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Ovarian cancer is the third most common gynaecological cancer worldwide after cervical and endometrial cancer. About 20,000 women per year are newly diagnosed with ovarian cancer worldwide, and about 12,000 women every year die due to ovarian cancer worldwide making it the most common killer of gynaecological cancer. This brings us to the question why ovarian cancer is such a dreaded disease? Is it incurable? Actually, no. In very early stages ovarian cancers are 100% curable, but seldom a patient presents in such early stages.
Ovarian cancers are of two types: one arising from covering over the ovary and others from the ovary itself. The one arising from covering is called Ovarian epithelial cancer, it's commonly seen after 60 years of age and is more common, but in those having genetic mutations it may occur at an earlier age. Epithelial cancer spreads along the walls of the abdomen called peritoneum, thus to cure this the whole wall needs to be scrapped which is technically difficult and even in expert hands is never 100% assured. If a patient comes for treatment before the cancer has encroached upon the walls of abdomen, chances of cure is high as treatment required is removal of the ovaries. But in such early stages, patients are completely asymptomatic.
Common ovarian cancer symptoms or complaints include abdominal fullness brought on by water retention or a mass that is felt in the lower part of the abdomen. The tumour may also be compressing the rectum, where stools are stored, causing constipation, as well as the urinary bladder, causing urinary urgency. These symptoms could be a sign of an advanced illness. Rarely is an ovarian mass unintentionally discovered in a woman receiving an imaging test like an ultrasound or CT scan for any unrelated reason. Ovarian cancer this tiny can be entirely cured. But unfortunately, it's a rare occurrence.
Overall 5 years survival in ovarian cancer is 45%, i.e, out of 100 women treated for ovarian cancer only 45 remain alive at the end of 5 years despite best treatment. In contrast, for early stage ovarian cancers, 5 Years survival rate is 75%. Coming to the question why patients present at a late stage? Firstly, patients are not detected at early stage as in early stage this cancer is silent and by the time it becomes symptomatic the disease has reached to advanced stages. Secondly, due to the absence of an effective screening program for early detection of ovarian cancer.
It was initially proposed to screen for ovarian cancer using routine ultrasound (abdominal and transvaginal) and a blood test called CA-125. But later this recommendation was withdrawn by US- FDA (Food & Drug Administration) as ultrasound is an operator dependent investigation, where a good radiologist may give very meticulous reports while an inexperienced one missing the diseases and alarming physiological variations of ovary. It is common in young women to have fluid filled cysts in the ovary during various phases of the menstrual cycle, thus routine use of ultrasound for screening led to a high number of false positive reports. Similarly, the blood test CA-125 can be raised in many non-cancerous conditions like infections, pregnancy etc., and may not rise in some variants of cancer like mucinous epithelial cancers. Thus, routine screening of the normal population is no longer recommended, however high-risk populations like those who have first degree relatives (mother or siblings)/second degree relatives (aunt or grandmother) with history of ovarian cancer. Usually these people have a genetic mutation like BRCA or mismatch repair gene defect.
For ovarian cancer prevention, oral contraceptive pills are one of known medical therapies. Among surgical therapy, risk-reducing surgery, i.e., removal of both tubes along with removal of fallopian tubes are done once childbearing is complete. Currently all risk reducing manoeuvres are recommended for high risk populations like those carrying genetic mutations associated with ovarian cancers.
So, in absence of effective screening methods and less morbid risk reducing interventions for general populations rely only on presenting to oncologists on getting symptoms, by that time it may have reached an advanced stage thus making chances of cure slim. Although still treatment with modern surgical techniques and chemotherapies can very well treat these patients. Currently a new method of chemotherapy delivery called HIPEC (Hyperthermic Intra peritoneal Chemotherapy) has revolutionised ovarian cancer treatment, where chemotherapy is instilled in the abdomen soon after surgery.
Thus, our recommendation for, high risk population (those having known relatives with ovarian cancer) to meet your doctor immediately for screening and risk reducing interventions.
