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- Ovarian cancer
Globally, ovarian cancer is the 8th most common cancer in women, and it ranks 5th in cancer deaths in women. The risk of a woman developing ovarian cancer during her lifetime is 1 in 78. In 2018, the global no. of deaths from ovarian cancer was 4.4%. In 2020, the US alone had more than 20,000 new cases of ovarian cancer, with estimated deaths of more than 13,000 people.
In India, almost 60,000 new ovarian cancer cases have been estimated by the end of 2020. While the cases are on the rise in India, ovarian cancer treatment in Delhi NCR and other parts of India has also evolved.
Ovarian cancer incidence in women is rapidly increasing globally due to several changing factors including, lifestyle, stress levels, pollution, unhealthy habits, changing food habits, and more. However, a diagnosis of ovarian cancer is not the end of the world; it is merely a change. Women can live with ovarian cancer and have a good quality of life thanks to the modern treatments available. So, if you or your loved one suspect ovarian cancer, you should immediately consult an expert, like Dr. P.K.Das, the best ovarian cancer doctor in Delhi, for the latest treatment, care, & support available.
What is Ovarian cancer?
There are two ovaries in the female reproductive system, each ovary on either side of the uterus. The ovaries are about the size of almonds. They produce eggs or “ova” along with the hormones estrogen and progesterone, which are important components for sexual and reproductive development & health.
Ovarian cancer is an uncontrolled growth of cells forming in the ovaries. These cells multiply quickly and can easily invade healthy body tissue, in turn destroying or killing them.
Being the best medical oncologist in Delhi, Dr. P.K.Das and his team have treated thousands of ovarian cancer cases over his lustrous career, offering top-line care, the latest treatments, and utmost support.
What causes ovarian cancer?
While the cause of ovarian cancer is not known, there are several risk factors. These include:
Age
Increasing age may increase the risk of ovarian cancer, as it occurs mostly post-menopause. 8 in 10 women with ovarian cancer are over 50, generally.
Family history & genes
People with a family history of ovarian cancer are more likely to get ovarian cancer. It is sometimes when an individual has inherited a mutated version of a specific gene called BRCA1 or BRCA2.
Hormone Replacement Therapy
Some researchers have suggested that people taking/receiving HRT or hormone replacement therapy have an increased risk of getting ovarian cancer. But studies have shown conflicting results.
Endometriosis
People with endometriosis may have an increased risk of developing ovarian cancer because in endometriosis patients, the cells lining the womb usually grow elsewhere in the body. They act as if they were in the womb leaving the body painful.
Other factors
There are other factors that increase the risk of ovarian cancer as well, like obesity, regular smoking, asbestos exposure, talcum powder usage, and more.
Stages of ovarian cancer
Stage 1
Stage I ovarian cancer is the least advanced ovarian cancer stage. It has 3 further stages. In stage IA the cancer is in one ovary, in stage IB the cancer is in both ovaries, and in Stage IC the cancer is in both ovaries. Certain other things like cancer cells leaking into the pelvic area during surgery or lab tests finding cancer cells in the pelvic or abdominal fluid may have occurred.
Stage 2
In stage II, the cancer has reached organs close to the ovaries but not to the lymph nodes or other distant organs. It is divided into stage II-A, where the cancer has spread to the uterus, fallopian tubes, or both, and stage II-B, where it has spread to other organs in the pelvic region like the bladder, the colon, or the rectum.
Stage 3
In stage III, along with nearby organs, the cancer has reached the stomach lining, the lymph nodes behind the belly, or both. It is also divided into 3 adjoining stages. There's stage IIIA, which is further divided into stage IIIA1, where cancer is in the lymph nodes & maybe growing in nearby organs. Stage IIIA1 is divided into stage IIIA1(i) where cancer in the lymph nodes is less than 10mm and stage IIIA1(ii) where cancer in the lymph nodes is bigger than 10mm. Then there is stage IIIA2 where there are tiny cancer deposits in the stomach lining that can be seen under a microscope. The next stage is stage IIIB, where the cancer growth, though visible, is less than 2cm. The last stage is IIIC where the cancer growth is larger than 2cm.
