Condition & Treatment – Ovarian Cancer

Key Facts

  • Ovarian cancer is 8th most common cancer in India
  • Age of presentation is usually 40 years
  • Surgery is the mainstay of treatment

Risk Factors

  • Obesity
  • Not having children
  • Late menopause
  • Early menarche
  • Infertility
  • Family history of ovarian cancer


Clinical Signs And Symptoms

  • Abnormal or postmenopausal bleeding
  • Abdominal pain or discomfort and Abdominal bloating or swelling
  • Unexplained weight loss or weight gain
  • Indigestion, and/or nausea
  • Constipation
  • Urinary frequency, and/or incontinence

History And Physical Examination

  • Besides routine history and general physical examination, pelvic examination is must
  • A pelvic exam is usually done to palpate your abdomen by pressing hand over the abdomen in order to feel (palpate) your pelvic organs
  • A pervaginal examination is also done to check for any abnormal findings in the genital organs

Investigations

  • Routine Blood tests along with kidney function tests and liver function tests are done to determine overall health
  • Blood tests to measure cancer antigen 125(CA125)
  • Imaging-Ultrasound whole abdomen/Transvaginal sonography or CECT/MRI Abdomen are done as per clinician decision
  • Histopathological Diagnosis- Biopsy is done either by Laparoscopy or by exploratory laparotomy as per disease status and clinician decision
  • Cytological Diagnosis- If fluid is present in abdomen(Ascites), ascitic fluid cytology for malignant cells to be done

Treatment options

Surgery
  • Surgery is the mainstay of treatment.
  • Total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO)- Surgeon removes both ovaries and fallopian tubes, the uterus, including the cervix
  • Debulking Surgery- Surgeon aims to remove as much of the tumor as possible. This is done in case of extensive disease
Chemotherapy
  • Neoadjuvant chemotherapy – This is given prior to surgery to shrink the tumor,control the tumor growth and to make it amenable for surgery.
  • Adjuvant chemotherapy – Chemotherapy that is given after the surgery to destroy left-over (microscopic) cells that may be present after visible tumor is removed by surgery
  • Current Regimens – Combination of Taxanes (Paclitaxel, Docetaxel) and Platinum compounds (Cisplatin, Carboplatin)

Targeted therapy
  • Targeted therapy includes agents like Bevacizumab,Olaparib,Niraparib which is given as per disease status and institute’s protocol

Fertility Preservation

  • Stimulation for cryoconservation of fertilised or unfertilised egg cells is the most established procedure for fertility preservation
  • Women have several options to preserve or restore their fertility, so that they may start a family after they complete their cancer treatment. These options include:
  • In vitro fertilization (IVF) and embryo freezing:
    • This method combines fertility medication with retrieval of the eggs prior to chemotherapy or radiation
    • The eggs are then fertilized through IVF, and the embryos are frozen for later use. While this is the most established and successful option, it does require precise timing, expense, and the availability of sperm
  • IVF and egg freezing:
    • This option is available for women who may not have a partner. The eggs are harvested and frozen without being fertilized in the hopes of later using them for IVF

Follow up

  • Follow up is usually done 2 – 4 monthly for first 2 years followed by 3-6 monthly for next 3 years and Annually there after
  • Blood tests along with Tumor markers like CA 125 and Imaging modalities like pelvic CT scan are done on follow up visits to see the status of disease whether it is stable ,increasing or decreasing

Remember

  • Ovarian cancer is curable in early stages
  • Surgery is mainstay treatment. DON’T BE AFRAID OF IT!!
  • Always visit a doctor in case of symptoms like pain in abdomen, discharge per vaginum
  • Remember early disease detection has better cure rates.
  • In case of family history, be in continuous consultation with your cancer specialist
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