Ovarian cancer

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Ovarian cancer (medical ovarian cancer) is a malignant tumor of the ovaries. The cancer is often only discovered at an advanced stage of the disease, when the tumor has already spread to the abdominal cavity. The risk increases with age - most women are affected after the menopause. Here you can find out everything you need to know about ovarian cancer.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. C56D39C57

Ovarian cancer: description

Ovarian cancer (medical: ovarian cancer) is a malignant tumor of the ovaries. These are located to the left and right of the uterus and have a relatively large amount of space - because their position and size change slightly during the female cycle. A tumor on the ovary therefore usually only causes symptoms at an advanced stage and is often noticed late.In around 50 percent of cases, the cancer affects both ovaries.

Doctors differentiate so-called germ line stroma tumors from cancer that arises from the ovarian cells themselves. This type of tumor develops from embryonic germ lines. This is how 15 to 20 percent of ovarian tumors develop. One example is the Brenner tumor, a round tumor up to several centimeters in size, which is usually benign and only degenerates in 0.5 to 9 percent of cases.

Malignant ovarian cancer quickly forms daughter ulcers, so-called metastases. These spread mainly within the abdominal cavity and the peritoneum. The liver, lungs, pleura or lymph nodes can also be affected via the blood and lymph vessels.

The disease runs in four stages, which are divided according to the so-called FIGO classification:

• FIGO I: Early stage. Ovarian cancer only affects the ovarian tissue. One ovary or both ovaries can be affected.
• FIGO II: The tumor has already spread in the pelvis.
• FIGO III: The cancer has metastases in the peritoneum (medical: peritoneal carcinosis) or in the lymph nodes.
• FIGO IV: Very advanced stage. The tumor tissue is already outside the abdominal cavity. For example, distant metastases can develop in the lungs. You get there via the bloodstream or the lymphatic system.

Mostly older women are affected by the disease after the menopause. Ovarian cancer rarely occurs before the age of 40. Ovarian cancer is the second most common cancer of the female genital organs after breast cancer. Every year between 7,000 and 8,000 women fall ill in Germany, writes the Robert Koch Institute. The risk of developing a malignant tumor on the ovaries is 1.5 percent (one in 68 women is affected).

Other ovarian tumors

Tumors that cannot be traced back to a degeneration of the ovarian cells - such as daughter tumors of other cancers - can also occur in the ovaries. This includes the Krukenberg tumor, which develops as a secondary tumor of gastric cancer.

Ovarian cancer: symptoms

You can read everything you need to know about the typical signs of ovarian cancer in the article Ovarian cancer symptoms.

Ovarian cancer: causes and risk factors

Like almost every type of cancer, ovarian cancer arises from cells that grow out of control. In the later stage, the tumor then forms metastases that spread to the surrounding tissue, for example in the abdominal cavity. Why the cells degenerate is not known in detail. Genetic factors seem to play a role, however, because ovarian cancer occurs more often in families and certain genetic changes (mutations) occur more frequently in cancer patients. Furthermore, the number of female cycles plays a role in the development of the disease. Women with a late first menstrual period and an early onset of menopause are therefore less likely to develop an ovarian tumor. This also applies to women who have been pregnant one or more times or who have used hormonal contraception for a longer period of time.

Genetic and environmental factors

Changes in the BRCA1 and BRCA2 genes significantly increase the risk of developing ovarian cancer. However, they were only found in a small proportion of the women affected. Further genetic factors are currently still the subject of research. Breast cancer patients also often have altered genes of the BRCA group (BReast CAncer). Women who have first-degree relatives who have breast or ovarian cancer are at increased risk of developing the disease. Harmful environmental influences and an unhealthy diet can also play a role. There is evidence that being overweight (obese) increases the risk of the disease.

Ovarian cancer: examinations and diagnosis

A first indication of a tumor on the ovary is palpation of the abdominal wall and the female genital organs. This is usually followed by an ultrasound examination (medical: sonography) of the abdominal region and the vagina. It already provides information about the size, location and nature of the cancerous tumors. It may also be possible to estimate whether the tumor is benign or malignant. How far the disease has already spread can be determined with the help of computer or magnetic resonance imaging. The doctor can discover metastases in the chest or abdomen. If there is suspicion that the tumor has already affected the bladder or rectum, a cystoscopy or rectal examination can provide information. A reliable diagnosis is only possible after examining a tissue sample, which must first be surgically removed (medical: biopsy).

To assess the course of the disease, the doctor can measure specific tumor markers in the blood. If the amount of these cell proteins increases, this indicates that metastases have grown. After a tumor has been surgically removed, the examination can provide indications of a tumor relapse, a so-called relapse.

There is no statutory screening for prevention of ovarian cancer. Regular gynecological examinations and a vaginal ultrasound can help to identify the cancer at an early stage. It is also under discussion whether a blood test in combination with ultrasound could be a standard procedure for obtaining early evidence of ovarian cancer.

Ovarian cancer: treatment

Therapy for ovarian cancer essentially comprises two procedures: surgery and chemotherapy. Usually the doctor treats the patient with a combination of both. Which therapy method is used depends on the stage of the tumor.

surgery

The chances of recovery from ovarian cancer depend to a large extent on the complete removal of the tumor: the ovary (usually both), uterus, fallopian tubes and the large abdominal network are therefore usually removed by the doctor. If the tumor is detected very early or if the tumor is clearly unilateral, this operation can also be deviated from. If the tumor has already spread significantly, it may also be necessary to remove other parts of the peritoneum, parts of the intestine, the appendix or the lymph nodes.

The operation is also used for diagnostic purposes. The doctor can search the entire abdomen for metastases. Tissue samples can be taken from suspicious, enlarged lymph nodes for further examination.

chemotherapy

Chemotherapy is usually carried out after the operation. The aim of the treatment is to prevent tumor foci that may not or may not have been removed from developing further. The drugs either act on the entire body or can be introduced specifically into the abdominal cavity. They kill cancer cells. The most effective against ovarian cancer are substances containing platinum, such as carboplatin, which is given in combination with other active substances such as paclitaxel.

Additional drugs can specifically disrupt certain properties of the tumor and thus support chemotherapy. Substances that suppress the formation of new blood vessels worsen the supply of oxygen and nutrients to the tumor, thereby slowing down its growth.

If the tumor on the ovary was discovered very early, chemotherapy may be dispensed with. Chemotherapy alone is also successful in patients who cannot be operated on by the doctor due to their poor state of health. Radiation therapy is only used in exceptional cases.

Ovarian cancer: disease course and prognosis

The earlier a tumor is detected, the better, applies to ovarian cancer - the chances of a cure drop drastically if metastases have already developed in the abdominal cavity. A disease that is confined to the ovaries has a very good prognosis - on average, patients live 15 years or longer after diagnosis. If the tumor tissue has been completely removed by surgery before the cancer tissue has spread metastases, a complete cure is possible.

Unfortunately, many cases are only diagnosed at an advanced stage. The reason: the disease shows no early symptoms. If the cancer has already spread to the abdomen, the chances of a cure are poor. In the end-stage ovarian cancer, the disease spreads throughout the body. Organs outside the abdominal cavity such as the liver and lungs then also contain metastases. At this stage, the average ovarian cancer life expectancy is only 14 months. In patients with advanced ovarian cancer, the disease often comes back after treatment has been completed.

The 5-year survival rate for ovarian cancer is around 40 percent - that is, five years after diagnosis, around half of the patients are still alive. Overall, ovarian cancer has the worst prognosis of all gynecological cancers.

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