Current research shows that ovarian cancer is the fifth most common cancer in women. Almost 22,000 women are diagnosed with ovarian cancer every year and 14,000 of them die. In every 73 women, a woman’s life time risk of developing ovarian cancer is about one.

Ovarian cancer is the most common sarcoma after cancer of the breasts, in women over 40 years old; in some developed countries like Mexico it occupies the fourth place in deaths with gynecological tumors.

According to Leonard Gakindi, a consultant obstetrician and gynecologist at King Faisal Hospital, Kigali, the term "ovarian cancer” includes several types of cancer that all arise from cells of the ovary.

Gakindi says most common tumors arise from the epithelium, or lining cells of the ovary. These cancers include epithelial ovarian (from cells on the surface of the ovary), fallopian tube and primary peritoneal (the lining inside the abdomen that costs many abdominal structures) cancer.

"There are also less common forms of ovarian cancer that come from within the ovary itself including germ cell tumors and sex cord-stromol tumors,” he says.

Dr Iba Mayele, an obstetrician gynecologist at Gyenecology Clinic Galien, Kimironko, Kigali, says nobody completely understands the cause of ovarian cancer; however, some known risk factors are linked to a higher chance of developing the disease.

"For example, family history genetic screening can determine whether somebody carries certain genes that are associated with an increase in the risk,” he says.

Dr Theodomir Sebazungu, a gynecologist at University Teaching Hospital, Kigali (CHUK), also says it is not clear what causes ovarian cancer.

"In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Some genes mutation such as BRAC1 and BRAC2 are known to be associated with ovarian cancer,” he says.

Sebazungu adds that risk factors for ovarian cancer include a positive family history of ovarian cancer, personal history of breast cancer and increasing age.

Mayele also says that majority of ovarian cancer cases occur in women over 65 years. He, however, says there is a connection between the total number of ovulations during a woman’s life and the risk of ovarian cancer.

Signs and symptoms

According to Sebazungu, epithelial ovarian cancer was historically called the "silent killer” because usually it shows very late.

"However, an asymptomatic mass may be palpated during a routine pelvic examination or occasionally detected as an incidental finding during routine obstetric ultrasound examination or at the time of cesarean delivery,” he says. Sebazungu adds that advanced ovarian cancer typically presents with pelvic pain, abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and bowel metastases. Difficulty in breathing is occasionally present due to a fluid in pleural cavity, he says.

"The more times a woman becomes pregnant, the lower the risk of ovarian cancer, but women who have never been on contraceptive pills have a higher risk to ovarian cancer while women who started their periods at an early age have a higher risk as well,” Mayele says.

Some studies have found a link between infertility treatment and a higher risk of getting ovarian cancer.

Mayele also notes that being obese increases the risk of developing ovarian cancer.

Dr Stephen Rulisa, an obstetrician gynecologist at CHUK, says the common symptoms of ovarian cancer are indigestion, loss of appetite, tiredness, and changes in menstruation.

Mayele explains that ovarian cancer at an early stage does not have many symptoms, but the advanced stage causes symptoms like abdominal bloating or swelling, quickly feeling full while eating, weight loss, discomfort in the pelvis area, constipation and a frequent need to urinate.

Stages of ovarian cancer

Rulisa says there are several stages of ovarian cancer but the most common one is Figo classification.

Mayele explains that in stage one, cancer is limited to the ovary and has not spread to the abdomen, pelvis or lymph node or to a distant site.

"In stage two, the cancer is on one or both ovaries and has spread to the pelvis region, such as the fallopian tube or uterus,: he says.

Mayele adds that in stage three, the cancer is in one or both ovaries and has spread beyond the pelvis to the lining of the abdomen or it has spread to the lymph node.

"The fourth stage is the most advanced form, which means that the cancer has metastasised to a distant site such as the inside of the spleen, liver, lung or other organs outside the abdomen.”

Treatment

Mayele says surgery is usually the first step, but it depends on how far the cancer has spread.

"During surgery we remove the ovaries, uterus, cervix and fallopian tube. The other tissues that are typically removed include the lymph node and fatty apron covering the intestines,’” he says.

Mayele notes that chemotherapy helps get rid of any cancer cells that are still in the body; however, radiation can be used if the cancer has come back after treatment and helps to control symptoms like pain.

"The cornerstone in treatment of ovarian cancer is surgery. Doctors can decide to give cancer drugs before or after surgery, depending on the extent of the disease,” says Sebazungu.

According to John Butonzi, an affiliate oncologist in Butaro Hospital in Burera District, if cancer is genetic, for example if your mother had it and you are detected to have it, then the best treatment is to remove the ovaries.

Butonzi also says that in the first stage of ovarian cancer, the doctors should do surgery alone. They have to go for check-up every after three months.

"If the patient becomes better, then they can start going for checkups every after six months. For the fourth stage, the doctors give symptomative management by treating any visible signs. If it is ascitis (water in the abdomen) that is what they treat or if a patient has pain that is what exactly is treated,” he says.