Ovarian Cancer

There are two ovaries situated on either side of the uterus. When cancer cells originate from ovary it is known as primary ovarian cancer. Sometimes, the cancer cells originate from different organ and falls on to the ovary and this is called secondary ovarian cancer (Krukenberg). Ovarian cancers are generally seen around the age of 50 years, but even younger women can be affected with ovarian cancer. When disease is diagnosed early and treated, the survival is better.  Ovary has different layers and cell; hence there are several types of ovarian cancer depending from where the cells are arising. The common type of ovarian cancer is epithelial cancer. Ovarian, fallopian tube and primary peritoneal cancer have similar clinical presentation and have similar staging and treatment.

What are the causes?
  • Risk increases with age
  • Obesity or being overweight
  • Risk is slightly higher in women who have not had children and in women who have had early menarche (first menstruation) and late menopause
  • If there is family history of ovarian or breast cancer (genetic BRCA1 and BRCA2). 1% of ovarian cancers may be due to hereditary
What are the symptoms?
  • Pain in the tummy
  • Abdominal swelling.
  • Swollen abdomen
  • Feel lump in your tummy
  • Feeling full even with small meal
  • Loss of appetite
  • Loss of weight
  • Frequency of passing urine
  • Constipation
  • Heartburn
What test will be required for diagnosis?
  • 1.  To confirm the diagnosis
    • Doctor will usually do a vaginal examination (internal examination) if you have symptoms that may possibly be like
      cancer.
  • 2.  Assessing the extent and spread
    • Further tests may be advised to assess if the cancer has spread to other organs such as, an ultrasound scan, a CT scan, PET CT an MRI scan, a chest X-ray, blood tests like CA125 tumor marker or other tests.
    • This assessment is called staging of the cancer, done to asses the extent of the spread and to know the stage.
    • If your tummy is swollen with fluid (called ascites) of mass, you may be advised to have this fluid drained or have biospy of the mass. This is usually done with the help of ultrasound (ultrasound guidance). The removed fluid or biopsy of the mass may be checked for cancer cells.
What are the treatment options available?
  • Surgery is the mainstay of treatment. The type of surgery will depend on the stage of cancer and age of the patient.
  • Guideline is to remove womb with cervix (total hysterectomy), both ovaries and fallopian tubes (bilateral salpingo-oophorectomy), fatty apron near the stomach (omentum) and fatty tissue (lymph glands) and to remove all the visible tumor, this surgery is known as cytoreductive surgery (CRS). There are various surgical treatment for ovarian cancer depending on the stage of the cancer and other considerations. Aim of the surgery is – not gross tumor left behind.
  • HIPEC
  • In young patients – fertility sparing surgery can be offered in early stages, wherein only the effected ovary with cancer, omentecomy and lymph glands are removed. Here the uterus and opposite ovary will be retained.
  • When the cancer is in advance stages, you may be advised to have neo-adjuvant chemotherapy (NACT) to shrink the tumor and then go for CRS.
  • Chemotherapy
    • In chemotherapy treatment drugs are used to kill or slow the growth of cancerous cells. It’s usually given through an IV injection.
Prevention

Though ovarian cancer is not preventable, women with the BRCA1 gene or a family history of this cancer should be monitored closely. Some women with genetic abnormalities choose to have a prophylactic removal of the ovaries and fallopian tubes.

Follow-up after treatment
  • You should strictly follow-up with your doctor as per their advice.
  • In addition to receiving treatment for cervical cancer your success of treatment will depend only when you have regular follow-up.