Ovarian Cancer Symptoms, Stages, Grades, Complications

Signs and Symptoms of Ovarian Cancer

Ovarian cancer is usually diagnosed late since it develops insidiously, with very few warning signs or symptoms. Even when present, the complaints are often so vague that it is invariably mistaken for gastrointestinal symptoms. Abnormal vaginal bleeding may be the only gynecological problem.Even so, ovarian cancer is usually not the first diagnosis to be considered in women with such symptoms. This is further compounded by the lack of good screening methods for detecting ovarian cancer in the early stages. Unfortunately, this delay in diagnosis usually costs the patient in terms of treatment and management.

The symptoms of ovarian cancer may be develop over several months. The common symptoms are :

Non-specific Gastrointestinal Complaints

  • Nausea
  • Indigestion
  • Loss of appetite
  • Bloating – feeling of fullness, especially after a meal
  • Abdominal distention is usually due to ascites (fluid accumulation in the abdomen). This is likely to be seen in advanced cases.
  • Altered bowel habits, such as constipation

Gynecological Complaints

  • Abnormal vaginal bleeding may occur when there is concomitant endometrial carcinoma, or due to metastasis to the uterus, cervix or vagina. This may present as heavy periods or postmenopausal bleeding.
  • Menstrual irregularities may be the result of excessive estrogen or androgen production by some types of ovarian cancer.
  • Pain during intercourse
  • Virilization in case of androgen producing tumors.
  • Pelvic mass detectable on examination or even an abdominal mass with a large tumor

Other Complaints

  • Feeling of weight or pressure in the pelvis usually with large tumors
  • Lower abdominal discomfort
  • Severe pelvic or abdominal pain
  • Urinary symptoms – retention, frequency, or urgency
  • Rectal discomfort
  • Bowel obstruction
  • Intractable back pain, worsening over time
  • Unintentional and unexplained weight loss or gain
  • Excessive fatigue

Complications of Ovarian Cancer

  • Cancer may spread (metastasis) to other tissues and organs.
  • Ascites.
  • Bowel obstruction.
  • Urinary complications.
  • Swelling of the legs due to lymphedema.
  • Virilization, such as abnormal hair growth.
  • Shortness of breath due to a pleural effusion may occur in advanced cases.
  • Loss of ovarian function leading to problems such as infertility.
  • Complications of treatment, including complications of surgery and chemotherapy.
  • Psychological problems.

Stages of Ovarian Cancer

Staging indicates the degree of spread of the cancer. This helps to indicate the prognosis and determines the type of treatment that is to be undertaken. Surgical staging may be done at the time of surgery if the cancer appears to be confined to the pelvis. The excised uterus, fallopian tubes, ovaries, lymph nodes and other abdominal tissues are examined for macroscopic signs of cancer and are sent to the laboratory to be examined under the microscope for cancer cells. Imaging tests such as CT scan and MRI can determine the spread of disease and help in staging of ovarian cancer.

Stage 1

The cancer is limited to one or both ovaries. Cancer cells may be present on the surface of one or both ovaries, in the ascitic fluid or in peritoneal washings.

Stage 2

The cancerous growth is present in one or both ovaries, with pelvic extension. This means that the cancer has spread beyond the ovaries to other tissues and organs in the pelvis, such as the fallopian tubes or uterus, but is confined to the pelvis. Cancer cells may be present on the surface of one or both ovaries, in the ascitic fluid or in peritoneal washings.

Stage 3

The cancer is present in one or both ovaries. It has spread beyond the ovaries and the pelvis (cancer cells may be found on the liver surface), or to the regional lymph nodes (retroperitoneal or inguinal nodes).

Stage 4

The cancer is present in one or both ovaries, with distant metastasis to the liver parenchyma (deeper structures of the liver) and lungs. Cancer cells may also be found in the pleural effusion fluid.

Recurrent Ovarian Cancer

Recurrent ovarian cancer refers to cancer that has returned after complete remission following initial therapy. Typically, recurrence of ovarian cancer occurs within a few months or years, but in some cases it may come back after many years. Patients with advanced disease (stage 3 or 4) are more at risk of recurrence after treatment than those with early stage disease. Cancer that persists during and following treatment is known as persistent ovarian cancer.

Grading of Ovarian Cancer

Grading is done by examining the cancer cells under the microscope and determining how different or abnormal it is from normal cells. Grading helps in deciding upon the treatment as well as indicating the outlook of the disease.

Grade 0

These are non-invasive tumors with low malignant potential (LMP). It is also known as a borderline tumor.

Grade 1

Also known as low grade tumors, the cells are slightly abnormal but look more or less similar to normal ovarian cells. It is described as ‘well differentiated’. These types of cancer cells are slow-growing and less aggressive than the other grades.

Grade 2

These cells are slightly more abnormal than grade 1 cells and are known as middle grade tumors.

Grade 3

These cells are clearly abnormal and described as ‘poorly differentiated’. The cancer cells are rapid-growing and are more aggressive. It is known as a high grade tumors.

Prognosis of Ovarian Cancer

As with all cancers, the prognosis or likely outcome for patients with ovarian cancer is primarily related to the stage and grade of disease at the time of diagnosis. Since most ovarian cancers are detected after the cancer has disseminated within the abdominal cavity or has metastasized to remote sites, the prognosis is often poor. The outcome is significantly improved when the cancer is detected while still confined to the ovary.

Survival Rate

Prognosis of a cancer is often described in terms of the 5-year survival rate. This indicates the percentage of patients who survive or live 5 years or more after diagnosis of the cancer. The type of ovarian cancer also determines its prognosis. On the whole, the 5-year survival rate of germ cell carcinomas are better than that of epithelial carcinomas of the ovary. Read more on types of ovarian cancers.

Ovarian cancer detected in stage 1 of the disease, when it is limited to the ovary, may have a 5-year survival rate of over 90%. However, the survival rate drops drastically to less than 20% when detection is in the late stages with metastasis to distant organs.

The other factors that may be related to prognosis of ovarian cancer are the age of the patient, general health status, the type of treatment undertaken and the individual response to it. The prognosis of recurrent ovarian cancer is usually poor.

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