KOCHI: Ovarian cancer is a significant health concern worldwide. It is the seventh most common cancer among women and it ranks eighth in cancer deaths among women globally. Though ovarian cancer affects those above 20 commonly, it is mainly diagnosed after menopause. The tumours that originate in the cells of the ovaries are the cause of cancer. The four main types are epithelial carcinoma, germ cell tumour, sex cord-stromal tumour, and Krukenbergs tumour.
Although the overall incidence rates of ovarian cancer have remained stable over the years, due to genetic and economic factors, the rates seem to have certain differences between countries and races. Unfortunately, there is no effective screening programme for ovarian cancer, and most cases are diagnosed at an advanced stage when it has already spread to other parts of the body.
The primary risk factors involved are advancing age and a family history of ovarian and breast cancer. Over 75% of patients present with advanced-stage disease show symptoms like back pain, fatigue, abdominal pain or bloating, constipation, or urinary symptoms for more than three months. Through CT/MRI scans, endoscopies, blood tests (CA 125, CEA, CA 19-9) and needle biopsies one can evaluate and stage the disease.
Early-stage ovarian cancer, which is limited to one or both ovaries and the uterus, can be treated surgically through a procedure called primary cytoreduction, followed by chemotherapy to decrease the chance of recurrence. Whereas laparoscopic surgery is not recommended for ovarian cancers due to the risk of cancer spread caused by the tumour rupture.
Advanced-stage ovarian cancer involves cancer cells that have spread throughout the abdominal cavity and caused fluid accumulation and abdominal distension. In such conditions, 3 to 4 cycles of chemotherapy, followed by the surgery called Interval cytoreduction will be performed, where the cancerous deposits within the abdominal cavity, including the uterus and both ovaries get removed. In stage III cancer cells get deposited over the liver, intestine and abdominal wall; this requires aggressive treatment.
Another treatment for advanced ovarian cancer is cytoreductive surgery, which includes HIPEC (hyperthermic intraperitoneal chemotherapy) to further reduce the chance of cancer recurrence. This procedure involves the instillation of chemotherapy into the abdominal cavity at 42 to 44°C for 60 minutes.
HIPEC is performed only in specialised high-volume centres with trained oncologists, anaesthetists, and intensivists adhering to high levels of safety standards. The surgery is followed by 2 to 3 more cycles of chemotherapy after complete recovery.
The risk of ovarian cancer must be considered in those presenting with cysts and tumours of the ovary.
It is always better to refer ovarian cancer patients to specialized centres with a multidisciplinary approach and equipped with cutting-edge technology like HIPEC rather than going for laparoscopic surgeries.
The writer is a consultant and coordinator, of surgical oncology, KIMSHEALTH Cancer Centre
Mind & Body
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