Ovarian cancer is one of the most serious gynaecological cancers, often referred to as the ‘silent killer’ because it tends to present late with vague and non-specific symptoms.
Both globally and in India, the incidence is rising, making awareness about risk factors, prevention, diagnosis, and treatment increasingly important.
What is ovarian cancer?
Ovarian cancer arises in the ovaries, the two small reproductive organs on either side of the uterus that produce eggs and female hormones. It is the leading cause of death from all gynaecological cancers.
Is it hereditary?
Women with close blood relatives affected by ovarian cancer are at higher risk. Those who inherit BRCA 1 or 2 gene mutations face an increased risk of both breast and ovarian cancer, with the lifetime risk rising by 15 to 40 per cent.
Who is at risk?
All women are at risk of ovarian cancer, but certain factors significantly increase the likelihood of developing the disease.
What are the risk factors?
The presence of the following factors may raise the risk:
Increasing age: While ovarian cancer can occur at any age, it is most common after 50 years.
Genetic predisposition: Inherited mutations in BRCA 1 and 2, and some other genes.
Family history: A family history of breast, ovarian, or bowel cancers.
Reproductive factors: Early menarche, late menopause, and nulliparity (never having given birth).
Medical conditions: Endometriosis
How can we reduce the risk?
Oral contraceptive pills: Use for five or more years reduces risk.
Pregnancy and breastfeeding: Both have a protective effect.
Tubal surgeries: Ligation or tubectomy reduces risk as many ovarian cancers originate from the distal end of the fallopian tube.
Preventive surgery: Women with inherited BRCA 1 or 2 mutations may be advised to undergo removal of both tubes and ovaries after completing their family, usually after the age of 35.
Is there any effective screening for ovarian cancer?
At present, there is no effective population-based screening. Women with BRCA mutations are sometimes advised to undergo ultrasound and CA-125 testing every six months from the age of 30, although the impact on survival remains uncertain.
Can ovarian cancer be detected by the Pap test?
No. The Pap smear detects cervical cancer, not ovarian cancer.
What are the symptoms?
Ovarian cancer often presents late and with vague complaints, which may be mistaken for other conditions. Symptoms include:
Abdominal bloating or distension
Feeling full quickly (early satiety)
Frequent urination
Lower abdominal or back pain
Constipation
Pain during sex
Unusual vaginal bleeding
These symptoms do not always mean cancer, but if they are new and persist daily for more than two to three weeks, it is vital to consult a doctor. If ovarian cancer is suspected, referral to a gynaecological oncologist is advised.
What are the tests used to diagnose?
The initial test is usually an ultrasound scan. If suspicious findings are present, further tests may include blood markers such as CA-125 and CEA, as well as MRI or CT scans to determine the nature and stage of the disease.
Are all ovarian cysts malignant?
No, most are benign. Some may be borderline (abnormal but not invasive), while a minority are malignant. Further investigations are necessary to confirm the diagnosis.
What are the treatment options?
Treatment usually involves surgery and chemotherapy. Depending on the stage, treatment may begin with surgery followed by chemotherapy, or chemotherapy first, then surgery and more chemotherapy. Newer treatments, such as targeted therapies in tablet form, may be offered after standard treatment to reduce the risk of recurrence.
What is the prognosis?
It depends largely on the type and stage of cancer. Germ cell tumours, often affecting younger women, generally respond well to treatment. Early-stage cancers confined to the ovaries also have a better outlook. Unfortunately, most cases are detected at an advanced stage, when survival rates are lower.
Is it possible to get pregnant after being treated for ovarian cancer?
In some cases, particularly among young women with specific tumour types, fertility-preserving surgery may be possible, with only the affected ovary removed. Chemotherapy may still be required, and patients are usually advised to wait a few years before attempting pregnancy. The possibility of future fertility depends on the tumour type and stage, so it is best discussed with a gynaecological oncologist.
The writer is gynaecological oncologist at SUT Hospital, Pattom, Thiruvananthapuram