When is ovarian cancer dangerous Stages and modern treatment methods

Ovarian cancer is one of the most dangerous types of gynecological cancers because it’s often discovered in its late stages. That’s why understanding its stages, symptoms, and treatment options is essential for every woman. In this article, we’ll guide you through the different stages of ovarian cancer—from early to advanced—along with the latest approved treatment methods, whether medical, surgical, or targeted therapies. You’ll also learn the differences between each stage and how that affects recovery and survival rates. If you’re looking for reliable and simplified information about ovarian cancer, this article on            Dalili Medical will be your complete guide.

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that begins in the ovaries or fallopian tubes. It occurs when some cells start growing uncontrollably and abnormally. These cells can multiply rapidly and form a tumor. If not treated early, the cancer can spread to other parts of the body.

What makes ovarian cancer particularly dangerous is that it usually doesn’t show clear symptoms in its early stages. That’s why it’s considered one of the most serious and common cancers of the female reproductive system.

What Are the Ovaries and What Do They Do?

The ovaries are two small organs, each about the size of a walnut, located on either side of the uterus. They play a vital role in the female reproductive system. The main functions of the ovaries are:

• Releasing eggs during ovulation each month

• Producing female hormones like estrogen and progesterone

• If the egg is fertilized by a sperm, it can lead to pregnancy

How Does Ovarian Cancer Spread?

If not detected early, ovarian cancer can spread beyond the ovaries. The usual pattern of spread includes:

1. Starting in the pelvic area

2. Then spreading to lymph nodes, the abdomen, or intestines

3. In advanced stages, it may reach the stomach, chest, or even the liver

That’s why early detection and regular medical follow-ups are so important—once the cancer spreads, treatment becomes more complex.

Can an Ultrasound Detect Ovarian Cancer?

If there’s a suspicion of an ovarian issue, the first test a doctor typically recommends is an ultrasound (sonar). This imaging test helps visualize the ovaries and detect any abnormalities in their shape or size.

Ultrasound can help detect:

• A mass inside the ovary

• The nature of the mass: is it fluid-filled (usually benign) or solid (could indicate a tumor)?

However, it's important to note that ultrasound alone cannot confirm cancer. It only raises suspicion and helps the doctor decide on further tests like blood work or a biopsy to examine the cells under a microscope for cancer.

Can Ovarian Cancer Come Back After Treatment?

Unfortunately, ovarian cancer can recur after treatment, and the recurrence rate varies depending on the stage at which the cancer was diagnosed. Statistics show:

• Stage 1: Around 10% chance of recurrence

• Stage 2: Up to 30%

• Stage 3: Around 70%

• Stage 4: As high as 90%

Is Ovarian Cancer Curable?

Yes, ovarian cancer can be cured, especially if it’s detected in the early stages. In its initial stages, the chances of full recovery are very high. Many women recover completely with proper treatment. That’s why early diagnosis is key to better outcomes.

What Are the Early Symptoms of Ovarian Cancer?

Ovarian cancer is often silent in the beginning, but there are some symptoms you should pay attention to—especially if they occur frequently:

• Persistent abdominal bloating

• Pain or pressure in the pelvic area

• Feeling full quickly after eating

• Loss of appetite

• Constant fatigue

• Lower back pain

• Constipation or digestive issues

• Frequent urination or urgency

If these symptoms last for more than two weeks, it’s best to see a doctor.

Is Ovarian Cancer Painful?

Yes, it can cause noticeable pain, especially as the tumor grows. Common areas of pain include:

• The lower abdomen or pelvic region

• The lower back

If the cancer spreads, it may also lead to:

• Shortness of breath

• Pain in the upper abdomen or chest

What Causes Ovarian Cancer?

Until now, there is no single known cause of ovarian cancer. However, researchers believe that certain factors may increase the risk of developing it, such as:

• A family history of cancer

• Aging

• Genetic mutations like BRCA1 and BRCA2

• Hormonal or reproductive factors

Ovarian cancer begins when a DNA mutation occurs inside a cell, causing the cell to grow and multiply uncontrollably. These abnormal cells can form a tumor that may spread to other parts of the body. While healthy cells die or stop functioning, cancerous cells continue growing.

