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There are different types of ovarian cancer. This is because the ovaries are made up of many different types of cells and tissues. Most people who get ovarian cancer are 60 to 70 years old. The risk of contracting the disease is greater if a genetic relative has had it.

More than 700 people get the disease every year. For the most part, ovarian cancer has already begun to spread when it is detected. Then it can be more difficult to get rid of the disease, but it can go. Otherwise, there are treatments that allow you to live a good life for a long time with ovarian cancer.

Ovarian cancer is also called ovarian cancer.

Symptoms of ovarian cancer

The symptoms of ovarian cancer are often unclear. Here are some examples of symptoms. You can have one or more of them:

  • You may have abdominal pain indefinitely.
  • You may feel swollen in your stomach.
  • You may feel a lump or bump in your stomach.
  • You may need to urinate often.
  • It can push against the rectum.
  • You may feel tired.
  • You can lose weight without knowing why.
  • You can quickly become tired when you eat or lose the appetite to eat.

The symptoms need not mean you have cancer. They can also be caused by, for example, harmless ovarian cysts, muscle nodules or any other disease.

When and where should I seek care?

Contact a health center or gynecologic clinic if you experience symptoms that you believe may be due to ovarian cancer. You can contact many receptions by logging in 

Investigations

When you see your doctor or gynecologist you will be told about your problems. Then, for example, the doctor may feel swollen lymph nodes at different places on the body and press differently on your stomach. The doctor can also feel your breasts. Stomach symptoms may be due to breast cancer that has spread, but it is uncommon.

The doctor also needs to feel and look at the ovaries, fallopian tubes, and uterus. Therefore, you are examined gynecologically and with a vaginal ultrasound. The ultrasound examination is performed with a narrow instrument that the doctor brings into the vagina. It does not hurt.

The doctor may also need to insert a finger into the rectum to feel if something is pressing against it.

The investigation is conducted in accordance with a standardized course of care

You are offered an examination according to a standardized course of care if the doctor suspects you may have ovarian cancer.

Standardized care processes are a way of organizing the investigation so that it goes as quickly as possible. Among other things, there are times set for the surveys you may need to do.

The doctor who writes the referral tells you why you should be investigated according to a standardized course of care and what it means and when you can be told if you have cancer or not.

It is often quick to get calls for examinations in a standardized course of care. It is good if you are clear about how the staff most safely reach you so that you do not miss any notifications.

Blood tests can help diagnose

You are given blood samples showing the content of a substance called CA125. The body can produce more of that substance in ovarian cancer. Therefore, the substance is called a tumor marker.

You can have a high level of the tumor marker without it being due to cancer, but the test response may be helpful when the doctor is to diagnose. The doctor can also use the test response to see how the tumor marker content is affected when you receive treatment. That way you can get the most effective treatment possible.

Examination with computer tomography or magnetic camera

You may need to be examined with computed tomography or magnetic camera. The studies can show if there is a change that appears to be ovarian cancer and whether it has spread.

Only surgery can provide a safe diagnosis

You usually need surgery to tell your doctor if you have ovarian cancer. Only the suspected ovaries are removed if you are of fertile age and everything looks good for the rest. The doctor usually also removes the other ovary, fallopian tubes, and uterus if you have passed the menopause. What is removed is sent on analysis to see if it contains cancer cells.

You are anesthetized during the operation. It can be done with puncture surgery, also called laparoscopy, or by incision. It depends on what the ovarian change looks like.

Most people can go home the same day after a peephole operation. You need to stay about four to five days if you have had an abdominal incision.

Sometimes the investigative operation needs to be more extensive. Read on under the chapter on treatments.

Treatments for ovarian cancer

A group of different gynecologic cancer specialists advises on all people who have been diagnosed with ovarian cancer. Your doctor will contact the specialists so that they can suggest the treatment for ovarian cancer that they believe will be best for you based on the examinations that have been done. Your doctor will tell you what the specialists will come up with.

