Ovarian Cancer

Ovarian cancer is known as a silent killer that’s because initial symptoms are mistaken as gastric issues and since ovaries are situated in the tummy the lady will notice the symptoms only when the disease has spread to other organs. About    20-25% of women with ovarian cancer have a hereditary tendency to develop the disease. When cancer cells originate from the ovary it is known as primary ovarian cancer. Sometimes, the cancer cells originate from different organs and fall 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 by ovarian cancer. When the disease is diagnosed early and treated, survival is better.  The ovary has different layers and cells; hence there are several types of ovarian cancer depending on where the cells are arising. The common type of ovarian cancer is epithelial cancer. Ovarian cancer, fallopian tube cancer, and primary peritoneal cancer have a similar clinical presentation and have similar staging and treatment.

HIPEC

  • In young patients – fertility-sparing surgery can be offered in early stages, wherein only the effected ovary with cancer, omentectomy, 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 neoadjuvant chemotherapy (NACT) to shrink the tumor and then go for CRS and then go for adjuvant chemotherapy, this is a kind of sandwich therapy: neo-adjuvant chemotherapy - CRS - adjuvant chemotherapy.

Where are the ovaries situated in the body?
  • There are two ovaries situated on either side of the uterus. Ovaries are oval in shape and are attached to the uterus with the help of a ligament called Ovarian ligament.

  • The ovary has two main functions, one produces hormones and the other is it produces ovum every month. This ovum will be picked up by the fallopian tube and transferred to the uterus for fertilisation with the sperm. 

  • Ovaries are situated in the lateral part of the pelvis called the ovarian fossa.

What are the causes?
  • Risk increases with age.

  • Obesity or being overweight.

  • Risk is slightly higher in women who have not had children.

  • Risk is high in women who have had early menarche (first menstruation) and late menopause.

  • If there is a family history of ovarian or breast cancer (genetic BRCA1 and BRCA2). 1% of ovarian cancers may be due to hereditary.

  • Hereditary breast and ovarian cancer syndrome (HBOC): women with HBOC are characterized by a high risk of breast and ovarian cancers and they also tend to develop primary peritoneal cancer.

  • Hereditary breast and ovarian cancer syndrome (HBOC): women with HBOC are characterized by a high risk of breast and ovarian cancers and they tend to develop cancer at an earlier age than the general population. The absolute lifetime risk of developing cancer with HBOC as compared to the general population.

What are the symptoms?
  • Pain in the tummy

  • Abdominal swelling

  • Swollen abdomen

  • Feel lump in your tummy

  • Feeling full even with a small meal

  • Loss of appetite

  • Loss of weight

  • Frequency of passing urine

  • Constipation

  • Heartburn

  • Some ovarian tumours can also cause menstrual irregularities

  • In young women, ovarian tumours can cause hormonal changes such as excessive hair growth on the body, change in voice, and change in the external genitalia 

What tests will be required for diagnosis?
  1. To confirm the diagnosis

    • ​The doctor will usually do a vaginal examination (internal examination) if you have symptoms that may possibly be like cancer.

  1. Assessing the extent and spread

    • ​Further tests may be advised to assess if 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 the staging of cancer, done to assess 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 a biopsy 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?

Surgery 

  • Surgery is the mainstay of treatment. The type of surgery will depend on the stage of cancer and the age of the patient.

  • The guideline is to remove womb with the 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 treatments for ovarian cancer depending on the stage of cancer and other considerations. Aim of the surgery is – not gross tumor left behind.

  • HIPEC: hyperthermic intra-peritoneal chemotherapy is an intra-operative procedure which may be offered on a case to case basis. The principle of this procedure is that after complete removal of the tumor the tummy is washed with heated chemotherapy. 

Chemotherapy:

  • In chemotherapy, treatment drugs are used to kill or slow the growth of cancerous cells. It’s usually given through an IV injection.

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 in treatment will depend only on when you have a regular follow-up.

Can we prevent ovarian cancer?

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 prophylactic removal of the ovaries and fallopian tubes in order to prevent them from developing ovarian cancer.

Ovarian Cancer

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