Overview of Ovarian Cancer

Ovarian cancer has become an epidemic in today’s world. Ovarian cancers are the common leading cause of mortality among women in United States, affecting 1 in 75 women among the female population, as estimated by the American Cancer Society. The estimated chance of mortality is 1 in 100 among females (Glance, 2013). Women aged between 35 and 74 years are the most common victims of this dreadful disease. The most common type predominant among women is the epithelial ovarian cancer, 70% of whose diagnosis occurs in the later stages of cancer progression (Desai et al., 2014). The disease prognosis is dependent on the stages of progression of cancer, therefore there is a lack of a common method of diagnosis and treatment. The clinical profile of women diagnosed with ovarian cancer shows a heterogeneity of symptoms, which make prognosis confounding and difficult. Conventional diagnostic methods include surgical removal of the malignant ovaries and chemotherapy post-surgery. Bloating of stomach, a common symptom in ovarian cancer is not specific to the pathology. Bloated condition is associated with other different pathologies like Celiac disease, liver disease, renal failure, intestinal parasitic infection and Gastroparesis.

The variability of the clinical profile and non-specific symptoms causes difficulty in clearly understanding the etiology of ovarian cancer. Ovarian cancers are histologically divided into many subtypes like epithelial ovarian cancer, stromal and germinal ovarian cancer. Epithelial ovarian cancer is the most predominant subtype diagnosed among women at higher grades of development. Diagnosis of any of these subtypes occurs at later stages, mostly stage III and IV of the progression, so early steps of developing the cancer is not clearly known. The development of ovarian cancer depends on a variety of factors as hypothesized in recent years. The multifactorial developmental origin of the ovarian cancer can be traced to the accumulation of genetic abnormalities or mutations during ovulation, hormonal factors causing uncontrolled cellular buildup on the epithelium of ovary forming a tumor or from the fallopian tube itself (Wentzensen et al., 2016). Many cases of diagnosis have shown the involvement of fallopian tube in progression of epithelial ovarian cancers. The disease presents with heterogeneity in clinical profile and its developmental ways, therefore the exact etiology remains further to be elucidated.

The ovarian cancers have been reported with high incidence rates depending on wide variations of geographic distribution. In United States, higher incidence rates have been among the White population and lowest incidence occurs among the Black population and the Asians (Reid, Permuth & Sellers, 2017). Higher incidences of the ovarian cancers have been observed in developed countries as compared to rural regions. High predisposition of the cancerous progression has been attributed to the genetic susceptibility. People with a family history of ovarian cancer are at increased risk of developing the disease at an earlier age; the first generation relatives being most susceptible. High mutation rates of BRCA1b and BRCA2 have associated with the increased pathogenesis of ovarian cancers. These genetic factors account for around 10% of this gynecological cancer with a high lifetime risk for the women (Reid, Permuth & Sellers, 2017).

Discussion

Ovarian cancer, be it any histological subtype, is better detected and diagnosed at later developmental stages, mainly stage III and IV. Early stages of development are difficult to detect as the disease presents non-specific symptoms. Few women have been diagnosed at early stage of progression, within one month as detected depending on the size of the tumor. Based on the diagnosis of these women, early signs and symptoms have been assumed as risk factors for disease progression to later stages. Frequent menstrual cycles within a month, irregular bleeding with abdominal cramps similar to menstruation have been assumed as early signs of malignancy (Ebell, Culp & Radke, 2016). Loss of appetite and abdominal fullness, disorder bowel motions, increasing back pain with discomfort, a bloated stomach are some of non-specific symptoms which are regarded as benign by the women and hence increases the risk of developing the disease. The urge to frequently urinate is also a significant symptom to be considered.

Diagnosis of the ovarian cancers commonly occur in the advanced stages, stages III and IV since the early symptoms are not intense to cause easy detection. Diagnosis at earlier stages is difficult. So, there is no reliable and consistent diagnostic tests available; still women at increased risk of ovarian cancer are recommended some screening tests to determine the certainly of their inheriting the malignancy. An interactive session is held with the consulted gynecological oncologist to determine the prevalence of prior medical history or familial genetic history. Imaging tests are initially recommended to those women who are suspected to have a malignant predisposition in ovaries. Ultrasound therapy, particularly transvaginal ultrasonography is offered to suspected women and also to those who are at early stages of detection. Through sound waves, an entire histological image of the ovary is taken which shows if there is an initiation of malignancy. Genetic testing and genetic counseling are also efficient methods of screening for ovarian cancers.  This helps to know the genetic susceptibility in cases of familial history (Liang et al., 2018). Blood tests like CA-125 testing is efficient for screening of ovarian cancers. A mucin-16 protein is produced by ovaries, whose level increases to a higher level in cases of gynecological cancers. The CA-125 screening test determines the level of this protein, a measure to determine the risk of developing ovarian malignancies (Suidan et al., 2014). Once any of these screening tests turn out positive for the suspected women, a CT scan is recommended for a higher accuracy. Finally, a more confirmative test is biopsy, where a minute portion of the tumor is taken and observed under microscope to determine its malignancy. Surgical removal increases the survival rate in women with advanced stages of progression.

