Navigating Ovarian Cancer: Symptoms, Diagnosis, and Treatment Options

‘Cancer’ is a term that induces panic, anxiety, and ambiguity, affecting numerous people globally. This article aims to shed light on an important malignancy specific to females, that is Ovarian cancer. Women encounter a challenging terrain of cancer risks, with ovarian cancer posing a significant threat. In India, ovarian cancer ranks as the third most common disease among women with a cumulative risk of 1 in 133 [as per National Cancer Registry Programme (NCRP)- ICMR] and accounting for 7-10% of all cancer cases in women. The age-adjusted risk (AAR) of Ovarian cancer is 5.3 in Nagpur and AAR of 4.9 in Wardha District respectively with the highest AAR of 13.7 in Papumpare district of Arunachal Pradesh, AAR of 9.8 in Delhi and the lowest AAR of 2.0 in Meghalaya (NCRP).

Understanding ovarian cancer-

Your ovaries are gonads in the female reproductive system. Ovaries produce and store eggs and produce hormones (mainly estrogen, and progesterone) to control menstrual cycles and pregnancy. During ovulation, one of your ovaries release an egg.

Around 90% of ovarian cancers develop from cells of the coelomic epithelium or modified mesothelium. These cells are part of primitive mesoderm, which undergo metaplasia. Malignant transformation can happen once these cells are genetically predisposed to oncogenesis or because of exposure to oncogenic agents.

There are various risk factors associated with ovarian cancer. The strongest risk factors are a positive history of breast and ovarian cancer in the family and a personal history of breast cancer. Women without a significant family history or known gene mutations have a 1-2% lifetime risk of developing ovarian cancer.

Genetic risk: The most common genes associated with Ovarian cancer are BRCA1 &2. BRCA 1 positive patients can have absolute risk of developing ovarian cancer 39-58%, breast cancer >60% and BRCA 2 positive patients can have absolute risk of developing ovarian cancer 13-29%, breast cancer >60%. (NCCN guideline update version 2024).

Types of Ovarian Cancer-

1. Epithelial Ovarian Cancer:

· Most widespread types (around 85-90% of ovarian cancers) derive from the surface cells (epithelial tissue) of the ovary.

o They can spread to the lining and organs of the pelvis and abdomen before possibly reaching other parts of the body.

2. Germ Cell Tumors:

· Less common (around 10% of ovarian cancers), normally affecting younger women (under 30).

o Develop from the egg cells (germ cells) of the ovary.

o They can sometimes produce hormones that cause bizarre symptoms like breast growth or menstrual irregularities.

3. Stromal Cell Tumors:

· Rarest type (less than 5% of ovarian cancers), arising from the conjunction tissue (stroma) of the ovary.

o Can be either benign or malignant.

Recognizing the warning signs-

1. Problem with eating or feeling full quickly

2. Frequent Bloating

3. Feeling the need to urinate repeatedly or urgently

4. Constant abdominal discomfort or pelvic pain

5. Changes in bowel habits such as constipation or looseness of the bowels

6. Vomiting, nausea

7. Vaginal bleeding or abnormal discharge

8. Unexplained weight loss or weight gain

A doctor first will note your complaints and will examine you clinically and then may advise several tests to diagnose ovarian cancer:

1. Pelvic Examination- This physical check-up allows the doctor to evaluate the patient.

2. Imaging Tests- Ultrasound, CT scan, or MRI Scan can provide comprehensive pictures of the disease.

3. Blood Tests- Certain blood tests, like tumor markers, can be helpful in combination with other tests.

Treatment Options-

Treatment options for ovarian cancer vary on several factors like the stage and type of cancer, your overall health, and personal preferences.

1. Surgery- This is often a major treatment. It involves the removal of the affected ovary or both ovaries and fallopian tubes and at times the uterus with proper comprehensive staging. Frozen sections of diseased ovarian mass play a major role intraoperatively if surgery is the primary treatment (known as Staging Laparotomy). The fertility-sparing surgical approach is an option to be individualized by your doctor depending upon treatment needs. Interval Cytoreduction is another type of surgery advised after a few cycles of primary chemotherapy (Neo-adjuvant chemotherapy) in case of certain advanced diseases after biopsy confirmation of ovarian cancer.

2. Risk-Reducing Surgery: It plays an important role in the presence of genetic risk of breast and ovarian cancers.

3. Chemotherapy- This uses effective and powerful medications to terminate cancer cells throughout the body. Chemotherapy settings are different types- Neo-adjuvant chemotherapy (NACT), Adjuvant chemotherapy, Palliative chemotherapy, and Second-line Chemotherapy.

4. Targeted Therapy- These drugs target specific irregularities in tumor cells, posing a more specific approach to treatment.

5. Hormone Therapy- This may be used in specific types of ovarian tumors to stop the growth of cancer cells.

Ovarian cancer presents a unique challenge due to its silent nature. However, identifying the cautionary signs, seeking timely medical assistance, and being informed of the potential diagnostic and treatment options can encourage you to navigate this journey toward optimal health and well-being. Remember, early detection and intervention greatly improve the chances of successful treatment.

~ Dr. Moumita Bag, Consultant Gynaecologic Oncologist, HCG Cancer Centre, Nagpur