Ovarian Cancer
The female reproductive system consists of two ovaries on each side of the uterus. These ovaries are responsible for the production of eggs and hormones such as estrogen and progesterone, and cancers developing in ovaries are called ovarian cancer.
These cancers often do not produce any symptoms during the early stages and are often detected in advanced stages in 70% of cases, when the cancer has spread to the other parts of the abdominal cavity.
Also, the symptoms in the advanced stage are rather non-specific and include fullness, bloating sensation, abdominal distension, and problems in bowel and bladder habits, which are easily confused with other disease conditions, resulting in delays in patients seeking timely medical consultation.
Symptoms of Ovarian Cancer:
Types Of Ovarian Cancer
The various types of ovarian cancers are as mentioned below:
- Serous papillary carcinoma
- Mucinous carcinoma
- Clear cell carcinoma
- Brenner’s or Transitional carcinoma
- Teratoma (Immature or Mature)
- Dysgerminoma
- Yolk sac/Endodermal sinus tumour
- Mixed GCT
Diagnostics Facilities
Dr. Karthick Rajamanickam
Advanced Cancer Diagnostics
Advanced Cancer Treatment
General Diagnostic Facilities
Causes of Ovarian Cancer
The causes of ovarian cancer are not very clear however the following factors have been identified to increase the risk of the disease:
- Old age: Ovarian cancer is more common in women above 50 years of age.
- Infertility: Infertility may increase the risk of ovarian cancer in nulliparous women.
- Genetic Mutations: A few cases of ovarian cancers are linked with inherited genetic changes like breast cancer gene 1 and breast cancer gene 2, or BRCA 1 and BRCA 2, which increases the risk of ovarian cancer apart from breast cancer. Other genetic changes associated with Lynch syndrome also increase the risk of ovarian cancer.
- Family History: If an immediate family member has been diagnosed with ovarian cancer or breast cancer, the risk of other women family members contracting ovarian cancer increases.
When to see the doctor?
The symptoms vary with individuals, and if you are experiencing any of these symptoms, especially for more than 2-3 weeks, you should consult a doctor.
Prevention of Ovarian Cancer
There is no particular way to prevent ovarian cancer however, its recommended that women undergo periodical screening to diagnose cancer at the early stage before progresses and for better treatment outcomes.
Testing for Ovarian cancer includes
On consulting a specialist, the following tests may be carried out:
- A physical exam: A thorough physical examination will be conducted after obtaining a detailed history of your symptoms.
- Ultrasound: An abdominal +/- transvaginal ultrasound is usually the first test conducted to see if any suspicious ovarian masses are present.
- Blood tests: Routine blood tests, along with special tests for assessing tumour markers like CA 125, CEA, CA 19.9 etc., will be taken.
- CT scan: A CT scan of the chest, abdomen and pelvis is done to determine the stage of the disease and decide on the best treatment approaches for the patient.
- MRI scan: An MRI scan is essential particularly in the early stages of ovarian masses, to confirm or rule out suspicious findings on a CECT scan.
- PET CECT scan: A PET CT scan may be suggested in advanced or recurrent cases to rule out cancer spread to other sites like the lungs, liver, bone, etc.
- Diagnostic laparoscopy and biopsy: In advanced cases, a diagnostic laparoscopy is advised to document the spread of the disease. A biopsy is performed simultaneously to determine the exact histopathological type of ovarian cancer, which help decide the best treatment approaches for the patient.
Treatment for Ovarian Cancer
The treatment for ovarian cancer depends upon the stage and type of cancer.
Surgery:
Surgical procedures to remove ovarian cancer include:
- Staging: Staging surgery consists of removing the uterus, both ovaries and pelvic and abdominal lymph nodes and total omentectomy is executed. This process is carried out in women who have completed their families and in the case of early ovarian cancer. In women who wish to maintain their fertility, only the affected ovary, lymph nodes and omentum are removed, preserving the normal ovary and uterus called the ‘Fertility preserving surgery’.
- Cytoreductive surgery: This surgery is performed before or after the chemotherapy process in cases of advanced ovarian cancers. In addition to staging surgery, the lining of the abdominal cavity, called the peritoneum, having deposits of cancer cells due to the advanced stage, along with the rectum, colon, small bowel, appendix, and gall bladder, are also removed depending on the spread of cancer.
Chemotherapy:
Chemotherapy in the form of injections may be suggested depending on the stage of the disease.
- Adjuvant chemotherapy: The chemotherapy process given after surgery, usually, consisting of 6 cycles wherein each cycle varies between 2-3 weeks.
- Neoadjuvant chemotherapy: The chemotherapy given before surgery is called neoadjuvant chemotherapy, consisting of 3 cycles wherein each cycle constitutes a duration of 3 weeks, another boot of chemotherapy is given post-surgery as adjuvant chemotherapy consisting of 3 cycles.
- Intraperitoneal chemotherapy: This is a special form of delivering chemotherapy directly into the peritoneal (abdominal cavity) in patients with advanced ovarian cancer. An intra-peritoneal (IP) port system is introduced underneath the skin of the abdominal wall through a tubing passed into the abdominal cavity, under general anaesthesia. This new approach is used successfully in neoadjuvant or adjuvant treatment procedures, especially in patients with peritoneally metastasised ovarian cancer.
Targeted therapy:
Targeted therapy uses drugs to target specific proteins within the cancer cells, to eliminate them. For example, Bevacizumab targeting VEGF protein in ovarian cancer cells may be suggested during treatment for ovarian cancer.
Immunotherapy:
In advanced cases, biological therapy or immunotherapy may be suggested for treatment. Immunotherapy targets the cells, which affect the body’s immune response and helps the body in eliminating cancer cells.
Doctors
Dr. Aruna Prabhu
Dr. Deepti Mishra
Dr. Bhavesh Poladia
