Ovarian Cancer Treatment in India - A woman's lifetime risk of

dying from ovarian cancer is 1.1 per cent.

It is one of the most common cancers in women after breast

and cervix cancer. It is called a 'silent killer' as it is

asymptomatic in early stages and 75 per cent of cases are

diagnosed in the advanced stage. A woman's lifetime risk of

dying from ovarian cancer is 1.1 percent.

What constitutes ovarian cancer?

It largely means tumours of epithelial origin, but it can also

arise from other elements namely germ cells and stroma.

Epithelial ovarian cancers typically occur in

postmenopausal women and are in advanced stage at the

time of diagnosis, whereas germ cell tumours occur at a

young age, are detected in the early stages and are

completely curable.

Who Are At Risk?

•The majority of women with ovarian cancer have no known risk factors. Early

menarche, late menopause, being over the age of 30 at first childbirth, and nulliparity

are said to increase the risk.

What are the protective factors?

Childbirth, breast-feeding, oral contraceptives, tubal ligation, bilateral removal of

ovaries (bilateral oophorectomy), and hysterectomy.

Symptoms are non-specific like pelvic pain, back pain, abdominal

discomfort, bloating, early satiety, vaginal bleeding, and

frequent urination. Ovarian masses are sometimes detected on

pelvic examination.

What Are The Symptoms?

How is it Diagnosed?

Transvaginal Ultrasound (TVU) is an important diagnostic tool in

evaluation of patients with pelvic mass. Computed Tomography (CT)

and Positron Emission Tomography (PET scan) help in defining the

extent of the disease. MRI is sometimes helpful. Tumour markers

like CA 125 are adjunct to imaging and useful in follow up.

All masses in the ovary are not cancers. TVU helps distinguish

benign from malignant ovarian cysts. Complex cysts, defined as

cysts with both solid and cystic components, septations and

echogenicity, are malignant and require exploration. In contrast

simple cysts that are thin walled, less than 5-10 cm and without

septations are usually benign.

Are all ovarian masses cancers?

Screening for ovarian cancer has not been successful as natural

history of ovarian cancer is not well understood. There is no well-

defined precursor lesion and the length of time from localised

tumour to dissemination is unknown. Multiple efforts are underway

to develop effective screening methods. Pelvic examination, CA 125,

and TVU with Doppler are studied as screening methods in high-risk

individuals.

Is ovarian cancer genetic?

Around 5-10 per cent of patients carry germline mutation. Breast-

ovarian cancer syndrome accounts for approximately 90 per cent of

hereditary ovarian cancer and is suspected whenever there are

multiple affected family members with , bilateral or early onset

breast cancer, both breast and ovarian cancer in the same

individual, or a male relative with breast cancer.

Can we detect early?

Ovarian Cancer Treatment depends on the age, stage, tumour type

and the desire to preserve fertility. Surgery and chemotherapy is

the mainstay of treatment.

What complications can I expect after chemotherapy?

The most common early complications are loss of hair, nausea and

vomiting. There can be reactions during infusion of chemotherapy,

which are prevented with good premedication. Late complications

include tingling and numbness in fingers and toes.

What are the treatment of Ovarian Cancer modalities?

Chemoprevention is by oral contraceptives. Surgical prevention is by

bilateral oophorectomy, tubal ligation and hysterectomy. Risk-

reducing bilateral oophorectomy is strongly recommended in

women who carry germline mutation for hereditary ovarian cancer,

because of high mortality of ovarian cancer and lack of effective

screening and preventive approaches. Fortunately, risk of ovarian

cancer does not rise dramatically until the late 30s in women with

germline mutation, so women have the opportunity to complete

their family prior to surgery.

Since ovarian cancer is one of the common cancers in women and

there are no effective population screening methods, high index of

suspicion is necessary for early diagnosis. With the new trends in

chemotherapy, survival is increasing in ovarian cancer patients and

awareness is necessary among the public for seeking early medical

attention.

How do I prevent?

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