Ovarian cancer is relatively uncommon and can arise from different types of cells within the ovary. Inherited mutations in the BRCA1 and BRCA2 genes greatly increase a woman's ovarian cancer risk as well as breast cancer risk. Most ovarian cancers are diagnosed in advanced stages, even in more advanced tumors, symptoms and signs are vague and nonspecific. There are no reliable screening tests for ovarian cancer.

Ovarian Cancer Treatment In Malaysia



 

Types of ovarian cancer

Epithelial ovarian cancer (EOC)

Epithelial ovarian cancer (EOC) or ovarian carcinoma accounts for a majority (85%-90%) of all ovarian cancers. The four most common tumor cell types of epithelial ovarian cancer are serous, mucinous, clear cell, and endometrioid. The serous cell type is the most common variety. It is now thought that many of these cancers actually come from the lining in the fallopian tube.

Ovarian low malignant potential tumor

Ovarian tumors of low malignant potential account for about 15% of EOC. They are most often serous or mucinous cell types. They often develop into large masses that may cause symptoms, but they only rarely metastasize. Often, removal of the tumor, even at more advanced stages can be a cure.

Germ cell ovarian cancers

Germ cell tumors arise from the reproductive cells of the ovary. These tumors are uncommon and are seen mostly in teens or young women. This type of tumor includes different categories: dysgerminomas, yolk sac tumors, embryonal carcinomas, polyembryomas, non-gestational choriocarcinomas, immature teratomas, and mixed germ cell tumors.

Stromal ovarian cancers

Another category of ovarian tumor is the sex cord-stromal tumors. These arise from supporting tissues within the ovary itself. Stromal ovarian cancers (hormone-producing tumors) include granulosa-stromal tumors and Sertoli-Leydig cell tumors.

Risk Factors

Risk factors are related to two major categories.

Ovulation
Early onset of menarche, late menopause and nulliparity are risk factors.
Family History
15% of ovarian cancers are genetically related. Current guidelines recommend that all women with ovarian cancer should undergo testing for BRCA1 and BRCA2 gene mutations. BRCA1 and BRCA2 are genes that have been identified with hereditary cancer risk.

Less commonly, Lynch syndrome, Li-Fraumeni syndrome, and Cowden's syndrome can be associated with an increased risk of ovarian cancer.

 

IS OVARIAN CANCER PREVENTABLE?

If a patient is positive for a BRCA or Lynch syndrome genetic defect, then the patient should strongly consider removal of her tubes and ovaries to decrease the chance of her getting a cancer. Women with these mutations are at a very high risk of ovarian cancer, and in this situation the risk of heart disease is not as significant as dying of one of these cancers. This can be planned at the end of child bearing, or at age 35.

Talk to our Oncologists and Genetic Counselor at Onco Life Centre about your ovarian cancer risk based on your age and family history of the disease, and how your risk of ovarian cancer can be minimised.

 

OVARIAN CANCER STAGING

 

 
Stage 1

Limited to one or both ovaries

 
Stage 2

Limited to the pelvis

Stage 3

Disease outside of the pelvis, but limited to the abdomen, or lymph node involvement, but not including the inside of the liver

Stage 4

Disease spread to the liver or outside of the abdomen

Complete staging of an ovarian cancer includes hysterectomy, removal of the ovaries, tubes, pelvic and aortic lymph node dissection, biopsies of the omentum and peritoneum.

Ovarian cancer staging is determined surgically. If it is stage 4, then diagnosis can be proven with biopsy, and neoadjuvant chemotherapy may be started before surgery.

 

TREATMENT OPTIONS

Talk to our oncologists at Onco Life Centre about your treatment options. Treatment recommendations by our oncologists at Onco Life Centre are tailored and personalized and depends on type and stage of ovarian cancer, genetic changes in the blood or tumor, and the patient’s preferences and overall health. The landscape of drug treatment in ovarian cancer has evolved immensely over the last 1 to 2 years.

Surgery

Surgery is used for both staging and debulking. Staging is the determination of the extent to which as cancer has spread in the body. Debulking is removing as much of the tumor as possible. This surgery usually results in removal of tubes and ovaries (known as salpingo-oophorectomy), the uterus (hysterectomy), removal of the omentum (omentectomy), lymph node biopsies, and any other organ involved in the disease. To accomplish "optimal debulking," at minimum, no individual nodule greater than 1 cm should be left behind. To achieve “optimal debulking”, individual patients might need to go through several rounds of chemotherapy prior to surgery (neoadjuvant chemotherapy).

Chemotherapy

Any patient healthy enough to tolerate chemotherapy will often benefit greatly from its use. When initially diagnosed, the usual first-line approach is to give a combination of a platinum drug and a taxane drug.

Stromal and germ cell ovarian tumors are most often treated with a combination of chemotherapy drugs. There is much less research on these as they are more curable and much less common than epithelial tumors.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. To find the most effective treatment, our oncologist may run tests to identify the genes, proteins, and other factors in your tumor.

Typically, about 20% of high-grade tumors have mutations in the BRCA genes. The BRCA mutation, even if found only in the tumor and not in the blood, may increase the effectiveness of poly ADP-ribose polymerase (PARP) inhibitors. Less common ovarian cancers such as low-grade serous, endometrioid, and clear cell cancers may express mutations in BRAF, PI3KCA, and PTEN genes.

1)PARP inhibitors block an enzyme involved in repairing damaged DNA, leading to cell death and slowing down or stopping tumor growth. The BRCA genes are normally involved in DNA repair, and a mutation in these genes interferes with this pathway function. PARP inhibitors make it difficult for cells that otherwise have a BRCA mutation to grow and divide.

2)Anti-vascular endothelial growth factor monoclonal antibody effectively obstructs the action of a protein called vascular endothelial growth factor (VEGF) and blocks new blood vessel formation. Because a tumor needs nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

Hormone therapy

Hormone therapy such as the Selective estrogen receptor modulator (SERM) drug and aromatase inhibitors, is more often used to treat stromal tumors, such as recurrent granulosa cell tumors.

Immunotherapy

Immunotherapy is an emerging area within gynecologic malignancies, including ovarian cancer. Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Currently, there is approval for immunotherapy for microsatellite instability (MSI)-positive ovarian cancers.

Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.

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