The cancer is operated

In ovarian cancer, it is common to have to remove both ovaries, fallopian tubes and uterus if it was not done during the first, surgical procedure. The surgery is done by a gynecological tumor surgeon. They may also need to remove some of the peritoneum, appendicitis and lymph nodes near the area of ​​cancer to remove cancerous cells that may have spread there.

You are anesthetized during the operation.

It is common for a thin plastic tube to be inserted into a larger blood vessel during surgery. The plastic tube is called a central venous catheter, CVK. Through it, you can receive medication as treatment continues after surgery.

Sometimes a major operation is needed

The surgery can be larger if cancer has spread outside the ovaries. Then it is common to have parts of the peritoneum. The spleen or part of the intestine may also need to be removed.

It is good if as much visible cancer as possible can be removed during surgery. It increases the chance that you will get rid of the disease or that treatment can slow it down. If there is visible and disseminated cancer, it can be removed already at the first, investigative operation.

Before the operation

Before the surgery, talk to your doctor about what the operation can mean. When you come to the hospital, you get to talk more with the contact nurse, the gynecological tumor surgeon, and the anesthetist. You can also talk to more specialists if you want, such as a physiotherapist, physiotherapist, dietician or curator.

After the surgery

You have some form of pain relief when you wake up. It may be back anesthesia that was given while you were anesthetized for the operation. There are also other types of pain relief.

How long you need to stay in the hospital depends on how big the operation was and how you feel. Most people need to stay for up to a week.

The skin has healed after seven to ten days. Muscles and membranes have healed after about four weeks. During that time, avoid stress. Avoid lifting. Hold a pillow against your stomach for support, for example, if you need to sneeze, cough or laugh.

Stop smoking or quit

It is good if you who smoke quit it before the operation. The wounds heal better, the risk of infection decreases and you recover faster after treatment. The best thing is if you completely quit smoking, otherwise make a stop before and after the operation. Talk to your doctor if you need help and support to quit smoking.

Consequences of the operation

You enter the menopause if both ovaries have been removed and if you have not already passed the menopause. You can no longer get pregnant.

Sometimes the operation means that part of the bowel has been removed. Then the part that is left can either be sewn together so that it works as before, or you get a stoma. This depends, among other things, on how big the operation was, what part of the bowel has been removed and how you feel.

Stoma means that the intestine is discharged through a hole in the stomach where the stools are collected in an ostomy bag. You get to meet a specialist nurse who teaches you how to manage the stoma. The stoma may be temporary or permanent. Read more in the chapter How is life affected by ovarian cancer?

Treatment with cytostatics

Sometimes it is enough to operate, but often you need more treatment. The most common are drugs called cytostatic drugs. They are a type of cell inhibitory drug and can remove cancer cells that may remain after surgery.

Often you get various cytostatic drugs that drip into your bloodstream for one day. It’s called a cure. After the cure, it should be some time before it is time for the next cure. It is most common with six courses and three weeks should pass between each course.

You may also need cytostatics before surgery to shrink the cancerous tumor, for example, if it is large or sometimes if it has spread.

Side effects of cytostatic drugs

Some cytostatic drugs can make you lose your hair. It always grows again when the treatment of ovarian cancer is complete. You can try out a wig before treatment begins if you wish.

Some cytostatic drugs can make it stick and fall into your hands and feet. Tell them if this is the case for you. Then the doctor can adjust the amount of medicine. It can relieve.

The treatment can make you sensitive to infections.

Antibody treatment

Sometimes you can get treatment with drugs that contain antibodies.

One type of antibody prevents cancer cells from forming new blood vessels that the cancer cells need to grow and develop. You can get such antibodies together with cytostatic drugs that drip into the bloodstream.

Another type of antibody is called a PARP inhibitor. They stop a protein that the cancer cells need in order to continue functioning. There are various drugs with PARP inhibitors. You take those capsules by mouth.