Improvement of treatment is better achieved through medication schemes post-surgery in women with advanced progression of ovarian cancer. A treatment management of dose dependent strategy have shown positive results. A combination of paclitaxel with a dosage of 80mg and carboplatin on a basis of weekly intake has been an improvement in increasing the survival rate of the women who have undergone surgical treatment (Sue et al., 2018).

Etiology of Disease

A predominant but non-specific symptom of ovarian cancer is bloating of stomach, a condition when a person feels abdominal fullness and suffers from loss of appetite. This bloated condition is common to a number of pathological conditions, some of which are Celiac Disease, Liver Disease, Kidney Failure, Intestinal infestation with parasitic infection namely Ascaris lumbricoides and Gastroparesis where emptying of stomach is much delayed producing a bloated condition.

The autoimmune Celiac Disease occurs due to gluten sensitivity in individuals when they consume gluten containing wheat, rye or barley. Gluten consumption damages the microvilli lining the intestines, which are involved in nutrient absorption. This delays the emptying of stomach causing a bloated condition with discomfort.

Liver Disease often accompanies ascites which is accumulation of fluids in the abdomen. This produces a distention of the waist and a bloated stomach.  

Kidney failure or chronic kidney disease is associated with fluid accumulation between the renal tubes, in turn leading to abdominal fluid accumulation. This shows a bloating of stomach with distension causing much discomfort.

Intestinal infection by parasites, particularly cestodes and nematodes are a major cause of bloating of stomach. Parasitic worms like tapeworm (Ascaris lumbricoides) causes gastric infection. This causes loss of appetite due to feeling of bloated stomach, also causing loss of weight.

Gastroparesis occurs due to impairment of intestinal muscles; the muscles lose motility and cannot move the food particles down the digestive tract. As a result, it takes enormous time for the stomach to empty its contents, causing a bloating condition.  

Conclusion:

Ovarian cancers, along with its histological subtypes are the leading cause of deaths annually among women. Among the symptoms, bloating of stomach cannot specify the susceptibility of ovarian cancer; this symptom has been observed for many other diseases and syndromes. In all such cases, bloating does not lead to development of ovarian malignancies; therefore it may be concluded that bloating alone does not indicate initiation of cancer in gynecological cases, it may be due parasitic infections and other disorders mentioned above.

References:

Desai, A., Xu, J., Aysola, K., Qin, Y., Okoli, C., Hariprasad, R., & Franklin, G. (2014). Epithelial ovarian cancer: An overview. World journal of translational medicine, 3(1), 1. doi:  [10.5528/wjtm.v3.i1.1]

Ebell, M. H., Culp, M. B., & Radke, T. J. (2016). A systematic review of symptoms for the diagnosis of ovarian cancer. American journal of preventive medicine, 50(3), 384-394. doi.org/10.1016/j.amepre.2015.09.023

Glance, A. (2013). Ovarian cancer: an overview. Am Fam Physician, 80(6), 609-616.

Liang, M. I., Wong, D. H., Walsh, C. S., Farias-Eisner, R., & Cohen, J. G. (2018). Cancer Genetic Counseling and Testing: Perspectives of Epithelial Ovarian Cancer Patients and Gynecologic Oncology Healthcare Providers. Journal of genetic counseling, 27(1), 177-186. doi.org/10.1007/s10897-017-0135-2

Reid, B. M., Permuth, J. B., & Sellers, T. A. (2017). Epidemiology of ovarian cancer: a review. Cancer biology & medicine, 14(1), 9. doi:  [10.20892/j.issn.2095-3941.2016.0084]

Suh, D. H., Chang, S. J., Song, T., Lee, S., Kang, W. D., Lee, S. J., & Kim, H. S. (2018). Practice guidelines for management of ovarian cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement. Journal of gynecologic oncology, 29(4).  https://doi.org/10.3802/jgo.2018.29.e56

Suidan, R. S., Ramirez, P. T., Sarasohn, D. M., Teitcher, J. B., Mironov, S., Iyer, R. B., … & Aghajanian, C. A. (2014). A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecologic oncology, 134(3), 455-461. doi.org/10.1016/j.ygyno.2014.07.002

Wentzensen, N., Poole, E. M., Trabert, B., White, E., Arslan, A. A., Patel, A. V., & Black, A. (2016). Ovarian cancer risk factors by histologic subtype: an analysis from the ovarian cancer cohort consortium. Journal of Clinical Oncology, 34(24), 2888. doi:  [10.1200/JCO.2016.66.8178]