Can You Get Pregnant After Ovarian Cancer?

Ovarian cancer and its treatments can affect fertility, depending on the stage of the disease and the type of treatment. In some cases, one or both ovaries may need to be removed, or even the uterus, which directly impacts a woman’s ability to conceive.

Chemotherapy or radiation therapy can also lead to early menopause and affect ovarian function. However, if the cancer is diagnosed at an early stage and only one ovary is removed, the remaining ovary may still function, and pregnancy may still be possible. Still, chemotherapy can damage the healthy ovary, reducing fertility chances.

Can a Woman Get Pregnant with One Ovary?

Yes, many women have successfully become pregnant with only one ovary. The remaining ovary can continue to produce eggs normally, though there might be some challenges, especially if:

• There are issues with the fallopian tube

• Hormonal imbalances exist

• The woman is older

• Ovarian reserve is low

Statistics show that the chances of getting pregnant after the removal of one ovary range between 42% and 88%, depending on the woman’s overall health and the type of surgery performed.

Are Pregnant Women More Likely to Develop Ovarian Cancer?

Ovarian cancer is most commonly diagnosed after menopause, especially among women aged 55 to 64. It is much rarer during childbearing years. In fact, it is uncommon for ovarian cancer to be discovered during pregnancy.

Studies have shown that pregnancy before the age of 35 may reduce the risk of ovarian and breast cancers. The more full-term pregnancies a woman has, the lower her risk. Sometimes, tumors are discovered during pregnancy through routine ultrasounds, but this is usually coincidental and doesn’t mean that pregnancy is a direct cause of cancer.

Does Ovarian Cancer Affect the Way a Woman Gives Birth?

Most women with ovarian cancer can carry their pregnancies to term and deliver naturally. However, the method of delivery depends on the stage and spread of the cancer.

In many cases, natural childbirth is possible without complications. But in some situations, a cesarean section may be recommended. Sometimes, doctors may perform a C-section along with tumor or cancer removal surgery, depending on the medical assessment of the case.

Does Ovarian Cancer Affect the Baby’s Growth During Pregnancy?

Generally, ovarian cancer does not harm the developing fetus. However, there could be risks if the cancer is in an advanced stage, especially if it affects blood flow to the fetus or leads to abnormal hormone levels.

In some situations, cancer treatments—like surgery or chemotherapy—pose a greater risk to the baby than the cancer itself. Therefore, treatment decisions during pregnancy must be made carefully and individually.

Is It Possible to Breastfeed During Chemotherapy or Radiation Treatment?

Breastfeeding during chemotherapy or radiation therapy is generally not considered safe. The medications used in chemotherapy or radiation therapy can transfer into breast milk, potentially causing serious side effects for the baby. Therefore, it is generally recommended to avoid breastfeeding while undergoing these treatments.

Types of Ovarian Cancer

Ovarian cancer varies based on the type of cells from which the tumor originates. The types are as follows:

• Germ Cell Tumors: These occur within the cells that produce eggs and are a very rare type of ovarian cancer.

• Epithelial Tumors: These appear in the outer layer covering the ovaries and are the most common type, making up around 90% of ovarian cancer cases.

• Stromal Tumors: These develop in the cells that produce hormones and make up about 7% of ovarian cancers.

Who is at Risk for Ovarian Cancer?

Ovarian cancer primarily affects women and individuals assigned female at birth (AFAB). This type of cancer is more common among Native American and Caucasian populations compared to African American, Latina, or Asian individuals. Additionally, people of Ashkenazi Jewish descent are more likely to carry genetic mutations like BRCA, which increases the risk of ovarian and breast cancer. In India, ovarian cancer accounts for about 3.34% of cancer-related deaths among women.

Stages of Ovarian Cancer

Ovarian cancer is divided into four main stages to determine the expected treatment and predict the prognosis:

• Stage 1: The cancer is confined to the ovaries or fallopian tubes.

  • Stage 1A: The cancer is found in only one ovary.

  • Stage 1B: The cancer has spread to both ovaries.