Several controls after treatment

When the treatment is completed, you have to go on several checks so that the doctor can detect early if the disease should come back. The doctor does a gynecological examination with ultrasound. Sometimes you also need to have blood tests and be examined with, for example, chest x-rays computed tomography.

If you get sick again

Cancer can come back. It’s called a relapse. What kind of treatment you receive them depends on the characteristics of the cancer tumor, where it is located if it has spread, what treatment you have received before and how you feel otherwise. Often you can get cytostatic drugs and antibodies, but you may want to try other varieties than when you first had the disease. You may also be re-operated if there is a possibility that all cancer can be removed.

Treatment with yellow body hormones can also work against ovarian cancer and if cancer has spread. Hormone therapy may be an option if you have any more disease than ovarian cancer. You will receive the treatment as tablets or sometimes as syringes.

If you don’t get rid of the cancer

Sometimes it is not possible to get rid of the disease. Then there is the treatment that can still allow you to live a good life long with the disease. There are treatments that can slow down the disease and that can relieve symptoms for a long time, sometimes for many years. Such treatment is called palliative care.

What is the cause of ovarian cancer?

It is not clear what ovarian cancer is due to. But the number of ovules is important. The fewer ovaries you have had, the less the risk of getting ovarian cancer. You do not ovulate if you are pregnant, breastfeeding or using contraceptives with two types of hormones. Examples of such contraceptives are combined with birth control pills.

The risk of ovarian cancer is also less if you are sterilized, or if the fallopian tubes or uterus have been removed. This may be because some ovarian cancer can begin in the fallopian tubes.

Heredity increases the risk

There are several things that can increase the risk of getting ovarian cancer. The biggest risk is if more people in your genetic family have had the disease. Then it may be due to a change in the DNA of the cells. The change is found in the genes BRCA1 or BRCA2. The change can be inherited from parents to children. Every tenth person who gets ovarian cancer has got the disease that way.

People with hereditary ovarian cancer tend to get sick in their 50s. People with other ovarian cancers usually get sick after age 60.

Investigation can show if you have an inherited risk of getting ovarian cancer

The risk of ovarian or breast cancer is high if you have DNA change. Contact a cancer genetic clinic if several genetic relatives have had ovarian cancer. Cancer genetic receptions are available at every university clinic. There, an investigation can show if you carry the DNA change.

Everyone regardless of gender can have DNA change and pass it on to the next generation. Therefore, genetic relatives on both parents’ sides must be included in the investigation.

You are recommended to go on annual checks if you have the DNA change.

Report on the risk of hereditary cancer:  “At first I thought it was not true.”

Prevention operation

You can remove the ovaries even if they are healthy if you have inherited the DNA change that can cause ovarian cancer. The doctor usually recommends that you wait for surgery until you are 40 years old and have given birth if you can and want to. 

Getting the ovaries removed does not completely protect against cancer. Cancer tumors may begin to grow in other parts of the peritoneum. But it is unusual, and the risk of getting ovarian cancer is very small compared to not having the ovaries removed.

You are carefully investigated and meet with both a specialist doctor and a psychologist before making a decision about a surgery that may prevent you from getting ovarian cancer.

Heredity is tested if you already have ovarian cancer

Anything that is removed if you have ovarian cancer is sent for analysis. The analysis shows how cancer cells are changed compared to healthy cells. The cancer cells, for example, may have changes in any of the BRCA genes without it implying that the cancer is hereditary.

The cancer is hereditary if the change is also found in your healthy cells. It can be tested with a blood test. The blood test is taken at a cancer genetic reception. You will receive a referral there if you wish and if the analysis of the cancer cells shows that there is a change in any of the BRCA genes.

The staff at the cancer genetic clinic offers an investigation if the blood test shows that you have hereditary cancer. Then more people in your family can be tested and find out if they also have the inherited risk of getting ovarian or breast cancer.

More things that can increase the risk of ovarian cancer

There are several things that can lead to easier development of ovarian cancer, for example:

  • hormone therapy for a long time against  menopause
  • not to have children
  • polycystic ovarian syndrome, PCOS
  • endometriosis
  • overweight.

