The ovaries are the female reproductive organs, which contain the ova (eggs). Ovaries also release the female hormone estrogen, which helps support pregnancy and contributes to females sexual characteristics. A gradual decline in estrogen production normally takes place in women between the ages of 48 and 52. at the same time, the monthly release of eggs decreases and the menstrual cycle becomes irregular and eventually stops. This is called menopause.
The ovaries, like other body parts, are made of tiny structures called cells. When these cells grow abnormally, a tissue mass or tumor forms. Tumors can be benign – that is, neither spreading nor interfering with ovarian tissue function – or they can spread (metastasize) and become cancerous, compressing or invading normal tissues. Tumour cells can spread directly into nearby tissues, through lymphatic (drainage) channels, or through the bloodstream. When ovarian cancer spreads, it is usually by direct extension into nearby tissues or through lymphatic system.
Ovarian cancer is difficult to diagnose because the symptoms are vague. There may be abdominal enlargement, usually due to fluid accumulation. Some women experience a change in bowel function, urinary frequency, and/ or nausea. in some cases, ovarian cancer initially causes no symptoms and is discovered incidentally during a pelvic examination.
The Pap smear (a microscopic examination of cells shed into the vagina from the uterus) is not a reliable means of detecting ovarian cancer.
Your attending doctor will review your medical history and do a physical examination. He or she will review your laboratory results, as well as pertinent past medical records.
Ultrasound or CT (computerized tomography) scans of the abdominal organs may be done to help identify changes caused by pressure from the suspected tumor. You may also have blood tests for tumour markers – substances in the blood, which may be related to the presence of the tumour.
Surgery is often the initial treatment for suspected ovarian cancer. An operation called Staging Laparotomy is performed. This surgery involves making an abdominal incision to reach the ovaries. If cancer is found, as much of the tumour as possible is removed.
The extent of the surgery depends upon the type of cancer found and how much it has spread. In some cases, only one ovary is removed. More commonly, however, both ovaries, the fallopian tubes, uterus, pelvic and some para-aortic lymph nodes, and the omentum (tissue that covers the bowels) are removed because they are the most common sites for tumour spread.
With any surgery there are risks of bleeding, infection, and unusual anaesthetic reactions. You may require blood transfusions during or after surgery. There are risks related to surgery in the abdomen. These include damage to bowel, bladder, ureters (tubes that drain urine from the kidneys to the bladder), or the large blood vessels and nerves in the surgical area. Blood clot formation, nerve damage, or prolonged leg swelling may occur, but are quite rare. Your doctor will discuss these risks with you.
Recovering at home
Before leaving the hospital, you will be told what to expect in the coming days. Although it is unusual to experience complications after you leave the hospital, do inform your doctor if you have any of the following:
- Excessive bleeding
- Fever above 37.5 Degree Celsius
- Shaking chills
- Unusual pain or swelling
- Unusual vaginal or wound discharge
- Disturbing emotional reactions
- Any other related problems that concern you
We recommend that you get adequate rest and nutrition, as well as mild physical and light activities, during your recovery from surgery. A balanced diet with an emphasis on high protein foods will help you to build your strength and aid healing.
Light activity is encouraged in the first two weeks after surgery or until you are seen in the GCC Clinic for the first time after your surgery.
Delay driving or prolonged sitting for three or four weeks. You may begin isometric (tightening) exercises of the abdomen after three or four weeks. Avoid heavy lifting and strenuous exercise for two to three months after surgery.
Ovarian cancer is a stressful disease and the treatment can be complicated. Each woman reacts to the diagnosis and treatment differently. You may feel anxious, worried, depressed or bewildered about the way your life and the lives of those close to you will be affected. Allow yourself some time to adjust. Talking to your nurses, doctor, family or close friend can provide answers and emotional support.
Removal of the uterus causes cessation of menstrual periods and loss of childbearing function. In younger women, removal of the ovaries may bring on menopausal (change of life) symptoms such as hot flushes, night sweats, or mood changes. Sometimes these symptoms can be alleviated by taking a hormonal medication, which may be prescribed by your doctor.
Sexual feeling need not be altered as a result of surgery for ovarian cancer. However, sexual intercourse, as well as vaginal douching or use of tampons, should be delayed for up to three weeks after surgery, depending on wound healing. Feel free to discuss concerns you or your partner have about sexual activity with your doctor or nurse at any time.
Most ovarian cancer patients require additional therapy after they have recovered from surgery. Chemotherapy (treatment with anti-cancer drugs) may be given to kill any remaining cancer cells.
Chemotherapy – These medicines kill cancer cells regardless of their location in the body. The intravenous route is the most common way to give chemotherapy for ovarian cancer.
Once in the blood, the drug is distributed to all parts of the body. The cells that divide most rapidly, such as cancer cells, take up most of the drug. Chemotherapy drugs act by interfering with growth and duplication of the cell, and the cell is eventually destroyed.
Chemotherapy can also affect normal, actively dividing cells. Normal cells, however, have a tremendous capacity to repair themselves. Such normal cells that might be affected include those in the bone marrow (where blood cells are formed), gastrointestinal tract (lining of mouth, stomach and bowels), and hair follicles. Chemotherapy is usually given in cycles. This allows normal cells to recover from the effects of the medication. The cancer cells cannot repair themselves.
Drug frequency and dose are determined by the body’s response to, and recovery from, the chemotherapy. You will have periodic blood counts to determine the recovery rate of blood cells (red blood cells, White blood cells, and platelets) in the bone marrow. Examinations are done to determine if any remaining tumour is shrinking. Your doctor will discuss with you what period chemotherapy treatments will be given.
Follow – up care
Even after completing treatment, follow-up examinations are recommended every three months for the first 2 years and then at four to six-month intervals during subsequent years.
Despite treatment, there is a risk that cancer may recur and further treatment may be required.
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