Ovarian cancer: Recognising its signs and knowing its treatment options

Ovarian cancer is any cancerous growth arising from the ovary. Posing as a clinical challenge it is the fifth most common cause of cancer deaths in women

Ovary-Screening

Ovarian cancer is one of the most ferocious gynaecologic cancers with a high death rate. Age-Specific Incidence Rate for this cancer showed an increased risk after 35 years with a peak in between 55-64 years.

When to suspect ovarian cancer clinical challenge

The early stage of ovarian cancer may show few symptoms (pain in lower abdomen, heaviness in abdomen, indigestion, frequent urination, change in bowel habits, pain during sexual intercourse) or no symptoms.

As the cancer progresses we may notice nausea, weight loss, loss of appetite, breathlessness.

Appearance of any one of the six symptoms (difficulty eating, bloating, abdominal distension, feeling of fullness, pain in abdomen or pelvis) more than 12 times in a month for less than a year warrants thorough workup to diagnose ovarian cancer.

Risk factors

What causes ovarian cancer and how can we prevent it

Multiple risk factors have been implicated in the causation of ovarian cancer. Early menarche, late menopause, nulliparity, failed infertility treatment, obesity, endometriosis, menopausal HRT, BRCA 1 and BRCA 2 mutation, LYNCH syndrome is associated with increased risk of developing ovarian cancer while multiparity, lactation, hysterectomy, tubal ligation, OC pill use have shown to have a protective role against the cancer.

Many people mistakenly believe that cancer is largely a hereditary disease, as if fate and the family gene pool alone dictate your chances of getting sick.

5- 10 % are due to gene mutation and rest 90 -95 % of cancers are due to the lifestyle choices you make, the foods you eat and the amount of exercise you incorporate in life.

That’s why prevention and awareness have become vital tools in the fight to end cancer, and they start with knowing how to nourish your body and how to develop healthy habits with lasting benefits.

Treatment modalities and palliative care

Surgery remains the main stay in treatment extension depends upon the stage and spread of the disease like:

  • Salphingo-oopherectomy: Surgery is done to remove the ovaries and fallopian tubes.
  • Radical Hysterectomy: Removal of uterus with both ovaries and tubes
  • Lymph node dissection of para aortic and pelvic nodes

Cytoreductive or debulking surgery: high stage cancers are managed by this method where removal of as much cancerous tissue as possible is done to relive symptoms and make chemotherapy more effective

Chemotherapy: Chemotherapy is the use of certain medications which prevent the cancer cells from dividing and growing. Chemotherapy is used to target cancer cells that surgery cannot or did not remove. Treatment usually involves 3 to 6 chemotherapy sessions, or cycles.

Targeted chemotherapy: Newer medications can directly target specific pathways or fucions in cancer cells. These medications include bevacizumab (Avastin) and olaparib (Lynparza). Unlike traditional chemotherapy, these drugs limit damage to normal cells.

This reduces common side effects. As chemotherapy targets rapidly, dividing cells such as red and white blood cells, and hair follicles may also be affected.

Common side effects are nausea, vomiting, diarrhoea, hair loss, loss of appetite, mouth sore, anaemia, infections due to low WBC count. The damage healthy cells normally repair themselves rapidly after treatment is over and the side effects soon disappear.

Hormone therapy: It may be added to the treatment plan to prevent estrogen from reaching cancer cells. Cutting off the supply of estrogen slows the growth of the cancer cells. This therapy may include goserelin (Zolodex), leuprolide (Lupron), Tamoxifen or an aromatase inhibitor.

Radiation therapy: Radiation is less often used in ovarian cancer treatment. It may be used if there are small traces of cancer in the reproductive system, or to treat the symptoms of advanced cancer.

Success rate of treatment: Successful treatment is possible in ovarian cancer if diagnosed at early stages

  • At stage I, the 5-year survival rate is 90 per cent.
  • At stage II, it is 70 per cent.
  • At stage III, it is 39 per cent.
  • At stage IV, it is 17 per cent.

For this reason, it is important to attend all recommended screening and to seek medical help as soon as any symptoms appear.

10 tips to reduce your risk of developing cancer

  • Ginger consumption – Destroys cancer cells
  • Green tea – Protects DNA
  • Tomato juice – reduce risk by 50%
  • Pepper – breaks carcinogens
  • Nuts -reduce tissue inflammation
  • Belgian endive – Starves precancerous cells
  • Flax seeds – Protects ovaries at the time of estrogenic surges.
  • Vitamin C and vitamin E consumption – Shuts down enzymes required for abnormal cell growth
  • Sleeping on time – Increases melatonin secretion which is a powerful anti- cancer hormone.
  • Strengthen your immunity with regular exercise.

The authors are obstetricians and gynaecologist at Motherhood Hospital, Kharadi in Pune