Ovarian Cancer
Disease Details
Family Health Simplified
- Description
- Ovarian cancer is a malignancy arising from the ovary, often characterized by late-stage diagnosis due to subtle symptoms.
- Type
- Ovarian cancer is typically classified as an epithelial tumor, which is the most common type, making up around 90% of cases. Other types include germ cell tumors and stromal tumors. The genetic transmission of ovarian cancer can sometimes be hereditary, often associated with mutations in the BRCA1 and BRCA2 genes, which follow an autosomal dominant pattern of inheritance. This means that having a mutation in just one of the two copies of the gene can increase the risk of developing the disease.
- Signs And Symptoms
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Signs and symptoms of ovarian cancer can often be vague and may include:
1. Abdominal bloating or swelling
2. Quickly feeling full when eating
3. Weight loss
4. Discomfort in the pelvic area
5. Changes in bowel habits, such as constipation
6. A frequent need to urinate
These symptoms can also be caused by non-cancerous diseases, but if they are new, persistent, or worsen, it is important to consult a healthcare professional. - Prognosis
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Ovarian cancer usually has a relatively poor prognosis. It is disproportionately deadly because it lacks any clear early detection or screening test, meaning most cases are not diagnosed until they have reached advanced stages.Ovarian cancer metastasizes early in its development, often before it has been diagnosed. High-grade tumors metastasize more readily than low-grade tumors. Typically, tumor cells begin to metastasize by growing in the peritoneal cavity. More than 60% of women presenting with ovarian cancer have stage-III or stage-IV cancer, when it has already spread beyond the ovaries. Ovarian cancers shed cells into the naturally occurring fluid within the abdominal cavity. These cells can then implant on other abdominal (peritoneal) structures, including the uterus, urinary bladder, bowel, lining of the bowel wall, and omentum, forming new tumor growths before cancer is even suspected.
The five-year survival rate for all stages of ovarian cancer is 46%; the one-year survival rate is 72% and the ten-year survival rate is 35%. For cases where a diagnosis is made early in the disease, when the cancer is still confined to the primary site, the five-year survival rate is 92.7%. About 70% of women with advanced disease respond to initial treatment, most of whom attain complete remission, but half of these women experience a recurrence 1–4 years after treatment. Brain metastasis is more common in stage III/IV cancer but can still occur in cancers staged at I/II. People with brain metastases survive a median of 8.2 months, though surgery, chemotherapy, and whole brain radiation therapy can improve survival.Ovarian cancer survival varies significantly with subtype. Dysgerminomas have a very favorable prognosis. In early stages, they have a five-year survival rate of 96.9%. Around two-thirds of dysgerminomas are diagnosed at stage I. Stage-III dysgerminomas have a five-year survival of 61%; when treated with BEP chemotherapy after incomplete surgical removal, dysgerminomas have a 95% two-year survival rate. Sex-cord-stromal malignancies also have a favorable prognosis; because they are slow-growing, even those with metastatic disease can survive a decade or more. Low malignant potential tumors usually only have a bad prognosis when there are invasive tumor implants found in the peritoneal cavity.Complications of ovarian cancer can include spread of the cancer to other organs, progressive function loss of various organs, ascites, and intestinal obstructions, which can be fatal. Intestinal obstructions in multiple sites are the most common proximate cause of death. Intestinal obstruction in ovarian cancer can either be a true obstruction, where tumor blocks the intestinal lumen, or a pseudo-obstruction, when tumor prevents normal peristalsis. Continuous accumulation of ascites can be treated by placing a drain that can be self-drained. - Onset
- The onset of ovarian cancer is typically insidious, meaning it develops gradually and without obvious symptoms early on. This often leads to diagnosis at a more advanced stage.
- Prevalence
- The prevalence of ovarian cancer varies by population and geographic region. Globally, ovarian cancer is one of the less common but more deadly gynecologic cancers. It is relatively rare compared to other cancers, with a lifetime risk for a woman of about 1 in 78. In the United States, it is estimated that about 1.2% of women will be diagnosed with ovarian cancer at some point during their lifetime.
