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Ovarian cancer is the fourth most common cause of deaths worldwide. It is also the commonest cause of death among all gynaecological cancers. The very high case-fatality rate for ovarian cancer is partly because the condition usually presents in advanced stages of the disease.

In a retrospective study carried out by Iyoke et al, in Enugu, ovarian cancer was found to be the fourth commonest cause of gynaecological deaths. Previous studies done in Nigeria showed that it constituted between seven and 22 per cent of all gynaecological malignancies.

Epithelial ovarian cancer is the commonest type of ovarian cancer and it is known to afflict postmenopausal women.

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancerous and they can spread to other areas of the body.  It can be likened to a breakdown of law and order.

Ovarian cancer begins in the ovaries. Ovaries are reproductive glands found only in females (women). The ovaries produce eggs (ova) for reproduction. The eggs travel through the fallopian tubes into the uterus where the fertilised egg implants and develops into a fetus.

The ovaries are also the main sources of the female hormones estrogen and progesterone. One ovary is on each side of the uterus in the pelvis.

The ovaries are made up of three types of cells. Each type of cell can develop into a different type of tumour:

Epithelial tumors, for example, start from the cells that cover the outer surface of the ovary. Most ovarian tumors are epithelial cell tumors.

Germ cell tumors start from the cells that produce the eggs (ova). Germ cells usually form the eggs in females and the sperm in males. Most ovarian germ cell tumours are benign, but some are cancerous and may be life threatening. Less than two per cent of ovarian cancers are germ cell tumors. Overall, they have a good outlook, with more than nine out of 10 patients surviving, at least, five years after diagnosis.

Stromal tumours start from structural tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone. About one per cent of ovarian cancers are ovarian stromal cell tumours. More than half of stromal tumours are found in women older than 50, but five per cent of stromal tumours occur in young girls.

The most common symptom of this type of tumour is abnormal vaginal bleeding. This happens because many of these tumours produce female hormones (estrogen). These hormones can cause vaginal bleeding (like a period) to start again after menopause.

In young girls, the tumours can also cause menstrual periods and breast development to occur before puberty. Less often, stromal tumours make male hormones (like testosterone). If male hormones are produced, the tumours can cause normal menstrual periods to stop. They can also make facial and body hair grow. If the stromal tumour starts to bleed, it can cause sudden and severe abdominal pain.

An ovarian cyst is a collection of fluids inside an ovary. Most ovarian cysts occur as  normal parts of the process of ovulation (egg release). They are called functional cysts. These cysts usually go away within a few months without any treatment. If you develop a cyst, your doctor may want to check it again after your next cycle (period) to see if it has gotten smaller.

An ovarian cyst can be more concerning in a female who isn’t ovulating (like a woman after menopause or a girl who hasn’t started her periods) and the doctor may want to do more tests. The doctor may also order other tests if the cyst is large or if it does not go away in a few months.

An ovarian cyst can be more concerning in a female who isn’t ovulating (like a woman after menopause or a girl who hasn’t started her periods) and the doctor may want to do more tests. The doctor may also order other tests if the cyst is large or if it does not go away in a few months.

There is emerging evidence that ovarian cancer may now be more common in the developing than developed countries. A recent estimate indicated that of over 240,000 cases of ovarian cancer worldwide in 2009, close to 156,000, or 64 per cent, occurred in developing countries compared to 84,600 cases in developed countries. There is scanty literature on the current state of ovarian cancer in Nigeria.

However, in the USA, according to cancer.org, the American Cancer Society estimates for ovarian cancer in the United States for 2016 are that 22,280 women will receive a new diagnosis of ovarian cancer and 14,240) women will lose their lives to the disease.

To be continued.

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