Women should become extra cautious as far as gynaecological cancers – such as breast, ovarian and cervical cancers are concerned. In majority of women these cancers are being detected quite late in the advanced stages – owing to which, comprehensive treatment, cost of treatment and more importantly, survival rates are becoming drastically lower. According to several research studies and cancer statistics, late-stage cancer detection is rampantly prevalent in India. The scenario of ovarian cancer prevalence and detection is quite pathetic as there are no proper screening tests for detecting ovarian cancers in the early stages – where treatment is immensely possible. The silent, asymptomatic spread of ovarian cancer further hinders its early detection. Ovarian cancer has therefore become the third leading cancer in women in India after breast and cervical cancers. The best way to curtail the growth of this type of cancer is through mass awareness and screening – which helps in detecting early stage ovarian cancer.
An Overview of Ovaries and Ovarian Cancer
Ovaries are the female reproductive glands that produce eggs and female sexual hormones: progesterone and estrogen. They are located in the pelvic region. In ovaries, there are three main types of cells: Epithelial cells: present in the outer layers of ovaries (epithelial cells tumours develop from these cells); Stromal cells: female hormones estrogen and progesterone are produced in these cells (stromal cells tumours develop here); Germ cells: these cells produce ova or eggs (tumours that develop from these cells are called germ cells tumours). Majority of the ovarian tumours are epithelial cells tumours; the other types of ovarian tumours are rare.
Benign or non-cancerous ovarian cancer remains confined to ovaries, whereas malignant ovarian cancer spreads (metastasize) to other cells, tissues and organs. Epithelial ovarian carcinomas can spread to both pelvic and abdominal region and even to distal organs like lungs and liver during the advanced stages. Early stage ovarian cancer does not spread to other organs.
The Risk Factors for Ovarian Cancer
The risk is associated with genes and strong family history. Though the overall genes associated risk is only 15 to 20%, women with BRCA1 gene mutations carry a 39% risk – whereas women with BRCA2 gene mutations carry 11% to 17% risk of developing ovarian cancer in their lifespan. In such cases genetic testing will help decide prophylactic treatment to minimize future risk and complications. Nulliparity, early menstruation (menarche) and late menopause are the other risk factors.
Ovarian Cancer Causes
Though the exact cause of ovarian cancer is not known, obesity, a strong family history, age (women over 50 years are at risk), estrogen hormone replacement therapy and endometriosis may increase the risk of ovarian cancer.
Symptoms of ovarian cancer
Ovarian cancer spreads subtly and silently causing no symptoms at all; symptoms if present, may be quite non-specific and often vague. Many women miss such common symptoms like heaviness in the abdomen, bloating, pain in pelvic and abdominal region, changes in bowel movements, frequent urination and abdominal swelling – assuming those to be due to common ailments.
Diagnosis of Ovarian Cancer
If a gynaecologist suspects something unusual based on the patient’s symptoms and medical history. She will do a pelvic examination – and if she finds something suspicious during the exam [an enlarged ovary or signs of fluid in the abdomen (ascites)], she will recommend some tests including imaging tests such as ultrasound and CT scans of the abdomen and pelvis, blood tests and tumour marker tests such as CA 125 test. These tests will help her in the diagnosis of ovarian cancer. To confirm the diagnosis accurately, rarely biopsy may be done or most preferably surgery is performed. After confirmation of the diagnosis, the doctor does staging of the cancer.
How is Ovarian Cancer Treated
Ovarian cancer treatment options are based on the staging and the type of treatment required. Different types of doctors are involved in the treatment team – including gynaec oncologist, surgical oncologist, medical and radiation oncologist. If an ovarian cancer is detected early, it is treated by surgery. However, treatment modality depends on the overall health status of the patient, location of cancer and invasiveness of the cancer. Early detection of cancer in a woman of child bearing age makes it possible to conserve both ovaries and uterus. For a metastasized cancer, systemic chemotherapy is the mode of treatment. Hormonal therapy uses hormones or hormone blocking drugs to treat recurrent ovarian cancers and stromal cancers. The other ovarian cancer treatment options include targeted therapy and radiation therapy.
Ovarian cancer remains confined to the ovaries during the early stages. It rarely causes any symptoms during early stages. Successful treatment of ovarian cancer is very much possible when it remains confined to the ovary during the early stages.
Ovarian cancer, being a silent cancer, can subtly and aggressively spreads to pelvis and abdomen. It remains usually undetected during this stage as well. Once an ovarian cancer becomes metastatic and aggressively spreads, it becomes fatal and relatively difficult to treat. Malignant ovarian cancer can spread even to liver and lungs in the advanced stages.
About 85% to 90% of ovarian cancers are epithelial ovarian carcinomas and majority of the ovarian cancers are diagnosed in advanced stages. The symptoms associated with ovarian cancer are mostly non-specific even in advanced cases.
Both Breast cancer and ovarian cancer risk is associated with inherited mutations in BRCA1 and BRCA2 genes.
The main treatment for ovarian cancer involves surgery and chemotherapy. Radiation therapy, hormone therapy and targeted therapy are the other treatment options. Therefore, timely diagnosis, effective treatment and palliative care are imperative to address the growing incidences of breast, cervical and ovarian cancers in women in India.