- Epidemiology
- Globally, in 2018, the incidence of ovarian cancer was 6.6 per 100,000 and mortality was 3.9. Globally, about 160,000 people died from ovarian cancer in 2010. This was an increase from 113,000 in 1990. The number of new cases per year in Europe is approximately 5–15 per 100,000 women. In Europe, Lithuania, Latvia, Ireland, Slovakia, and the Czech Republic have the highest incidences of ovarian cancer, whereas Portugal and Cyprus have the lowest incidences. In 2008, the five-year survival rate was 44%. This has increased since 1977 when the survival rate was 36%.
- Intractability
- Ovarian cancer is considered challenging to treat, particularly in its later stages. While early-stage ovarian cancer can sometimes be treated successfully with surgery and chemotherapy, advanced-stage ovarian cancer often presents difficulties due to its tendency to spread within the abdominal cavity and develop resistance to standard treatments. Despite these challenges, ongoing research continues to explore new therapies and improve outcomes.
- Disease Severity
- Ovarian cancer severity can vary significantly depending on the stage at diagnosis. Early-stage ovarian cancer (Stage I) confined to the ovaries has a better prognosis and is considered less severe. However, advanced stages (Stages III and IV), where the cancer has spread beyond the ovaries to other parts of the body, are generally more severe and associated with a poorer prognosis. The severity also depends on factors such as the cancer's specific type, the patient’s overall health, and how well the cancer responds to treatment.
- Healthcare Professionals
- Disease Ontology ID - DOID:2394
- Pathophysiology
- Ovarian cancer forms when errors in normal ovarian cell growth occur. Usually, when cells grow old or get damaged, they die, and new cells take their place. Cancer starts when new cells form unneeded, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called an ovarian tumor or growth. These abnormal cancer cells have many genetic abnormalities that cause them to grow excessively. When an ovary releases an egg, the egg follicle bursts open and becomes the corpus luteum. This structure needs to be repaired by dividing cells in the ovary. Continuous ovulation for a long time means more repair of the ovary by dividing cells, which can acquire mutations in each division.Overall, the most common gene mutations in ovarian cancer occur in NF1, BRCA1, BRCA2, and CDK12. Type I ovarian cancers, which tend to be less aggressive, tend to have microsatellite instability in several genes, including both oncogenes (most notably BRAF and KRAS) and tumor suppressors (most notably PTEN). The most common mutations in Type I cancers are KRAS, BRAF, ERBB2, PTEN, PIK3CA, and ARID1A. Type II cancers, the more aggressive type, have different genes mutated, including p53, BRCA1, and BRCA2. Low-grade cancers tend to have mutations in KRAS, whereas cancers of any grade that develop from low malignant potential tumors tend to have mutations in p53. Type I cancers tend to develop from precursor lesions, whereas Type II cancers can develop from a serous tubal intraepithelial carcinoma. Serous cancers that have BRCA mutations also inevitably have p53 mutations, indicating that the removal of both functional genes is important for cancer to develop.In 50% of high-grade serous cancers, homologous recombination DNA repair is dysfunctional, as are the notch and FOXM1 signaling pathways. They also almost always have p53 mutations. Other than this, mutations in high-grade serous carcinoma are hard to characterize beyond their high degree of genomic instability. BRCA1 and BRCA2 are essential for homologous recombination DNA repair, and germline mutations in these genes are found in about 15% of women with ovarian cancer. The most common mutations in BRCA1 and BRCA2 are the frameshift mutations that originated in a small founding population of Ashkenazi Jews.Almost 100% of rare mucinous carcinomas have mutations in KRAS and amplifications of ERBB2 (also known as Her2/neu). Overall, 20% of ovarian cancers have mutations in Her2/neu.Serous carcinomas may develop from serous tubal intraepithelial carcinoma, rather than developing spontaneously from ovarian tissue. Other carcinomas develop from cortical inclusion cysts, which are groups of epithelial ovarian cells inside the stroma.
- Carrier Status
- Carrier status for ovarian cancer typically refers to the presence of genetic mutations that increase the risk of developing the disease. The most well-known genetic mutations linked to a higher risk of ovarian cancer are BRCA1 and BRCA2. These mutations can be inherited and significantly increase the likelihood of ovarian, breast, and other cancers. Genetic testing can identify carriers of these mutations, allowing for informed decisions about surveillance and preventive measures.
- Mechanism
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Ovarian cancer primarily develops due to aberrant cellular mechanisms within the ovaries. Mechanisms initiating the disease typically involve genetic mutations that disrupt normal cell regulation, leading to unrestrained cell proliferation and tumor formation.