Also Read: Navigating Menopause, Understanding It's Effects On Women's Lives
Ovarian cancer is the third most common gynaecological cancer worldwide after cervical and endometrial cancer. About 20,000 women per year are newly diagnosed with ovarian cancer worldwide, and about 12,000 women every year die due to ovarian cancer worldwide making it the most common killer of gynaecological cancer. This brings us to the question why ovarian cancer is such a dreaded disease? Is it incurable? Actually, no. In very early stages ovarian cancers are 100% curable, but seldom a patient presents in such early stages.
Ovarian cancers are of two types: one arising from covering over the ovary and others from the ovary itself. The one arising from covering is called Ovarian epithelial cancer, it's commonly seen after 60 years of age and is more common, but in those having genetic mutations it may occur at an earlier age. Epithelial cancer spreads along the walls of the abdomen called peritoneum, thus to cure this the whole wall needs to be scrapped which is technically difficult and even in expert hands is never 100% assured. If a patient comes for treatment before the cancer has encroached upon the walls of abdomen, chances of cure is high as treatment required is removal of the ovaries. But in such early stages, patients are completely asymptomatic.
Common ovarian cancer symptoms or complaints include abdominal fullness brought on by water retention or a mass that is felt in the lower part of the abdomen. The tumour may also be compressing the rectum, where stools are stored, causing constipation, as well as the urinary bladder, causing urinary urgency. These symptoms could be a sign of an advanced illness. Rarely is an ovarian mass unintentionally discovered in a woman receiving an imaging test like an ultrasound or CT scan for any unrelated reason. Ovarian cancer this tiny can be entirely cured. But unfortunately, it's a rare occurrence.
Overall 5 years survival in ovarian cancer is 45%, i.e, out of 100 women treated for ovarian cancer only 45 remain alive at the end of 5 years despite best treatment. In contrast, for early stage ovarian cancers, 5 Years survival rate is 75%. Coming to the question why patients present at a late stage? Firstly, patients are not detected at early stage as in early stage this cancer is silent and by the time it becomes symptomatic the disease has reached to advanced stages. Secondly, due to the absence of an effective screening program for early detection of ovarian cancer.
It was initially proposed to screen for ovarian cancer using routine ultrasound (abdominal and transvaginal) and a blood test called CA-125. But later this recommendation was withdrawn by US- FDA (Food & Drug Administration) as ultrasound is an operator dependent investigation, where a good radiologist may give very meticulous reports while an inexperienced one missing the diseases and alarming physiological variations of ovary. It is common in young women to have fluid filled cysts in the ovary during various phases of the menstrual cycle, thus routine use of ultrasound for screening led to a high number of false positive reports. Similarly, the blood test CA-125 can be raised in many non-cancerous conditions like infections, pregnancy etc., and may not rise in some variants of cancer like mucinous epithelial cancers. Thus, routine screening of the normal population is no longer recommended, however high-risk populations like those who have first degree relatives (mother or siblings)/second degree relatives (aunt or grandmother) with history of ovarian cancer. Usually these people have a genetic mutation like BRCA or mismatch repair gene defect.
For ovarian cancer prevention, oral contraceptive pills are one of known medical therapies. Among surgical therapy, risk-reducing surgery, i.e., removal of both tubes along with removal of fallopian tubes are done once childbearing is complete. Currently all risk reducing manoeuvres are recommended for high risk populations like those carrying genetic mutations associated with ovarian cancers.
So, in absence of effective screening methods and less morbid risk reducing interventions for general populations rely only on presenting to oncologists on getting symptoms, by that time it may have reached an advanced stage thus making chances of cure slim. Although still treatment with modern surgical techniques and chemotherapies can very well treat these patients. Currently a new method of chemotherapy delivery called HIPEC (Hyperthermic Intra peritoneal Chemotherapy) has revolutionised ovarian cancer treatment, where chemotherapy is instilled in the abdomen soon after surgery.
Thus, our recommendation for, high risk population (those having known relatives with ovarian cancer) to meet your doctor immediately for screening and risk reducing interventions.
Also Read: Navigating Menopause, Understanding It's Effects On Women's Lives
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