  • Stage 1C: The cancer is on the outer surface of the ovaries or in the fluid around the ovaries.

• Stage 2: The cancer has spread beyond the ovaries and tubes to other tissues within the pelvic region.

  • Stage 2A: The cancer has spread to the uterus.

  • Stage 2B: The cancer has spread to other pelvic tissues.

• Stage 3: The cancer may have spread to the abdomen or lymph nodes.

  • Stage 3A: The cancer is visible under a microscope in the abdominal lining or lymph nodes in the pelvic area.

  • Stage 3B: The tumors are small, less than 3 cm in size.

  • Stage 3C: The tumors are large and may involve lymph nodes.

• Stage 4: The cancer has spread to distant organs such as the liver, lungs, or spleen.

  • Stage 4A: The cancer is found in the fluid around the lungs.

  • Stage 4B: The cancer has spread to lymph nodes and upper abdominal organs.

How is Ovarian Cancer Diagnosed?

Despite continuous efforts by health organizations to find methods for early detection, ovarian cancer remains difficult to detect in its early stages due to the lack of a reliable screening test. Therefore, it is important for women to undergo regular check-ups for early detection. If a problem with the ovaries is suspected, the doctor typically begins by asking about the patient's medical history and conducting a physical examination. Then, several tests are used to confirm the diagnosis, such as:

Imaging and Radiology Tests

Doctors may use several types of imaging tests to detect ovarian tumors, including:

• Pelvic Ultrasound: Used to examine the ovaries and detect any abnormal lumps or changes.

• Magnetic Resonance Imaging (MRI): Helps in determining the size and spread of the tumor.

• Computed Tomography (CT Scan): Provides detailed images of the organs inside the body.

• Positron Emission Tomography (PET Scan): Used to detect abnormal cellular activity that may indicate cancer.

Blood Tests

Blood tests can help support the diagnosis, including:

• Complete Blood Count (CBC): May show an elevated white blood cell count or a low hemoglobin level due to bleeding caused by cancer.

• Erythrocyte Sedimentation Rate (ESR): Can be elevated in cases of cancer.

• CA-125 Test: A key test used to look for tumor markers, which may indicate a potential ovarian cancer.

• Immunoglobulins: Measured through a process called electrophoresis, where the immune system interacts with some types of cancer by secreting immunoglobulins.

Surgical Evaluation

Doctors may be able to diagnose ovarian cancer during surgery, especially if abnormal growth is detected in the ovary. Typically, the tumor is removed if present.

Laparoscopy

During laparoscopic surgery, a small camera is inserted through a tiny incision in the abdomen to assess the condition of the ovaries. Biopsies may be taken for testing. In some cases, tumors can be removed from the ovary using this technique.

Risk Factors for Ovarian Cancer

• Age: The risk of ovarian cancer increases with age, particularly after menopause.

• Obesity: Obesity may play a role in increasing the risk of ovarian cancer.

• Late Childbearing or No Children: Having a first pregnancy after the age of 35 or being unable to carry a pregnancy to term may increase the risk.

• Fertility Treatments: Some research suggests a link between in vitro fertilization (IVF) and borderline ovarian cancers, although the research is inconsistent.

• Hormone Therapy after Menopause: Especially therapy containing only estrogen, which may increase the risk of ovarian cancer if used for an extended period.

• Family History: A family history of colon, rectal, breast, or ovarian cancer increases the likelihood of developing ovarian cancer.

Treatment Options for Ovarian Cancer

The treatment for ovarian cancer depends on the stage of cancer, its spread, and the overall health of the patient. Treatment methods include surgery, chemotherapy, targeted therapy, immunotherapy, and other options. Here are the main treatments:

1. Unilateral Oophorectomy
   In the early stages of cancer, when it has not yet spread, the doctor may remove one ovary and its attached fallopian tube. This procedure helps preserve the woman’s ability to have children after treatment.

2. Bilateral Oophorectomy
   If both ovaries are affected by cancer but have not spread to other areas, both ovaries and fallopian tubes may be removed. This surgery may result in menopause, but if the uterus is still intact, the woman may have the option to use frozen embryos or eggs for conception.

