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.