• If you are taking hormone therapy to control the symptoms of menopause.
• Having a child after the age of 35 or having never carried a child to full term.
• Obesity .

What are the symptoms of epithelial ovarian cancer?

This is a problem for many people. Epithelial ovarian cancer often has very few symptoms in the early stages. Symptoms become apparent only after the disease has spread a little. When it spreads to the membrane that covers the abdominal organs (peritoneum), a watery fluid can accumulate in the abdomen. This is called ascites.

In addition, the following symptoms may occur:

• Abdominal pain.
• Difficulty eating or feeling full after eating a small amount.
• Nausea and vomiting.
• Bloating.
• Pelvic pain.

There are also symptoms that are less commonly seen:

• Urge incontinence or frequent urination (overactive bladder).
• Abnormal vaginal bleeding.

Important: Having these symptoms does not necessarily mean you have cancer. However, if they persist, it is best to see a doctor for advice.

How is epithelial ovarian cancer diagnosed?

Unfortunately, there are no specific screening tests that can detect ovarian cancer in its early stages. Screening is usually only done if you have symptoms or are at high risk. Your doctor may first do a pelvic exam to check for any abnormal lumps or swelling.

Then, you can have a blood test to check the level of a protein called `CA-125`. This `CA-125` stands for cancer antigen 125. If the level is high, you will need to do more tests.

Imaging tests like these can help diagnose ovarian cancer:

• Transvaginal ultrasound test.
• CT scan test.
• MRI (MRI) test.
• Positron emission tomography (PET) scan.
• Chest X-rays (to see if the cancer has spread to the lungs).

Sometimes a procedure called a laparoscopy may be done. This is like surgery, but it is done without making a large incision. This allows the doctor to look at your reproductive organs. They may also take a tissue sample (biopsy) from a lump to see if there are any cancer cells there. This biopsy is the only way to know for sure if you have ovarian cancer.

What are the stages of epithelial ovarian cancer?

Knowing the stage of cancer helps doctors understand the progress of the cancer. It is also important for determining whether the cancer has spread and for making treatment decisions. The stage of the cancer is determined by the same tests used to diagnose the cancer.

There are four main stages of ovarian cancer. Some stages have sub-stages. The higher the stage number, the more advanced the cancer is.

• Stage 1: The cancer is in only one ovary or one fallopian tube.
• Stage 2: The cancer has spread to the uterus or the lining of the abdominal cavity (peritoneal cavity).
• Stage 3: The cancer has spread to other organs outside the pelvis, to the lymph nodes, or both.
• Stage 4: Cancer cells are present in the fluid around the lungs, lymph nodes in the groin area, other organs, or other parts of the body.

Can epithelial ovarian cancer be cured?

Surgeons perform a debulking surgery to remove as much of the cancer as possible. This is followed by chemotherapy. Although most people recover initially, the disease can come back in many people later.

Early-stage patients may decide to remove only the diseased ovary and fallopian tube.

For people with advanced cancers, a debulking surgery is usually performed to remove the following organs:

• Removal of both fallopian tubes and both ovaries (bilateral salpingo-oophorectomy).
• Removal of the uterus (hysterectomy).
• Removal of the fatty tissue (omentum) that covers the abdomen (omentectomy).
• Removal of surrounding lymph nodes.
• Removal of other diseased parts (such as the small intestine, large intestine, or spleen).

What are other treatments?

Depending on the type of cancer, you may be given one or more of these treatments after surgery:

• Chemotherapy: To kill cancer cells. This uses drugs such as platinum compounds (carboplatin) and paclitaxel (Taxol®) or docetaxel (Taxotere®).
• Intraperitoneal chemotherapy: To treat stage 3 ovarian cancer, the drugs cisplatin and paclitaxel are injected directly into the abdominal cavity through a surgically inserted catheter (a thin, hollow tube).
• Targeted therapies: Drugs like Bevacizumab (Avastin®) stop cancer cells from growing and multiplying.
• Radiation therapy: Uses high-energy X-ray beams to destroy cancer cells.

Can epithelial ovarian cancer be prevented?

Research shows that women who take hormonal birth control pills for five years or more can reduce their risk of developing ovarian cancer by about half.

Some surgeries can also reduce the risk of cancer. Surgery to prevent cancer is called prophylactic surgery. This involves removing the fallopian tubes and ovaries, with or without the uterus. This is usually considered for women who are at high risk because of a family history (such as those with a BRCA mutation or Lynch syndrome). However, doctors advise that these procedures be performed only if medically necessary. This is because removing the ovaries can cause early menopause, which can have a negative impact on the body.

These surgeries do not completely eliminate the risk of cancer. Some people may have cancer that is not found at the time of surgery. People with BRCA gene mutations can still develop primary peritoneal cancer even if their fallopian tubes and ovaries are removed. Ask your doctor about BRCA testing to find out if you have the BRCA gene.

What is the outlook for people with epithelial ovarian cancer?

More than 13,000 people die from ovarian cancer each year. It is the fifth leading cause of cancer death among women. However, there is hope for new treatments currently in clinical trials. Researchers are also working to detect the disease at an early stage.

If epithelial ovarian cancer is detected before it has spread, the five-year survival rate is over 90%. However, once the cancer has spread (metastasized), this rate drops to about 30%.

Many factors influence the prognosis of a cancer:

• The extent to which the cancer has spread.
• Treatment success.
• The location, size, and number of cancerous tumors (stage of cancer).

When should you see a doctor?

If you have any of these symptoms, see a doctor immediately:

• Changes in the frequency or urgency of urination.
• Loss of appetite or feeling full after eating a small amount.
• Persistent pain in the abdomen or pelvic area for no reason.

What questions should you ask your doctor?

You can ask the doctor questions like these:

• Should I get a BRCA test?
• What type of epithelial ovarian cancer do I have?
• What is the best treatment for me?
• What are the side effects of the treatments?
• Am I at risk of metastatic cancer? How can I reduce that risk?
• Should I be concerned about complications?

What is the most aggressive form of ovarian cancer?

High-grade serous ovarian cancer (HGSOC) is a very aggressive type of ovarian cancer. Although this cancer initially grows slowly in the fallopian tubes, it spreads very quickly once it reaches the ovaries. Unfortunately, many people with HGSOC have advanced/metastatic ovarian cancer when they are diagnosed.

Is it possible to have non-cancerous (benign) epithelial ovarian cysts?

Yes. In fact, most epithelial ovarian tumors are not cancerous. Some tumors are called borderline tumors or atypical proliferating tumors. These were previously called low malignant potential tumors.

In borderline tumors, abnormal cells grow into the epithelial tissue but do not invade the supporting tissue of the ovary (stroma). These cells are usually found in the ovary itself and rarely become cancerous. If cancer does develop, three out of four are stage 1 (confined to the ovary and easy to treat). These tumors usually affect younger people.

Take-Home Message

Epithelial ovarian cancer is the most common type of ovarian cancer. It also includes fallopian tube cancer and primary peritoneal cancer. Ovarian cancer often has very few symptoms in its early stages. The disease is often too advanced to be detected by the time it is diagnosed. This is especially true for the most common type of epithelial cancer, called `HGSOC`.

If you have a high risk of developing ovarian cancer (such as a family history), it is important to ask your doctor about whether prophylactic measures are right for you. Always take care of your body. Don't ignore any unusual symptoms. Seek medical advice.

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