Kerala Kaumudi Online
Thursday, 21 January 2021 1.16 AM IST

Ovarian cancer, the silent killer


Ovarian cancer is the second most common gynaecological malignancy and the most common cause of death among women with gynaecologic cancer. This poor prognosis is due to the fact that most patients are diagnosed at an advanced stage. Early stages of the disease are potentially curable.

Ovarian cancer is often called the "silent killer" because symptoms usually occur very late, and hence diagnosed at advanced stage, affecting its outcome.

Ovarian cancer occurs most often in women ages 50 to 65, but can happen in younger or older women. Sometimes ovarian cancer runs in families.

Usual symptoms of ovarian cancer are abdominal discomfort, bloating, abdominal distention, nausea, anorexia, or early satiety due to the presence of ascites and omental or bowel metastases; dyspnea is occasionally present due to a pleural effusion. These symptoms are common feelings. They might also be caused by conditions that are not ovarian cancer, but if they persist for long then consult your physician.

Patients with epithelial ovarian cancer had a significantly higher rate of these symptoms compared with those with benign ovarian masses

Patients at a risk of ovarian cancer

●Older age

●Having one or more relatives with ovarian cancer

●Having abnormalities in a gene, called BRCA1 or BRCA2

●Having genes that are linked to hereditary nonpolyposis colorectal cancer (HNPCC; also called Lynch syndrome)

●Never being pregnant

●Being overweight

Factors that can reduce your risk of developing ovarian cancer

●Using hormonal methods of birth control (pills, patch, vaginal ring, injection)

●Being pregnant, breastfeeding

●Tubal ligation to prevent pregnancy

●Having your uterus or ovaries removed

Screening for ovarian cancer is not recommended for general population. But those who have strong family history of cancer in their family, mainly breast and ovary can undergo regular check up to detect disease at early stage.

Benefits of screening--The potential benefit of ovarian cancer screening is the chance of diagnosing it in early stage when it is potentially curable.

Risks of screening--The potential risk of ovarian cancer screening is having a false-positive screening test. This might lead to unnecessary surgery for many healthy women. Surgery carries risks including anxiety, injury, costs, and time out of work, as well as a small risk of serious complications.

Combination of CA 125 and Imaging with Ultrasound/CT scan can be used as screening method for high risk population.

Serum CA 125 is a marker of ovarian cancer, which is performed in blood. But this tumor marker used alone does not perform well for diagnosis or exclusion of ovarian cancer in premenopausal patients. Moreover, half of patients with stage I epithelial ovarian cancer have a normal CA 125 level.

CA 125 may be slightly higher in many benign conditions also like endometriosis, uterine fibroid and pelvic inflammatory disease.

Early detection is important because it reduces mortality by diagnosing the disease while it is confined to the ovary, when the five-year survival rate is 80 to 90 percent. Unfortunately, almost 80 percent of patients have lymph node or distant metastases at the time of diagnosis; five-year survival rates fall to 20 to 30 percent for advanced disease.

If the findings on physical examination are abnormal or symptoms are persistent, then we evaluate patients with a transvaginal and transabdominal ultrasound examination to evaluate the ovaries. Occasionally, abdominal or pelvic computed tomography (CT) is needed to clarify ultrasound findings.

How is ovarian cancer treated?

For most women, surgery to remove the cancer is the first part of treatment.

Most of the time, this involves doing a surgery called "total hysterectomy with salpingo-oophorectomy". For this surgery, the doctor removes the ovaries, the fallopian tubes and the uterus.

Further treatment will depend on the stage of the cancer. Some women might not need any further treatment after surgery while others may need chemotherapy. Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing.

After the treatment is complete, you require regular check-up and follow up to watch for relapse.

Dr P P Abdul shahid (MD, DM)

Consultant Medical Oncologist

Kimshealth Cancer Centre


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