Ovarian Cancer – Amplifying the Disease That Whispers
“The disease that whispers.” This phrase has been increasingly used to describe ovarian cancer, a malignancy that provides few and subtle signs to alert individuals to its presence. After endometrial cancer, ovarian cancer is the second most common cancer in the female reproductive tract, and the fourth most common cause of death due to cancer in women.
Why is this the case?
Ovarian cancer is not as easy to locate as other gynaecological cancers. For instance, with endometrial cancer, women tend to experience abnormal and unexpected bleeding, and usually see their doctor early to figure out what is happening. With cervical cancer, women who are receiving regular Pap tests are screened for the disease; if the Pap test comes back positive, the woman has cells in her cervix that could be at risk of becoming cancerous, and she receives further healthcare interventions. As well, in the process of performing a Pap smear, a family physician or gynecologist can examine the cervix to see if there are any obvious abnormalities that may indicate a cancerous growth.
The ovaries are different because they are smaller organs that are tucked away into the pelvis, facing the spine. It is a common misconception that Pap smears are used to detect ovarian problems, but the Pap smear is only able to detect abnormal changes in the cervix. To examine the ovaries properly, during what is called a bimanual examination, the woman and the muscles in her pelvis need to be completely relaxed. It is important to note that the ovaries are typically small and difficult to find on this exam, and the natural tension of the pelvic muscles makes it more challenging to locate them.
Since the anatomy alone cannot provide all the information needed to understand and detect ovarian cancer, the answers must come from science labs and clinical research.
What lies ahead?
Scientific research on ovarian cancer is constantly providing new clues on how these tumours can be better understood, and, therefore, better diagnosed. As most ovarian tumours are found on the epithelium, or the outer surface lining, of the ovary, these outer cancers are vital to understand. Interestingly, epithelial ovarian tumours have cells that actually resemble those in other areas of the woman’s reproductive tract: specifically, the Fallopian tube, endometrium, the internal lining of the cervix, and the upper part of the vagina, which are all Mullerian structures. Mullerian structures are developed from tubes called Mullerian ducts, which are found in the female embryo and give rise to significant parts of the female reproductive tract. Previous research findings suggested that the epithelial cells on the surface of the ovary transform or mutate into cells that have Mullerian features, and that this process of transformation is a signal that these cells are likely to become cancerous. New research indicates that some types of cancerous cells on the ovary’s outer surface are coming from non-ovarian Mullerian tissues, such as the fimbriae, or finger like ends of the Fallopian tubes. This is especially promising because it may provide an intervention that can prevent ovarian cancer in women who are at high
risk. If the abnormal cells are travelling from the female reproductive tract onto the surface of the ovary, then removing the Fallopian tubes may be one method of preventing ovarian cancer. If future research indicates that this theory is accurate, this surgical option may be available to women who are at risk of specific types of ovarian tumours, while still preserving the function of their ovaries. This is an important option because estrogen from the ovaries is protective for bone health, cardiovascular disease, and neurological functioning. As such, women who choose to keep their ovaries but remove their Fallopian tubes may be reducing their cancer risk and simultaneously delaying the menopausal like symptoms that come with low estrogen.
Improving quality of life, as well as quantity of life, is an essential goal of cancer research and cancer care. Current findings about ovarian cancer seem to indicate that this might be a tangible goal in the not too distant future.
References
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Dubeau, L. (2008). The cell of origin of ovarian epithelial tumours. The Lancet. Oncology, 9(12), 1191–7. http://doi.org/10.1016/S1470-2045(08)70308-5
Hawkins, N. A., Cooper, C. P., Saraiya, M., Gelb, C. A., & Polonec, L. (2011). Why the Pap test? Awareness and use of the Pap test among women in the United States. Journal of Women’s Health (2002), 20(4), 511–5. http://doi.org/10.1089/jwh.2011.2730
Jasen, P. (2009). From the “silent killer” to the “whispering disease”: ovarian cancer and the uses of metaphor. Medical History, 53(4), 489–512.
Mays, R. M., Zimet, G. D., Winston, Y., Kee, R., Dickes, J., & Su, L. Human papillomavirus, genital warts, Pap smears, and cervical cancer: knowledge and beliefs of adolescent and adult women. Health Care for Women International, 21(5), 361–74. http://doi.org/10.1080/07399330050082218
Ribeiro, J. R., Lovasco, L. A., Vanderhyden, B. C., & Freiman, R. N. (2014). Targeting TBP-Associated Factors in Ovarian Cancer. Frontiers in Oncology, 4, 45. http://doi.org/10.3389/fonc.2014.00045
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