Team L&M

Ovarian Cancer, the silent killer, can go unnoticed as it has hardly any signs and symptoms in the earlier stages. The symptoms appear mainly after the disease has advanced and the treatment becomes tricky. It begins in the ovaries or in the fallopian tubes and the peritoneum. Life & More spoke with Gynaecologist and Reproductive Endocrinologist Dr Duru Shah on the issue. Dr Shah holds over 40 years of experience in the field. Excerpts from an interview:

Why are we seeing a rising trend in women diagnosed with ovarian cancer?
Ovarian Cancer ranks third in the world after cervical and uterine cancer. Although it has a lower prevalence rate as compared to other cancers, studies have predicted that the evidence and the mortality rate of ovarian cancer is expected to rise significantly by 2040. According to recent study done on 1000 women from 39 countries, the number of women being diagnoised with it is likely to increase to 3,71,000 new cases per year by 2035!
This increasing trend could be due to increasing prevalence of obesity among women secondary to lifestyle habits. Obesity causes anovulatory cycles and also contributes to insulin deficiency. This can raise the risk. Processed meals, red meat, and bad eating habits all contribute to additional DNA damage. Smoking is a significant risk factor since it has a direct carcinogenic effect on ovarian follicular cells. According to one study, women who had ever smoked had a 6% higher risk of developing ovarian cancer than women who had never smoked.

Called the Whisper disease, what are the challenges in the diagnosis of ovarian cancer?
Unfortunately, ovarian cancer is detected at later stages, hence known as the “silent killer”. Despite newer innovations surfacing recently, the entire technology advancement has been very slow for ovarian cancer treatment. Several challenges include the non-specific vague symptoms it presents with, lack of confirmatory tests and the rarity of the cancer.
Screening for OC has always been very preliminary. Most women are never screened, especially in low socio- economic countries. Currently available screening tests include a blood test for tumor marker CA125 and a transvaginal ultrasound / color Doppler of pelvis. Inspite of the available, a confirmatory diagnosis can be difficult due to many false positive cases and decreased sensitivity of these tests. Moreover, only few tumors reach a sonographically detectable size before they start to spread; hence annual screening may fail to detect them.

Which is the most preferred diagnostic methodology and why so?
Various methods can be combined together to facilitate its detection and effective diagnosis. These include:-
Annual visits to the Gynaec, for a pelvic internal examination. Symptoms like abdominal pain, bloating, decreased appetite shouldn’t be ignored
Ultrasonography (TVS)  and color Doppler of pelvis followed by MRI / CT scan, if needed to confirm any suspicious findings
Genetic Blood tests (screening for BRCA 1/ 2 genes) to determine if you carry the gene that increase risk of ovarian cancer. This can be done if you have a strong family history of ovarian Breast, uterine cancer.
Blood tests like CA-125 and the most recent HER-4 marker combined together can help concluding a diagnosis. Many algorithms have been devised to assess the risk of cancer, but their diagnostic efficacy still needs to be improved. Recent advancements in cancer biomarkers, imaging technology, and genetic-based diagnostic techniques appear to be very promising in the near future.

What are the treatment options available for ovarian cancer today? Which stage are they most affective?
It can surely be treated and is not always fatal. The treatment depends on its type, size the spread of the cancer. Early stage detection rate is hardly 20 per cent, but the survival rate increases up to almost 70 per cent if detected in time. The various options are:-
Surgery- If the cancer has not spread beyond the ovaries, surgical options include removal of 1 or both ovaries/ Fallopian tubes or a hysterectomy (along with removal of the uterus). Depending on the spread of the disease, a surgical staging is performed and the type of surgery is decided
Chemotherapy:- Chemotherapeutic agents include Platinum and Taxane containing drugs, which help kill the cancer cells. It is critical to test the drug’s sensitivity prior to administration in order to optimise the treatment strategy. In OC, intraperitoneal chemotherapy is a type of regional chemotherapy in which medications are directly injected into the peritoneal cavity (space housing abdominal Organs). The most ideal treatment for ovarian cancer is surgical removal of malignant tissue followed by chemotherapy.

What are the signs and risk factors? Are there any India-specific   findings?
Family history of ovarian /breast cancer is an important factor to be looked into Awareness of ovarian cancer symptoms help in timely diagnosis and thus improved outcomes.
According to studies, women with ovarian cancer experience symptoms 20-30 times per month with higher magnitude compared to women having non-malignant ovarian masses. Most common symptoms include persistent abdominal / pelvic pain, back pain and postmenopausal bleeding. Other symptoms like bloating, early satiety after eating, changes in bowel/ bladder habits like frequent urination or constipation should be taken into consideration
A recent UK study of 2020 involving 101,299 women found that each additional symptom decreased survival rate in advanced stage disease. As discussed before, high risk factors for OC include Nulliparity (not having any children), obesity, smoking and strong Genetic predisposition.

What are the common myths surrounding ovarian cancer?
Lack of awareness regarding gives rise to many misconceptions surrounding it; these include:-
Any ovarian cyst is equivalent to ovarian cancer.
Cysts in ovaries could be hormonal, due to PCOS or due to Endometriosis, these benign cysts are usually called functional cysts, whereas ovarian cancer is a separate entity.
PAP smears can detect ovarian CA
Pap smear involves taking a small smear from your cervix (mouth of the uterus) to check for any abnormal cells. This is a screening test for cervical cancer. As of today, there is no such test to detect ovarian cancer.
Only women with a strong family history can develop ovarian cancer. Having Genetic mutations like BRCA1/2 definitely increases the risk of having the cancer. But only 10-15 per cent of ovarian cancers occur due to a strong family history or Genetic predisposition.
Other risk factors can also cause ovarian cancer.
Only older women can get ovarian cancer. Ninety per cent of cases of ovarian cancer are seen in women above the age of 80 yrs. and almost 75per cent of cases are seen in women over 50 yrs. Still there is no said age limit for it.
Birth control pills can cause ovarian cancer.
In fact birth control pills act as a protective shield against this type of cancer. According to studies, OCPs reduce the risks by 30 -50 per cent by ensuring regular ovulation.

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