Cancer is a dreaded word, but not a very well understood one. Let’s understand the basic definition. The word cancer is used to define a collection of diseases that share one unique characteristic – the uncontrolled growth of cells that has the potential to spread to other parts of the body. Gynecological cancers grow from women’s reproductive organs. When the cancer originates in the ovaries, it’s known as ovarian cancer. Dr Rama Joshi, Director – Gynecology Oncology, Fortis Memorial Research Institute, Gurgaon will now help us in taking a closer look at ovarian cancer.
Importance of gynecologic health
Each year in India approximately 1,60,000 women are diagnosed with gynaecological cancer – the most widespread is cervical cancer, but there are other types too, such as ovarian, uterine, vulvar or vaginal.
Unfortunately, many cancer deaths occur unnecessarily due to lack of awareness about symptoms and need for screening. There is a clear need to drastically increase our understanding of these cancers.
Ovarian cancer
Ovarian cancer is the seventh most common cancer among women worldwide. The incidence of ovarian cancer has been rising over the last two decades and is the third most common cancer among Indian women. (ICMR Cancer registry).
Types of ovarian cancer
Ovarian cancer is commonly of two types. Epithelial ovarian cancer that arises from the surface of the ovary and germ cell tumours originating in the germ cells of the ovary. About 85-90% cancers are epithelial ovarian cancers and are generally diagnosed in the age group of around 50 years and above. On the other hand, germ cell tumours are commonly diagnosed in adolescent girls and younger women. Ovarian cancer has specific spread pattern where cancer cells can implant themselves through the abdominal cavity and spread to distant organs like lungs and liver. It is possible to get ovarian cancer even though the ovaries have been removed – this is called primary peritoneal cancer. In this article, we will focus on the more common epithelial ovarian cancer.
Some unknown facts about ovarian cancer
● Ovarian cancer is the leading cause of death among the gynaecological cancers and the fifth leading cause of cancer death in women.
● Only 15% of all ovarian cancer cases are detected at the earliest, most curable stage and
nearly 85% women are diagnosed in the advanced stage.
● The Pap test only screens for cervical cancer and DOES NOT cover ovarian cancer.
● It has been proven that the maximum survival benefit can be extended to these patients when they are managed by specialist gynaecologists.
Major risk factors for ovarian cancer
● The risk of ovarian cancer increases with age and is especially high around the time of menopause.
● A family history of ovarian cancer, colon cancer, stomach cancer, uterine cancer, prostate cancer, premenopausal breast cancer or a personal history of premenopausal breast cancer places women at heightened risk of ovarian cancer.
● BRCA gene mutation in self or any close family member.
● Endometriosis
● Infertility and not bearing children are risk factors.
Risk-reducing factors of ovarian cancer
● Pregnancy
● Oral contraceptive pills significantly reduce the risk when taken for 5 years
● Breastfeeding
● Tying off or removal of fallopian tubes (Female sterilization)
Consult for these symptoms of ovarian cancer
● Bloating
● Pelvic or abdominal pain
● Abdominal distension
● Difficulty eating or feeling full quickly
● Urinary symptoms- urgency or frequency
Women who have these symptoms almost daily for more than a few weeks should see their doctor to consider ovarian cancer as the possible cause, although it most likely won’t be.
How is ovarian cancer diagnosed?
Confirmatory diagnosis of ovarian cancer is made on histopathology after the surgical excision of ovarian mass in early stages of cancer. In advanced stages, diagnosis is made by cytological examination of ascitic fluid (fluid in the abdomen) for ovarian cancer cells or diseased peritoneal/omental biopsy before the commencement of treatment.
Clinical examination, abdominal ultrasound, CT scan and MRI aid in the assessment of the obvious spread of the disease and defining the treatment line.
How is ovarian cancer treated?
The treatment of ovarian cancer is decided based on the existing standard guidelines in order to offer the best results. Usually, surgery includes specialized surgical procedures.
Early-stage ovarian cancer
Surgery is the mainstay of treatment for early-stage disease. The aim of surgery is to remove a tumour and establish the disease stage; this helps in deciding whether or not chemotherapy is needed. Fertility-sparing surgery can be offered in selected cases.
Frozen section evaluation is required for the intra-operative diagnosis of suspicious ovarian tumours or complex ovarian masses as defined on imaging. In absence of this facility, the diagnosis of these masses is made on histopathology report, and following this, these patients will require a second surgery to complete the treatment in order to offer the best survival results to these women.
Advanced ovarian cancer
Surgery and chemotherapy are the cornerstones in the management of advanced ovarian cancer. The patients receive chemotherapy either before and/or after the surgery.
It is recommended world over that the surgery in both suspicious and diagnosed cases should always be done at a specialized centre by an experienced Gynae-oncologist for the best possible outcome in terms of survival and quality of life.
What is the prognosis for ovarian cancer?
Prognosis depends on the type of cancer and stage of the disease at diagnosis. 5-year survival rates are encouraging for early-stage cancers, approximately 90%. In advance stages, survival is significantly lower between 17-39%.
Act in time
● Unfortunately, there is no general screening test for ovarian cancer. Therefore, women need to understand the risk and symptoms.
● If you have any of the aforementioned symptoms that are frequent, persistent or new to you, ask your doctor to consider ovarian cancer as a possible cause.
● Seek the opinion of a gynaecologist when diagnosis/suspicion of ovarian cancer is made or you have a family history of cancer.
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