3. Total Abdominal Hysterectomy and Bilateral Oophorectomy
   In more advanced or aggressive cases of cancer, doctors may recommend removing both ovaries, the fallopian tubes, the uterus, nearby lymph nodes, and surrounding fatty tissue. This procedure helps reduce the chances of cancer recurrence.

4. Surgery for Advanced Cancer
   In cases where cancer has spread to advanced stages, the doctor may attempt to remove as much of the affected tissue as possible. This may be followed by chemotherapy, either before or after surgery, to ensure all remaining cancer cells are eradicated.

Non-Surgical Treatment for Ovarian Cancer

In addition to surgery, there are several non-surgical treatments that may be used:

1. Chemotherapy
   Chemotherapy is used before or after surgery to kill cancer cells. It may be administered intravenously or orally, depending on the cancer type and patient’s condition.

2. Targeted Therapy
   Targeted therapy focuses on specific weaknesses in cancer cells. It involves using medications that block the growth and replication of cancer cells in a precise and effective manner. This treatment may be suitable for some types of ovarian cancer.

3. Hormonal Therapy
   If the cancer relies on hormones for growth, hormonal therapy may be recommended. This includes medications aimed at lowering hormone levels or blocking their effects on cancer growth.

4. Immunotherapy
   Cancer cells produce proteins that help them evade the immune system. Immunotherapy works by breaking this natural defense, stimulating the immune system to attack cancer cells.

5. Targeted Therapy Drugs
   These drugs focus on the cancer cells and alter their behavior to reduce the cancer’s spread. Targeted therapy is specific to ovarian cancer and not used for other cancers. It may be used in cases where cancer returns after chemotherapy. Some common drugs used in this area include Olaparib and Niraparib.

6. Herbal Treatment for Ovarian Cancer
   While herbs can be effective in certain cases, their efficacy is generally low, especially in advanced stages of cancer. In the early stages, some herbs may be used, such as:

   • Turmeric: Contains "curcumin," a potent antioxidant.

   • Black Seed: Known for its anti-tumor properties.

   • Ginger Root: Contains compounds that combat bacteria and viruses.

   • Red Sage: May be beneficial in supporting the immune system.

Surgical Treatment for Ovarian Cancer

Surgery remains a primary method of treating ovarian cancer, and the type of surgery depends on the stage and spread of the cancer. Here is an explanation of the most common surgical procedures:

1. Unilateral Oophorectomy (Surgery in Early Stages)
   If cancer is detected early and is confined to only one ovary, the affected ovary and its connected fallopian tube are removed. This surgery helps preserve the woman's reproductive ability, as the other ovary and uterus remain intact, allowing for potential future pregnancies.

2. Bilateral Oophorectomy and Fallopian Tube Removal (Surgery if Cancer has Spread to Ovaries)
   If cancer has spread to both ovaries but has not affected other areas, both ovaries and fallopian tubes may be removed. The uterus may remain intact, allowing the woman to consider pregnancy through assisted reproductive techniques, such as in vitro fertilization (IVF) or using frozen embryos.

3. Total Abdominal Hysterectomy and Bilateral Oophorectomy (Surgery in Advanced Stages)
   If cancer has advanced and spread to nearby tissues, it may be necessary to remove both ovaries, the fallopian tubes, the uterus, and lymph nodes, along with the surrounding fatty tissue. This surgery is typically used in cases of advanced cancer.

4. Surgery for Advanced Ovarian Cancer (Removing Tumors in Advanced Stages)
   In advanced ovarian cancer cases where the cancer has spread to different parts of the body, the surgeon will attempt to remove as much of the affected tissue as possible. Chemotherapy is often performed before or after surgery to ensure that any remaining cancer cells are destroyed.

Chemotherapy for Ovarian Cancer

Chemotherapy is one of the primary treatments for ovarian cancer, aiming to destroy cancer cells before, after, or, in some cases, without surgery. The decision to use chemotherapy depends on factors such as the stage of cancer and its spread.

When is Chemotherapy Given?
Chemotherapy may be given before surgery to shrink the tumor, after surgery to eliminate any remaining cancer cells, or in some cases, on its own if surgery is not an option.

