Winning the Fight

Understanding Ovarian Cancer to Beat it

Ovarian Cancer is the 4th common Gynaecological Cancer after Breast Cancer, Cervix Cancer and Uterus Cancer. It presents the greatest challenge as they are difficult to diagnose in the early stage and have very high mortality. The major types of Ovarian Cancer are – Epithelial Tumours and Germ Cell Tumours. The peak incidence of Invasive Epithelial Ovarian Cancer is 60 years of age and Germ Cell Tumour is below 20 years.

The high-risk predisposing factors are – low pregnancy rates, infertility or no pregnancies in the complete reproductive life cycle of a woman. About 5 to 10% of cases result from inherited susceptibility and genetic probability in their close relatives. These are associated with mutations of BRCA I and BRCA II genes. A full pedigree analysis should be done with maternal or paternal history of Ovarian Cancer. If the risk is well documented, Prophylactic Salpingo-oophorectomy (removal of fallopian tube and ovaries) is done to reduce the future risk of Ovarian Cancer.

Clinical symptoms are very vague including dull ache in the abdomen, nausea, vomiting, unexplained weight loss and generalised weakness. Few menopausal women experience postmenopausal bleeding and sudden increase in abdominal girth. Unfortunately, two third of women are identified with advanced disease at diagnosis. Hence, there is a definite place for screening with transvaginal sonography and CA 125 levels particularly in women with high risks. However, they must be careful about the interpretation of the results as the sensitivity of the test is very high and specificity is relatively low. Hence, false positive cases on screening test can occur very often.

As far as the treatment is concerned, for advanced cases above stage II, which usually is the case in more than 70% of women, debulking surgery followed by Chemotherapy is the standard treatment. Sometimes, Sandwich Therapy, i.e. Chemotherapy followed by Cytoreductive surgery which is again followed by Chemotherapy is required.

In 20% of patients, the disease can be detected at an early stage (particularly in Germ Cell Tumour), and the surgical excision in expert hands can also yield excellent results.

General awareness of the pathophysiology of Ovarian Cancer can enhance the early diagnosis and better survival results.

Dr. Amol Joshi

Dr. Gayatri Deshpande
Obstetrics & Gynaecology
Nanavati Super Speciality
Hospital, Mumbai