Molecular mechanisms contributing to ovarian cancer include:
1. Genetic Mutations: Mutations in genes such as BRCA1, BRCA2, and TP53 are strongly associated with increased risk. BRCA1 and BRCA2 are involved in DNA repair, and their mutations lead to genomic instability.
2. Oncogenes and Tumor Suppressor Genes: Alterations in oncogenes like KRAS and tumor suppressors like PTEN and RB1 contribute to uncontrolled cell growth and survival.
3. Epigenetic Changes: Abnormal DNA methylation and histone modification patterns can lead to silencing of tumor suppressor genes or activation of oncogenes.
4. Signaling Pathways: Dysregulation of signaling pathways such as the PI3K/AKT/mTOR pathway, MAPK pathway, and Wnt/β-catenin pathway plays a significant role in tumor cell proliferation, survival, and metastasis.
5. Angiogenesis: Enhanced angiogenesis driven by factors such as VEGF allows the tumor to access nutrients and oxygen, facilitating growth and spread.
These molecular alterations collectively contribute to the development and progression of ovarian cancer by promoting uncontrolled cell division, resistance to apoptosis, invasion, and metastasis. - Treatment
- For ovarian cancer, treatment typically includes a combination of surgery and chemotherapy. Surgery usually involves the removal of the ovaries, fallopian tubes, and possibly other affected tissues. Chemotherapy is often used to kill any remaining cancer cells and may be administered before or after surgery. Other treatments, such as targeted therapy, hormone therapy, or radiation therapy, may be utilized depending on the specific case. Early detection and personalized treatment plans are crucial for improving outcomes.
- Compassionate Use Treatment
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Compassionate use, also known as expanded access, allows patients with serious or life-threatening conditions, such as ovarian cancer, to access investigational drugs or treatments outside of clinical trials when no comparable or satisfactory alternative therapy options are available. This is typically done when the patient has exhausted all other treatment options and meets specific criteria set by regulatory bodies.
Off-label treatments for ovarian cancer include the use of drugs that are approved for other conditions but can be applied based on evidence supporting their effectiveness in ovarian cancer. Examples include:
1. **Bevacizumab (Avastin)**: Although primarily approved for colorectal cancer and other types, it is sometimes used off-label for ovarian cancer to inhibit tumor blood vessel growth.
2. **PARP inhibitors (e.g., Olaparib, Niraparib, Rucaparib)**: These drugs are often used in ovarian cancer patients with BRCA mutations, even though they might not be approved for all specific subtypes of ovarian cancer.
Experimental treatments refer to therapies still in clinical trials and not yet approved by regulatory bodies. These may include:
1. **Immunotherapy**: Drugs that help the immune system recognize and combat cancer cells. Checkpoint inhibitors like Pembrolizumab are under investigation for ovarian cancer.
2. **Targeted Therapy**: Agents targeting specific pathways or mutations in cancer cells, such as those affecting the PI3K/AKT/mTOR pathway.
3. **Gene Therapy**: Techniques designed to modify genetic material within cancer cells or influence gene expression.
Patients interested in off-label or experimental treatments should discuss these options with their healthcare provider and consider potential benefits and risks. - Lifestyle Recommendations
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For ovarian cancer, lifestyle recommendations that may help reduce risk or support overall well-being include:
1. **Dietary Choices**: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit processed foods and sugar intake.
2. **Regular Exercise**: Engage in regular physical activity, such as brisk walking, swimming, or yoga, to maintain a healthy weight and boost overall health.
3. **Avoid Smoking**: Smoking is linked to an increased risk of various cancers, including ovarian cancer. Quitting smoking can improve overall health.
4. **Limit Alcohol Consumption**: Keep alcohol intake to a moderate level, as excessive drinking can contribute to cancer risk.
5. **Maintain a Healthy Weight**: Obesity has been linked to an increased risk of ovarian cancer. Focus on achieving and maintaining a healthy weight through diet and exercise.
6. **Regular Medical Check-ups**: Attend regular health screenings and gynecological exams. Discuss any family history of ovarian or related cancers with your healthcare provider.
7. **Consider Birth Control**: Studies suggest that the use of oral contraceptives (birth control pills) may reduce the risk of ovarian cancer. Consult with a healthcare provider to understand the benefits and risks.
