Ovarian Cancer: Recognizing the Signs

All malignant tumours of the ovary (ovary) are summarized under ovarian cancer. In most cases, this is a so-called ovarian carcinoma; more rarely, there are spread foci (metastases) of other cancer diseases in the ovaries.

Diagnosis of ovarian cancer

Ovarian cancer is the second most common cancer of the reproductive organs in women after uterine cancer (endometrial cancer). Since there are usually no symptoms initially, the diagnosis is often only made at an advanced stage.

Therefore, the prognosis for ovarian cancer is somewhat unfavourable compared to other types of cancer because, in many cases, the tumour can no longer be entirely removed by surgery at the time of diagnosis.

 

Early stage: Unspecific signs

Usually, in the early stages, ovarian cancer does not cause any characteristic symptoms. Any early symptoms that may occur can also have a variety of other – often harmless – causes. Examples of non-specific symptoms of ovarian cancer include:

• Disorders of the menstrual cycle: Intermenstrual bleeding, too frequent, too infrequent or absent menstrual bleeding
• New or unusually severe pain during menstruation or around the time of ovulation
• unusually heavy or prolonged menstrual bleeding
• bleeding after menopause
• abdominal pain
• The feeling of fullness or pressure in the lower abdomen
• unexplained weight loss
• Fever
• profuse night sweats

Ovarian cancer: late-stage symptoms

A typical sign of advanced ovarian cancer is what is known as abdominal dropsy (ascites). The reason for this is that cancer cells settle within the abdominal cavity and, among other things, lead to an accumulation of fluid in the abdominal cavity by obstructing lymphatic drainage. The patients usually first notice this as an increase in the abdominal circumference.

If the cancer cells spread via the lymphatic vessels to the pleura, fluid can also collect (pleural effusion). This can then manifest itself as breathing difficulties.

If the tumour is so large that it presses on the surrounding organs, the following symptoms can occur:

• Diarrhea
• constipation
• gas
• increased urination
• Urinary retention with flank pain

 

Masculinization in hormone-producing tumors

Rare subgroups of ovarian tumours can produce sex hormones and thus lead to special symptoms: if the tumour produces the male sex hormone testosterone, this leads to masculinization (virilization or androgenization), which can manifest itself in increased body hair growth, hair loss on the head and a deeper voice.

Another type of tumour produces the female sex hormone estrogen, causing the uterus lining to thicken. As a result, irregular, absent or increased menstrual bleeding and infertility can occur.

Differential Diagnosis: Other causes of the symptoms

Many of the signs of ovarian cancer are non-specific, meaning there can be a variety of other causes causing the symptoms. Menstrual cycle disorders, for example, are caused much more frequently by an imbalance in the hormonal balance or by ovarian cysts. Endometriosis – a disease in which the lining of the uterus is outside the uterus – is also a common cause of menstrual problems.

If there is no menstrual period at all, an extrauterine pregnancy – a pregnancy in which the egg implants itself outside the uterine cavity – should also be considered. Ovarian inflammation can also be behind lower abdominal pain in connection with fever.

Meigs syndrome in benign ovarian tumour

Ascites and pleural effusion can indicate diseases of the lungs, liver and heart, as well as various cancers. In rare cases, a benign ovarian tumour (ovarian fibroma) can also be the cause – the combination of symptoms is then called Meigs syndrome.

 

Age and gene mutations as risk factors

About one to two per cent of all women will develop ovarian cancer in their lifetime. Women over the age of 45 are mostly affected – younger patients often have a mutation in a gene (BRCA1 or BRCA2), which significantly increases the risk of ovarian cancer. Because these mutated genes are inheritable, ovarian cancer and other cancers, such as breast cancer, can run in families.

In addition, the following risk factors can promote the occurrence of ovarian cancer:

• Early first menstrual period (before age 12)
• Late last menstrual period (after age 50)
• Few or no pregnancies
• Drug stimulation of ovulation – for example, as part of artificial insemination
• Polycystic Ovarian Syndrome (PCO Syndrome)
• Lynch Syndrome (HNPCC Syndrome)
• Nicotine consumption
• infertility

Since ovulating many times in one’s life (for example, if a woman has her period for 40 years) can increase the risk of ovarian cancer, hormonal contraceptives such as the birth control pill may have a protective effect by suppressing ovulation.

Ovarian cancer: diagnosis by ultrasound

If ovarian cancer is suspected, the gynaecologist will first carry out a physical examination with palpation of the abdomen after taking the medical history (anamnesis). An ultrasound examination is then usually carried out through the vagina.

A CT or MRI, on the other hand, is usually only performed after a confirmed diagnosis to plan an operation or to determine the tumour stage.

Operative staging: sampling and therapy

If a malignant tumour of the ovary cannot be ruled out with certainty by ultrasound, a sample must be taken. This is usually done through surgery. During the operation, the sample is sent to a pathologist, who performs a microscopic examination and informs the surgical team of the result within a short time (rapid section).

If ovarian cancer is present, the same operation will examine how far the tumour has spread and whether other organs are already affected (staging). The first treatment step can occur in many cases, and the tumour can be completely or partially excised.

 

Blood test not meaningful

A blood test that determines tumour markers – such as CA-125 or CA 15-3 – plays a relatively minor role in the initial diagnosis because these substances can be increased in various diseases in the blood and therefore do not specifically indicate ovarian cancer.

However, these blood values ​​can be helpful for check-ups after therapy has started or ended, as they indicate the response to therapy or a possible relapse.