Stage 4
This is the most advanced stage of ovarian cancer, and in it, the disease has spread to distant organs. It is further divided into two subcategories. There is stage IVA where the cancer cells are present in the fluids around the lung. However, it has not spread to other areas outside the abdomen. Then there is stage IVB, where the disease has been found by the doctors inside the lymph nodes and the tissues as well as organs including the skin, lungs, or even the brain.
Ovarian Cancer FAQs
Common-Epithelial ovarian carcinomas
85-90% of all ovarian cancers originate from epithelial cells. These cells cover the outer surface of the ovary. The cancer commonly spreads to the lining & organs of the pelvis and abdomen before it spreads to other parts of the body. The other organs it can spread to are the lungs, liver, brain, bones, and skin.
Some subtypes of cancerous epithelial tumors are:
- Serous carcinomas: Making up 52% of all epithelial cell ovarian cancers, they are often classified as either low-grade or high-grade carcinoma.
- Endometrioid carcinomas: These are slow-growing tumors, and they also cause fewer symptoms. While they are less likely to spread quickly to other body parts, they might not respond well to treatments as well.
- Mucinous carcinomas: Accounting for 6% of all ovarian cancer cases, this cancer tends to affect older women. They are slow-growing and rarely diagnosed in women younger than 35.
- Clear cell carcinomas: While it is a rare type of ovarian cancer, it has a good prognosis when caught and treated early, according to the top ovarian cancer specialists worldwide.
Uncommon
- Germ Cell Tumors
Beginning in the reproductive cells, germ cell tumors make up less than 2% of all ovarian cancers. Having a high survival rate, with it, 9 out of 10 patients survive 5 years after diagnosis.
- Stromal Cell Tumors
Accounting for 1% of all ovarian cancers, ovarian stromal cell tumors are very rare. They develop from female hormone-producing (estrogen & progesterone) stroma tissue cells.
- Ovarian Sarcoma
Ovarian sarcoma tumors develop in the connective tissues of ovarian cells. It can have a poor prognosis and hasn’t been studied in-depth. The most common symptom of an ovarian sarcoma tumor is abdominal pain.
- Krukenberg Tumors
Krukenberg tumors are stage 4 cancer; i.e., they are advanced cancer because they’re metastatic. Their cells readily break away from the original tumor and quickly multiply. While it’s often asymptomatic, the tumor may cause gastrointestinal symptoms.
Ovarian cancer symptoms: What are the signs of ovarian cancer?
Signs and symptoms of ovarian cancer can include:
- Abdominal bloating or swelling
- Feeling full quickly when eating
- Unintended weight loss
- Pelvic area discomfort
- Fatigue
- Back pain
- Changes in bowel habits, such as constipation
- A frequent need to urinate
Silent signs of ovarian cancer
- Spotting between periods
- Post-menopausal bleeding
- Cramps
- Vaginal discomfort
- Difficulty eating
- Pelvic Exam
A doctor inserts gloved fingers into the vagina while simultaneously pressing a hand on the abdomen to palpate the pelvic organs. External genitalia, vagina, and cervix are examined in this.
- Imaging Tests
Certain tests, like ultrasound (USG) or CT scans of the abdomen as well as the pelvis, can be suggested or done by doctors as they help determine the size, shape and structure of the ovaries.
- Blood Tests
Some blood tests may also be done. These tests may include organ function tests helping determine the overall health. Then there are tests for tumor markers.
- Surgery
Sometimes, it is difficult to diagnose ovarian cancer until the patient undergoes surgery to get an ovary removed and have it tested for the signs of cancer.
- Surgery
Surgery is one of the top treatments for ovarian cancer, at least in the primary stages.
-Surgery removing one ovary
In the case of early-stage cancer, if it hasn’t spread beyond one ovary, the surgery may involve removing the affected ovary along with the connected fallopian tube. It preserves one’s ability to have children.