What is Ovarian Cancer?

The ovaries are part of the internal genitalia. There are two ovaries that are attached to each side of the uterus. They are almond-shaped and 3-4 cm long. The ovaries produce eggs and secrete hormones: estrogen and progesterone, also called yellow body hormone. The hormones control ovulation. When you enter the menopause, the activity of the ovaries decreases and they decrease.

In ovarian cancer, a cancerous tumor has formed somewhere in or on the ovary. The cancerous tumor can also occur in any of the fallopian tubes. There are many different forms of ovarian cancer.

The ovaries have a lot of space around their stomach. Therefore, a cancer tumor there can grow long and spread before it begins to give symptoms.

Ovarian cancer can spread as small dots or nodules of cancer cells. They are called carcinomatosis and can be spread to the other ovary, fallopian tubes, uterus, and peritoneum. The peritoneum encloses most organs in the abdomen, from the bladder in the pelvis to the diaphragm under the ribs.

The cancer cells can later also spread to other parts of the body through the blood and lymph fluid, which is also called the lymph. This way, you can get cancer even in the lungs and in the liver but it is unusual.

How does cancer occur?

The body consists of many billions of cells. The cells divide to form new cells so that the body can function. Sometimes it gets wrong when a cell divides. Usually, it does nothing or the cell can stop the error from spreading to more cells at the next cell division. But sometimes it doesn’t work. Then more and more altered cells can be formed for each cell division. Eventually, cancer cells can form and become a cancerous tumor. The cancer cells divide uncontrollably and do not die when they should. You can read more in the article What is Cancer?

Other tumors of the Ovaries

The ovaries contain many different cells and tissues. This means that other types of tumors can also occur. They can cause the same symptoms as ovarian cancer but are often harmless.

Cysts

Borderline Tumors

Borderline tumors are neither benign nor cancerous. They can come when you are in your 40s or older. Borderline tumors usually have nothing to do with heredity. They usually do not spread in the body.

The doctor usually recommends that the ovaries, fallopian tubes, and uterus be removed but that you wait for the operation until you have given birth to one or more children if you can and want to. You do not need to go on checks after such an operation.

You need to go on checks if you would rather be operated on so that fertility is preserved. That’s because borderline tumors can come back. Then they can be removed again. The forecast is very good. A fertility preservation operation means that one ovary is saved or only part of it is removed. The uterus is also saved. This way you can still get pregnant.

How is life affected by ovarian cancer?

Ovarian cancer and the treatment of the disease will affect your life in some way. How big the changes will be for you depends on what treatment you need, if you have other illnesses and how you feel otherwise.

You may need rehabilitation. It can be anything from medical assistance to support to make you feel good mentally and socially. It is good if you, together with the healthcare staff, think about your needs as early as possible. You can write them down in the care plan. The needs may change over time. Then you have to change the care plan.

What you feel and how you feel can also vary – perhaps from one period to another, and certainly from person to person. Here are some things you may experience after treatment for ovarian cancer.

Some feel missing

The ovaries and the uterus can be an important part of who you are – whether you have already given birth or cannot or do not intend to. It may be the cause if you feel sadness and missing after treatment for ovarian cancer. Here you can read more about how you can get help with thoughts and feelings about cancer.

Usually to feel tired

It is common to feel very tired when you have a cancer disease. The fatigue remains even though you have slept. You may become more easily irritated and may not be able to cope with the things and relationships you usually use.

Fatigue can have one or more causes, for example:

• The disease can affect the body in different ways so that you get tired. 
• You get too little energy. 
• Treatment can be tiring in various ways. 
• Concern or depression.

Tell the health care provider if you are very tired. Make sure you and any close associates gain knowledge about the fatigue and what it is due to. It can also help and increase the understanding of the surroundings.

Physical activity that suits you can make you feel less tired.

Several short rest breaks are usually better than a single, longer rest break.