8. **Awareness of Symptoms**: Be aware of symptoms of ovarian cancer, such as bloating, pelvic or abdominal pain, difficulty eating, and frequent urination. Early detection can improve outcomes.
9. **Limit Exposure to Known Carcinogens**: Be cautious about exposure to certain chemicals and substances known to increase cancer risk.
10. **Genetic Counseling and Testing**: If you have a strong family history of ovarian or breast cancer, consider genetic counseling and testing for BRCA1, BRCA2, and other related mutations.
Implementing these lifestyle changes can help support overall health and may reduce the risk of ovarian cancer. Always consult with a healthcare professional for personalized advice. - Medication
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Ovarian cancer treatment often involves a combination of surgery and chemotherapy. Key medications used include:
1. **Platinum-based chemotherapy:**
- Carboplatin
- Cisplatin
2. **Taxanes:**
- Paclitaxel
- Docetaxel
3. **Targeted therapy:**
- Bevacizumab (Avastin)
- PARP inhibitors (e.g., Olaparib, Rucaparib, Niraparib)
4. **Hormone therapy:** (less common)
- Tamoxifen
- Letrozole
Treatment plans depend on the stage and specific characteristics of the cancer. - Repurposable Drugs
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Research into repurposable drugs for ovarian cancer includes drugs originally designed for other conditions but showing potential efficacy against ovarian cancer. Examples include:
1. **Metformin**: Originally used for type 2 diabetes, studies suggest metformin may inhibit ovarian cancer cell growth.
2. **Statins**: Primarily for lowering cholesterol, statins have been found to possess anti-cancer properties that may affect ovarian cancer cells.
3. **PARP Inhibitors**: Though specifically designed for cancer, these are highlighted due to their efficacy in treating BRCA-mutant ovarian cancer, which was not their initial target.
These drugs are still undergoing various stages of clinical trials and research to confirm their effectiveness and safety in the context of ovarian cancer. - Metabolites
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In the context of ovarian cancer, metabolites are small molecules produced during cellular metabolism that can be used as biomarkers for disease detection, progression, and treatment response. Abnormal levels of specific metabolites can indicate disruptions in cellular processes associated with cancer. For example, altered levels of lipids, amino acids, and glycolytic intermediates have been observed in ovarian cancer patients. Researchers are investigating these metabolic changes to develop better diagnostic tools and therapeutic strategies.
"Nan" might be shorthand for nanoparticles, which are increasingly studied for their potential in cancer diagnosis and treatment. Nanoparticles can be designed to target ovarian cancer cells specifically, deliver drugs directly to the tumor site, and enhance imaging techniques for better tumor detection. They offer a promising avenue for improving the efficacy and specificity of ovarian cancer treatments. - Nutraceuticals
- Research on nutraceuticals in the context of ovarian cancer is ongoing. Nutraceuticals are products derived from food sources with extra health benefits in addition to their basic nutritional value. They include vitamins, minerals, probiotics, and herbal products. Some studies suggest that certain nutraceuticals, such as curcumin, resveratrol, and green tea extracts, might have anti-cancer properties due to their antioxidant and anti-inflammatory effects. However, their efficacy and safety in treating ovarian cancer remain under investigation, and they should not replace conventional therapies. Always consult with a healthcare provider before starting any new supplement regimen.
- Peptides
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In the context of ovarian cancer, peptides and nanoparticles (nanotechnology) are emerging areas of research for diagnostic and therapeutic purposes.
**Peptides**: Certain peptides can be used as biomarkers for early detection of ovarian cancer. Additionally, therapeutic peptides are being developed to target specific pathways involved in cancer growth and metastasis. Peptides can also function as ligands to direct drugs to ovarian cancer cells, increasing treatment efficacy and reducing side effects.
**Nanoparticles (Nanotechnology)**: Nanoparticles are being explored for their potential to improve the delivery of chemotherapy drugs directly to ovarian cancer cells. These nanocarriers can encapsulate drugs, protecting them from degradation and aimed at tumor sites, thus minimizing harm to healthy tissues. Some nanoparticles are engineered to release their therapeutic payload in response to specific tumor microenvironmental conditions, enhancing treatment precision.
Both peptides and nanotechnology represent promising advances in the battle against ovarian cancer, offering potential improvements in early detection and more effective targeted therapies.