-Surgery removing both ovaries
If the ovarian cancer has spread to both ovaries, but no signs of additional cancer cells have been seen, both the ovaries and fallopian tubes might be removed. In this case, the uterus remains intact, so it is still possible for somebody to get pregnant using frozen embryos or embryos from a donor.
-Surgery removing both the ovaries and the uterus
If the cancer has become more extensive or if the patient doesn’t want to preserve their ability to have children, the surgeon may remove both the ovaries, the fallopian tubes, the uterus, the nearby lymph nodes, and a fold of fatty abdominal tissue also called the omentum.
-Surgery for advanced ovarian cancer
If the ovarian cancer has advanced, the cancer doctor may suggest extensive surgery removing as much of the cancer as possible. In certain cases, chemotherapy can also be given before or after surgery.
- Chemotherapy
Chemotherapy drugs kill fast-growing cells in the body, which includes cancer cells. They can either be taken by mouth or administered through veins. In ovarian cancer, it is often used post-surgery to kill any leftover/remaining cancer cells. However, it can also be used before surgery.
For certain patients, doctors may choose to heat chemotherapy drugs and infuse them into the abdomen during surgery. This is called hyperthermic intraperitoneal chemotherapy. The drugs are then kept in place for a pre-decided amount of time before they’re drained and the surgery is complete.
- Targeted Therapy
Targeted therapy in ovarian cancer focuses on unique weaknesses with a patient’s cancer cells, attacking them through treatments causing cancer cells to die in turn. So, they find and attack cancer cells while keeping the normal, healthy cells untouched. If targeted therapy is an option for you, the doctor might test your cancer cells to understand which targeted therapy is most likely to affect your cancer.
The fast-evolving development of targeted therapies around the globe is changing the treatment paradigms for patients with ovarian cancer.
- Hormone Therapy
Hormone therapy utilizes certain drugs to block the effects of reproductive hormones like estrogen on ovarian cancer cells. These hormones help the cancer cells grow. So, blocking the hormone/s can help control the growth of cancer cells. Hormone therapy is often used to treat certain types of slow-growing ovarian cancers. They are also used sometimes for cancers that come back after treatments.
Oncologists often suggest hormone therapy for patients suffering from ovarian stromal tumors. These tumors are rare. This type of treatment is not first-line therapy for epithelial ovarian cancer, the most common type of ovarian cancer.
- Immunotherapy
Immunotherapy is a type of treatment where the patient’s own immune system is used to kill/destroy cancer cells. At first, the body’s immune response might not fight the cancer cells because they produce proteins that help them stay hidden from the immune system. Immunotherapy works by interfering with protein production and hence makes the cancer cells visible to the immune system.
Currently, there are 3 FDA-approved immunotherapy options for ovarian cancer. One is a part of the targeted antibodies, and the other two are parts of immunomodulators.
- Supportive (Palliative) Care
Palliative care offers specialized medical care focusing on pain relief along with relief from other symptoms for certain patients with serious illnesses. In this, specialists work with the patient, the family, and the other doctors to give an extra layer of support complementary to ongoing care.
It can be used if the patient is undergoing other aggressive treatments, such as surgery and chemotherapy. It can also be used if the cancer is not treatable to ensure the quality of life.
Targeted therapy and immunotherapy in cancer patients, especially those suffering from ovarian cancer, is changing the face of cancer treatment today.
If you need a consult, the best treatment options, support, and assistance for ovarian cancer, you can connect with Dr. P.K.Das, a leading cancer specialist in Delhi NCR.
Women younger than 65 years, when diagnosed with ovarian cancer, have better survival rates than women 65+ years old.
The overall 5-year survival rate for ovarian cancer in India is estimated at 45 %.
No. Women who have had their ovaries removed cannot get ovarian cancer, technically. But they may get primary peritoneal carcinoma, a close relative.
The early symptoms of ovarian cancer are subtle, but if present, they might be bloating, pelvic or abdominal pain, difficulty eating, and urinary issues.
1 out of 10 (approximately) ovarian cancer cases are hereditary.
While several measures can reduce a woman’s risk of getting ovarian cancer, there is no proven way of preventing ovarian cancer.