Ovarian cancer is called a “silent” killer as the early symptoms can be difficult to detect. Its early symptoms could either be ignored or go undetected until it reaches advanced stages, as it’s difficult to screen. Ovarian cancer is one of the less common gynecological malignancy in India with a projected risk of 1 in 133 females having ovarian cancer, and more than 40,000 new cases per annum.
What is Ovarian cancer
Ovarian cancer refers to any cancerous growth that begins in the ovary. Having a close relative with a history of ovarian cancer increases a person’s chance of developing ovarian cancer themselves. Undergoing genetic screening for mutations in the BRCA gene may help determine if someone has a higher risk of ovarian cancer.
When ovarian cancer metastasizes, it may spread to organs and tissues in the abdomen, pelvis and lymph nodes, or to distant sites throughout the body, such as the lungs. The most common type of the disease is epithelial, which begins in the layer of cells that cover the ovaries and the abdominal cavity.
The usual associated symptoms of ovarian cancer are vague and non-specific, hence are often ignored. The usual symptoms are:
*Feeling of heaviness in lower abdomen
*Feeling too full too soon on eating
*Bloating, weight loss, discomfort in the pelvic area
*Constipation, frequent urination.
While these symptoms do not definitely mean a person has ovarian cancer, but they mean that the person should consult a doctor to find out he cause and rule out ovarian cancer.
Overall, about 49% patients of ovarian cancer survive upto 5 years. The 5-year for survival based on disease spread are as follows –Localized disease (limited to ovary) – 92.6%, regional (spread to surrounding area) – 74.8%, distant (spread to other parts of body 30.3%). This explains why early diagnosis is very important. Those with family history or known genetic mutations should be annually assessed with transvaginal ultrasound and ovarian tumour marker blood tests.
Anything that increases your chance of getting ovarian cancer is a risk factor. There are multiple risk factors for ovarian cancer.
*Age is an important risk factor. Most ovarian cancers are diagnosed beyond the age of 50 years. The germ cell tumours can be diagnosed in the second or third decade of life, but they are less common.
*A longer menstrual phase in life: Early age of onset of menses and late age of menopause. This means a greater number of ovulation cycles, which increases risk.
*Pregnancy and breast feeding interrupts the monthly ovulation cycles and has a preventive effect by reducing number of ovulation cycles. Women with no children or who do not breast feed are at higher risk of ovarian cancer
*Obesity is a risk factor, since the fat is a source of estrogen hormone which increases risk of ovarian cancer
*Smoking increases the risk of one type of ovarian cancer.
Approximately 10% to 15% of ovarian cancers are due to genes that make one more likely to develop cancer. Those with family history might be at risk since a few genetic mutations are associated with ovarian cancer like, BRCA 1 and 2, Lynch syndrome, BRIP1, RAD51C, RAD51D.
Some factors that may reduce the risk of developing ovarian cancer include using the oral contraceptive pill for several years, having your fallopian tubes tied (or removed), having children before the age of 35 and breastfeeding.
Treatment depends on the extent of the cancer. The treatment of ovarian cancer involves surgery, chemotherapy, and immunotherapy. While surgery remains the mainstay of treatment for ovarian cancer, it might be needed in the beginning or after chemotherapy. Chemotherapy is very effective in most cases and shows significant benefits. There is more research ongoing to establish more therapies and better outcomes.
The best combination and sequence vary with the type and stage of ovarian cancer. So, the best treatment will be decided for you by your doctor based on these. What is important is to be aware of our body and be alert to identify and investigate any symptoms to rule out ovarian cancer. Let us break the chain of fear and ignorance, and move ahead to being aware, early diagnosis and high cure rates.
(Dr Upasna Saxena is Radiation Oncologist, HCG Cancer Centre Mumbai; views expressed by the author in this article are her own)