Medicine can also help with fatigue.

The appetite and intestines can be affected

The recovery depends a lot on getting the nutrition you need. Sometimes it is difficult. The disease and treatments can affect the desire to eat. The taste experience can be affected. You may also get constipation or diarrhea.

Tell your doctor or contact nurse who can make sure you meet a dietician. The dietitian can help you with tips on food and strategies for eating and getting organized on the intestines. Here you can read more about food in cancer.

If you have had a stoma

You have had an ostomy if some of the bowels was also removed during the cancer surgery. Sometimes the stoma can be removed after a year. The intestine can be sewn together again if you feel well enough and have been without a cancerous tumor for at least six months or more.

Sexuality and closeness

It is possible to have a good sex life and cohabitation after ovarian cancer but it may take time. The illness and treatments can make you think differently about yourself and your body. Some lose their desire for feeling anxious or depressed.

It can be difficult to talk about the changed situation. You can get help, for example by a psychotherapist or a sexologist. You can get help whether you have a partner or not. If you have a partner, you can, for example, get call support or help discover new ways of being together. You can read more in the text about cancer and sexuality.

If it burns and feels dry in the vagina

The vagina can become dry and stingy because the body stops producing estrogen when the ovaries are removed. There are different kinds of drugs with estrogen or without estrogen. They relieve without affecting the cancer disease. Some drugs act locally in the vagina, other drugs affect the entire body.

Quality of life

It can feel difficult and much can be different after treated ovarian cancer. Many who have participated in it still think they have a good quality of life.

Be involved and influence your care

You have the right to be involved in your care as much as possible. The healthcare staff should tell you what treatment options are available. They should make sure you understand what the different options mean, what side effects are available and where you can get treatment. This way you can help decide which treatment is right for you, for example, if you want to keep the possibility of becoming pregnant and there is a possibility.

You can make a care plan together with the contact nurse, the doctor and other staff. It should answer questions that are important to you. Here you can read more about the contact nurse and the care plan.

You can get a new medical assessment

You may get a  new medical assessment from another doctor if you have a life-threatening or particularly serious illness. Obtaining another doctor’s assessment can help you, for example, if you are unsure of which treatment or treatment is best for you. 

Getting a cancer message

There are many ways to respond to a cancer message. Often, you need plenty of time to talk to your doctor and other healthcare professionals about what the message means. If possible, please let a relative accompany you. The related person can act as a support and help to remember what has been said.

You can also ask to have the information printed so that you can read it peacefully. Ask questions if you don’t understand. You have the right to receive information in your own language. You also have the right to receive interpreting assistance if you have a hearing impairment.

In many hospitals, there are special nurses called contact nurses who can provide support and also help with various practical things.

For many, it usually feels easier once treatment has begun and they know what is going to happen.

You can get support from several directions

The contact nurse or the hospital’s curator can help you if you need to talk more or if you have questions. You can also contact for example Cancer Counseling or Cancer Foundation.

There are patient associations where you can meet other people who have similar experiences to you. Favorable is a patient association for people with gynecological cancer. You can also contact the Gynecological Cancer Network. Here you will find contact information for advice and support in cancer.

Children also need to know

A minor child has the right to receive information and support based on his or her own needs if a relative is ill. You can get help with what you can say if you want to tell the child yourself. Often it is good to make children as involved as possible, regardless of their age. That doesn’t mean you have to tell everything. You can read more in the text Getting a cancer message.

Being related

Sometimes it can be difficult to be close to someone who is sick. It is common to want to provide support while having a strong concern and feeling bad.

If possible, try to let people in your vicinity support you. It can be family members, friends or acquaintances. Often it will be easier for other people to help you if you tell them how it feels and shows if you are worried or sad.

You can get help from the contact nurse or a curator at the hospital if you are close and need supportive calls.

You can read more in the text Related to someone who gets cancer. More texts and films can be found on the Cancer-Related page 

Muhammad Nadeem

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