How Often is Chemotherapy Given?
Ovarian cancer treatment usually follows a series of chemotherapy cycles. Typically, the first chemotherapy dose is given every 3 weeks. After each dose, the patient is given a period to recover from side effects. Usually, 6 cycles of treatment are needed, but some patients may require more, depending on their body’s response and the medical team’s guidance.

How Long Does Each Chemotherapy Session Take?
The duration of chemotherapy varies based on the patient’s condition and the type of dosage administered:

• Standard Duration: Chemotherapy sessions usually take 3 to 4 hours.

• Extended Duration: In some cases, challenging sessions may last 24 hours or more.

Chemotherapy is given in hospitals or outpatient clinics, depending on the dosage and duration.

Monitoring Chemotherapy Effectiveness
To track the effectiveness of chemotherapy, periodic tests such as blood tests and imaging studies are performed. These tests help determine if the treatment is achieving the desired results.

Effective Drugs for Ovarian Cancer

Treatment for ovarian cancer depends on several factors, including cancer stage, tumor size, and spread. The drugs used include chemotherapy agents, hormonal treatments, immunotherapy, and targeted therapy. Here are some effective drugs for ovarian cancer treatment:

1. Chemotherapy Drugs:

   • Paclitaxel: An essential drug for ovarian cancer treatment, working to stop cancer cell growth and multiplication.

   • Carboplatin: Often used with paclitaxel, it destroys cancer cells by interacting with DNA.

2. Immunotherapy Drugs:

   • Olaparib: Targets BRCA genetic mutations and is used for specific ovarian cancer cases.

   • Niraparib: Reduces the risk of cancer recurrence after chemotherapy, especially in cases with certain genetic mutations.

3. Hormonal Therapy Drugs:

   • Megestrol: Used to shrink tumors by affecting hormone levels, especially in certain types of ovarian cancer.

4. Targeted Therapy Drugs:

   • Bevacizumab: Works to block the blood vessels that supply tumors, used in some ovarian cancer cases.

Additional Effective Drugs for Ovarian Cancer:

1. PARP Inhibitors: These drugs target cancer cells and prevent DNA repair, which halts the division of cancer cells. Some examples include:

   • Rucaparib

   • Talazoparib
     These are used especially in patients with BRCA1 or BRCA2 mutations.

2. Modern Immunotherapy Drugs:
   In some cases, doctors use immunotherapy drugs to boost the immune system to attack cancer cells:

   • Pembrolizumab

   • Atezolizumab
     These are used for cases with MSI-H or dMMR mutations in the tumor.

3. Alternative Chemotherapy Drugs:
   If the cancer cells are resistant to traditional chemotherapy like carboplatin or paclitaxel, alternative drugs may be used, such as:

   • Topotecan

   • Gemcitabine

   • Liposomal Doxorubicin

4. Hormonal Therapy:
   These drugs are used in some types of ovarian cancer that depend on hormones for growth:

   • Letrozole

   • Tamoxifen

5. Other Drugs:

   • Etoposide: Works by disrupting the growth of cancer cells, used in recurrent or resistant cases.

   • Cyclophosphamide: One of the oldest chemotherapy drugs, used in cases of recurrence or resistance.

   • Ifosfamide: Similar to cyclophosphamide, used in experimental treatment protocols or as a second-line therapy.

   • Vinorelbine: Used in advanced cases when cancer cells are resistant to initial treatments.

   • Capecitabine: An oral chemotherapy drug, used in cases of relapse or resistant tumors.

The treating doctor for ovarian cancer is typically a gynecologist specializing in gynecological oncology or a medical oncologist. They may work in a multidisciplinary team, which includes:

• Medical Oncologist: Specialized in treating cancer with chemotherapy, immunotherapy, and targeted therapy.

• Gynecologist: Specializes in female reproductive health and performs surgeries like oophorectomy or hysterectomy.

• Radiologist: Conducts imaging tests like ultrasound and MRI for diagnosis.

• Surgeon: Performs necessary surgeries, such as removing tumors or affected tissues.