Few common questions about ovarian cancer answered by Dr. Rani Bhat.

1. How much does it cost to treat ovarian cancer?

  • Most of the time, patients with ovarian cancer come to us in the advanced stage (stage 3). In such circumstances, first, you would need a biopsy and this is an outpatient procedure (meaning you do not need admission). Once the biopsy confirmation happens that you have cancer, you would be generally advised to have three cycles of neoadjuvant chemotherapy (NACT). After NACT you go for a repeat CT / PET CT scan to check for the treatment response. If the scan shows a good response you would be advised surgery. Surgery for ovarian cancer is a major surgery that can take 4-8 hours depending on the complexity of the case. The average duration of hospitalisation for surgery would be 5-6 days. Two to three weeks of surgery, you would be advised to start another three cycles of adjuvant chemotherapy.

  • The cost of ovarian cancer treatment in Bangalore differs based on each individual diagnosis. Factors such as, at what stage the cancer was diagnosed, age of the patient, pre-existing diseases, etc… are to be considered to arrive at an estimated cost. Hence, it is difficult to give an estimated cost for the treatment.

2. Can you be fully cured of ovarian cancer?

  • When you have been told that you have cancer or someone close to you has been diagnosed with cancer, “cancer can be cured” are the words that you want to hear more than any other. Surprisingly it is also a word that most doctors won’t use. Unlike other chronic diseases, cancer has its own language: There’s no cure for cancer, but there are cancer treatments that may be able to cure some people of some cancers, but remember not all cancers can be cured. In recent years, cancer has been tagged as a lifestyle disease like diabetes. Diabetes also doesn’t have a cure but has to be managed with medication, diet and other lifestyle modifications.

  • If we can understand the difference between cure, controlled and remission, it makes all the difference.

Insight Into Cancer

Let us take an example, “Vegetable” is a general term you use to cover many different kinds: carrots, beetroots, peas, and more.

Likewise, “cancer” is a general word used for more than 200 types, including cancers of the endometrium, ovary, cervix, vagina, bladder, rectum, colon, etc.

In cancer, abnormal cells develop, multiply, and destroy healthy tissue around the organs in your body. Some types grow slowly (mild type); others spread quickly (aggressive type). Cancer can start in any part of your body and they have their characteristics such as grades (which tells how aggressive they are), stages (to what extent have they spread), and symptoms (mode of presentation).

Cure vs. Controlled vs. Remission

When a medical condition is treated and completely done and never comes back, only then doctors have used the word “cure”. For example, if you have acute appendicitis or gall bladder stones and doctors remove your appendix or gall bladder you have been cured of that medical condition.

In the world of cancer, “cure” works differently.

Based on statistics from a large group of studies done on cancer patients, doctors will give you their best perspective on whether or not your cancer will come back. But no doctor can give you a guarantee that you’ll be cured of cancer.

There are two reasons for this:

  1. Doctors are yet to conquer the cancer disease, though research has been going on for centuries we still do not know the nature of cancer.

  2. Even after treating main cancer, some cancer cells may remain silent in the body and can divide, grow, and become a new tumor after some time. So generally doctors avoid saying the word “you’re cured”.

Instead of talking about “cures,” most medical professionals use the word “control.”

Remission” means that the cancer signs and symptoms are reduced. Remission can be of two types, partial or complete. When all signs and symptoms of cancer have disappeared then we call a complete remission.

Most of the cancers recur within 5 years of completing the treatment. If the patient completes remission for 5 years or more, then the doctor may say the patient is cancer-free or cured of cancer. Even if a patient completes cancer treatment, some cancer cells can still live silently in the body for years and grow back someday to cause problems again, so complete remission doesn’t mean that cancer will not recur.

3. What is the survival rate of ovarian cancer patients?

  • The survival rate for ovarian cancer usually depends on many factors such as – stage, type of tumor, grade, age, etc. With a recent genetic study, it has been shown that the same type, stage and grade of tumor can behave differently in two different individuals. Thus, cancer treatment is becoming more individualised and tailor-made. In general, patients with early-stage of cancer have better survival than late-stage.

4. What is the most effective treatment for ovarian cancer?

Across the world treatment for ovarian cancer consists of two modalities that are surgery and chemotherapy.

  • If a patient comes in an early stage, then they would undergo surgery (cytoreductive surgery) first followed by chemotherapy (6 cycles of adjuvant chemotherapy).

  • Most ovarian cancers are diagnosed in stage 3 or 4. In such situations, the patient may first get 3 cycles of chemotherapy (neoadjuvant chemotherapy), followed by surgery (cytoreductive surgery) and then another 3 cycles of chemotherapy (adjuvant chemotherapy)

5. Is ovarian cancer painful?

  • Cancer treatment can be a bit prolonged as sometimes it involves combined modalities of treatment. In this current era of medical advancement ovarian cancer treatment is not painful.

6. How long do you live with stage 4 ovarian cancer?

  • In any cancer treatment, the terminology used for how long you will live is called survival rate and normally we take it as 5 years. The 5-year survival rate decreases rapidly from stages I to IV. The majority of ovarian cancer patients who have already reached advanced stages at the time of diagnosis have a lower survival rate. On average the 5-year survival rate ranges between 30% and 40%.

7. How does ovarian cancer kill you in the end?

  • There is no simple answer to this question because it is just not one reason for which a person dies. Like any chronic medical conditions such as diabetes and hypertension, cancer too can have an impact on various organs and multi-organs can be involved due to cancer and eventually lead to the end.

8. What happens if CA125 is positive?

  • CA 125 (cancer antigen 125) is a type of protein in your body. Ca 125 levels can be high if you have ovarian cancer, but you need to remember that CA 125 levels are not specific to ovarian cancer but can also be elevated in various conditions such as – endometriosis, pelvic inflammatory disease, uterine fibroids, liver disease, with ascites (fluid in the tummy), abdominal infection, during pregnancy and menstruation.

9. Does a normal CA125 mean no cancer?

  • In the early stages of ovarian cancer CA 125 can be normal, hence do not rely completely on CA 125 levels. Doctors don’t just depend on CA 125 value alone, they usually combine clinical and scan findings, CA 125 levels and make a diagnosis.

10. Does ovarian cancer spread fast?

  • It depends on the type of cancer and how aggressive the tumor is, not all cancers are aggressive. If the tumor is aggressive they tend to spread fast.

11. Where is back pain with ovarian cancer?

  • Since ovaries are situated in the lower tummy (pelvis), ovarian tumors, when they become big can put pressure on the lower tummy and lower back. If cancer has spread to the bones then depending on their location pain can vary in location.

12. Do you gain weight with ovarian cancer?

  • As ovarian cancer advances, there is a lot of fluid accumulated in the tummy and in later stages when the size of the tumor becomes big you may have a wrong notion that you are gaining weight.

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