Ovarian, Fallopian Tube, and Peritoneal Cancer

Ovarian, Fallopian Tube, and Peritoneal Cancer

Overview of Ovaries, Fallopian Tubes, and Peritoneum

• Ovaries: Part of the female reproductive system, producing eggs (germ cells) and hormones like estrogen and progesterone that influence menstruation, pregnancy, and physical development.

• Fallopian Tubes: Tubes connecting the ovaries to the uterus, facilitating the movement of eggs during ovulation.

• Peritoneum: A thin tissue layer lining the abdominal cavity, supporting organs like the uterus, bladder, rectum, and ovaries.

Ovarian, fallopian tube, and peritoneal cancers arise when abnormal cells grow uncontrollably, forming tumors. Some tumors can spread to other body parts, while benign tumors do not spread.

Types of Ovarian, Fallopian Tube, and Peritoneal Cancers

1. Epithelial Carcinoma

• Accounts for 85-90% of ovarian/fallopian tube cancers.

• Subtypes: Serous, Endometrioid, Clear cell, Mucinous, and Mixed tumors.

2. Germ Cell Tumors

• Develop in egg-producing cells and occur mostly in individuals aged 10-29 years.

• Subtypes: Dysgerminomas, Immature teratomas, Yolk sac tumors, Embryonal carcinomas.

3. Sex Cord-Stromal Tumors

• Rare cancer starting in granulosa or theca cells, responsible for hormone production.

4. Fallopian Tube Cancer

• Previously considered rare, research now shows that many ovarian cancers may originate in the fallopian tubes.

Statistics

• Ovarian cancer is the third most common cancer among women in India, with 36,170 new cases annually.

• 5-year survival rate: 50% in the United States.

Risk Factors

• Family History: Higher risk if a close relative has breast or ovarian cancer.

• Genetic Mutations: BRCA1, BRCA2, RAD51, PALB mutations increase the risk.

• BRCA1: 40% lifetime risk of ovarian cancer.

• BRCA2: 10-20% lifetime risk.

• Even without family history, BRCA mutations can occur.

• Inherited Conditions: Lynch syndrome, Peutz-Jeghers syndrome, and others.

• Age: Risk increases with age, especially after 50 years.

• Obesity: Studies show a link between obesity and ovarian cancer.

• Endometriosis: May increase cancer risk.

• Reproductive History: Early menstruation, no pregnancies, late menopause, or infertility increase risk.

• Hormone Replacement Therapy (HRT): Prolonged HRT use after menopause increases the risk.

Prevention

• Oral Contraceptives: Using birth control pills for over three years can reduce the risk by 30-50%.

• Breastfeeding: Longer breastfeeding durations lower the risk.

• Pregnancy: Full-term pregnancies reduce cancer risk.

• Surgical Options: Hysterectomy or tubal ligation can lower the risk.

Symptoms

Ovarian and fallopian tube cancers often remain undetected until advanced stages. Common symptoms include:

• Abdominal bloating or swelling

• Pelvic or abdominal pain

• Difficulty eating or feeling full quickly

• Frequent urination

• Fatigue

• Indigestion or back pain

• Pain during intercourse

• Constipation

• Menstrual irregularities

• Unusual vaginal discharge

Diagnosis

• Abdominal Examination: Checking for lumps or abnormalities.

• Blood Tests/CA-125 Assay: Measures the CA-125 tumor marker. Elevated levels can indicate cancer but may also rise due to non-cancerous conditions.

• Transvaginal Ultrasound: Imaging via the vaginal route.

• CT Scan, MRI, PET-CT: Advanced imaging to detect cancer spread.

• Paracentesis: Removing abdominal fluid for analysis.

• Biopsy: Removing a small tissue sample to confirm cancer.

• Biomarker Testing: Identifies genetic mutations like BRCA1 or BRCA2.

Treatment Options

1. Surgery

• Debulking Surgery: Removes as much cancer as possible.

• Salpingo-oophorectomy: Removal of one or both ovaries and fallopian tubes.

• Hysterectomy: Removal of the uterus.

• Lymphadenectomy: Removal of lymph nodes.

• Omentectomy: Removal of the fatty layer covering abdominal organs.

• Cytoreductive Surgery: Reduces tumor size before chemotherapy.

Side Effects: Surgery can cause pain, early menopause, and infertility.

2. Chemotherapy

• Often used before (neoadjuvant) or after (adjuvant) surgery.

• Common Drugs: Carboplatin, Paclitaxel.

• Treatment typically lasts 3-4 cycles, with infusions every 3 weeks.

Side Effects: Fatigue, infections, nausea, vomiting, hair loss, neuropathy, and infertility.

3. Targeted Therapy

• PARP Inhibitors (e.g., Niraparib, Olaparib) block proteins that help cancer cells repair DNA.

• Bevacizumab: An anti-angiogenesis drug that prevents tumor blood supply.

4. Immunotherapy

• Uses the body’s immune system to fight cancer.

• Drugs: Pembrolizumab (Keytruda), Dostarlimab (Jemperli).

5. Hormone Therapy

• Used for low-grade tumors, often in recurrent cases.

• Common Drugs: Tamoxifen, Letrozole, Anastrozole, Exemestane.

Follow-Up Care

After treatment, regular follow-ups are essential to:

• Manage side effects.

• Monitor for cancer recurrence.

• Include physical exams, blood tests, and imaging scans.

Impact on Fertility and Sexual Health

• Treatments like surgery and chemotherapy can affect fertility and sexual function.

• Common issues include decreased libido, body image concerns, vaginal dryness, and pain during intercourse.

• It is recommended to discuss fertility preservation and sexual health with healthcare providers before starting treatment.

Ovarian, fallopian tube, and peritoneal cancers require early detection and personalized treatment plans to improve survival and quality of life.

‍