Ovarian Cancer – Look out for these symptoms, Stay aware
By Dr. Akhter Jawade, Director, East India, Karkinos Healthcare
A fifty-five-year-old woman approached a gynecologist complaining of an unusual bloated feeling in her lower abdomen. She reported to the specialist after she had lost weight, although she felt physically very active.
While this woman was suffering with pain for four months , the gynecologist questioned her why she had not reported this to the physician earlier.
“Well, initially I had thought it to be pain due to gastritis and took some antacids, but when it did not subside and even got worse as I lost my desire to eat and started developing some pain in the lower abdomen, I thought of consulting a local doctor. But otherwise I am fine, and I am actively doing my housework. It’s just that my periods have become a bit irregular and I lost weight looking at my loose blouses,” said the woman to the gynecologist.
“What did the local doctor advise you?” asked the gynecologist.
The woman replied, “The doctor had said the pain could be due to many reasons including gas and chronic constipation. He had advised me to undergo an Ultrasound test and also do some blood work to determine my condition. On reviewing the woman’s test reports, the doctor advised me to consult a gynecologist.”
Suspecting the woman’s symptoms to indicate cancer, the gynecologist further referred her to an oncologist, who then diagnosed the woman to have ovarian cancer.
Narrated here is just one example of a woman overlooking her health. The woman mentioned here, however, constantly believed that she had no woman-related health issues and refused to believe that she had a medical condition beyond and much more serious than gastritis. This state of denial coupled with the lack of awareness amongst the people in general and also in a section of physicians lead to late presentation of the disease. This kind of lag in time causes the condition to worsen and in case of cancers the tumors metastasize.
Women need to be aware of what could possibly indicate ovarian cancer.
- A heavy feeling in the pelvis
- Pain in the lower abdomen
- Bleeding from the vagina
- Weight gain or loss
- Abnormal periods
- Unexplained back pain that gets worse
- Gas, nausea, vomiting, or loss of appetite should not be overlooked.
While taking a detailed history of patients’ suffering from Ovarian Cancer, it would be seen that most of them would have had these above mentioned symptoms but passed them off as vague abdominal discomforts attributing them to faulty food habits or irregular bowel movements, especially among Indian women, who always tend to neglect the warning signs and avoid doctor consultations in the pretext of prioritizing family over one’s own health.
Some Facts about Ovarian Cancer:
- Ovarian cancer is the third (6.7%) most commonly detected cancer amongst Indian women. Breast and cervical cancer are more common. However, ovarian cancer is not far behind.
- Ovarian cancer is the seventh most common cancer in the world. A 5-year rate of survival, amongst ovarian cancer patients worldwide, is 45%, if the cancer spreads to other organs in the stomach. If the cancer is restricted to the ovaries and fallopian tube, the overall 5-year rate of survival of patients is 92%.
- Estimates show that the overall 5-year survival rate for ovarian cancer, in India, is a poor 45%. One of the main reasons for such low success rates against this cancer is the fact that diagnosis of ovarian cancer is made only during the advanced stages of the disease. 56% of the diagnosis of ovarian cancer are made only in later stage III and stage IV of the cancer.
- Inherited gene variants of BRCA1 and BRCA2 can increase a woman’s risk of developing ovarian cancer by 65% and 35% respectively.
- BRCA1 and BRCA2 genes are the ones that are mutated in 50% of all ovarian cancers.
- Ovarian cancers can develop from the fallopian tubes as well.
- Ovarian and breast cancer can also be hereditary. It helps to have advanced knowledge of ovarian cancer in one’s family.
- Genetic tests are available to help estimate the risk of developing ovarian cancer. You can read more about these tests in other articles.
Awareness regarding the existence of such a disease especially among the general population who may be suffering from these vague symptoms or those with family history of breast /ovarian cancers is very essential and it’s the duty of health professionals to be aware and make the general female population aware of ovarian cancer.
The fundamental concept should be to – catch tumors at an early stage – before it crosses its boundaries and makes it impossible to arrest its proliferation.
What are the risk factors for Ovarian Cancer? It’s not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease.
Factors that can increase the risk of ovarian cancer include:
- Age The risk of ovarian cancer increases as you age. It’s most often diagnosed in older adults.
- Inherited gene changes A small percentage of ovarian cancers are caused by gene changes inherited from the parents. The genes that increase the risk of ovarian cancer include BRCA1 and BRCA2. These genes also increase the risk of breast cancer.
Several other gene changes are known to increase the risk of ovarian cancer, including gene changes associated with Lynch syndrome and the genes BRIP1, RAD51C, and RAD51D.
- Family history of ovarian cancer If you have blood relatives who have been diagnosed with ovarian cancer, you may have an increased risk of the disease.
- Being overweight or obese Being overweight or obese increases the risk of ovarian cancer.
- Postmenopausal hormone replacement therapy Taking hormone replacement therapy to control menopause signs and symptoms may increase the risk of ovarian cancer.
- Endometriosis Endometriosis is an often painful disorder in which tissue similar to the tissue that lines the inside of the uterus grows outside the uterus.
- Age when menstruation started and ended Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.
- Never having been pregnant. If one has never been pregnant, increased risk of ovarian cancer is possible..
How to prevent Ovarian Cancer?
- A full-term pregnancy before the age of 26 years
- Birth control pills used for 3 – 6 months to be avoided
- Tubal ligation or sterilization operation can pose a risk
- Removal of the Fallopian tubes at hysterectomy is a risk factor
- Hormone Replacement Therapy can cause ovarian cancer
- Smoking and other tobacco product consumption increases cancer risk
- Maintaining an ideal weight
However, once the cancer has been diagnosed, a proper staging work up is very necessary to determine
- The line of treatment
- Assessment of the disease prognosis. This prognostication is very important as it helps in treatment planning with a more practical approach and also the relatives could be clearly explained regarding their expectations from the proposed treatment.
Diagnosis and Treatment
Diagnosis in many cases is incidental, that is by chance. An Ultrasound of the Abdomen and Pelvis would be sufficient to point towards advanced testing like CT scans of the Abdomen and Thorax.
At times, it’s only after surgery of an ovarian tumor or a tubo-ovarian mass would one realize the malignant [potential of the disease confirmed by a biopsy report.
Treatment options are surgery and systemic therapies.
Surgery would remain the mainstay of treatment depending on the staging whether it would be upfront or after a course of Chemotherapy in cases of advanced disease. Other forms of Systemic therapy could be hormone therapy and immunotherapies.
Role of Tumor Markers Tumor markers, also called biomarkers, are substances that are produced by cancer, or by other cells of the body, in response to cancer. Tumor markers for ovarian cancer can be found in the blood. They are measured using a blood test. Having a high level of a tumor marker suggests that cancer may be present in the body, but by itself, a high tumor marker level is not enough to make a diagnosis.
The commonly used tumor markers are:
- CA-125: Used to help in diagnosis, assessment of response to treatment, and monitoring for recurrence.
- Alpha-fetoprotein (AFP): Used in ovarian germ cell tumors and used to assess stage, prognosis, and response to treatment.
- Beta-hCG (Beta Human Chorionic Gonadotropin): Used in ovarian germ cell tumors and used to assess stage, prognosis, and response to treatment