Ovarian Cancer Is The Third Most Common Disease In Women In India. Know Symptoms And Treatments

Ovarian cancer accounts for seven to 10 per cent of all cancer cases in women. In India, ovarian cancer ranks as the third most common disease among women.

There are various risk factors associated with ovarian cancer. The strongest risk factors are a history of breast and ovarian cancer in the family and a personal history of breast cancer. ( Image Source :Getty )

By Dr Moumita Bag

Cancer is a term that induces panic, anxiety, and ambiguity, affecting numerous people globally. Women are susceptible to a wide array of cancer risks, one of which is ovarian cancer. In India, ovarian cancer ranks as the third most common disease among women. One in 133 women are at risk of ovarian cancer, according to the National Cancer Registry Programme (NCRP), Indian Council of Medical Research (ICMR).

Ovarian cancer accounts for seven to 10 per cent of all cancer cases in women. The age-adjusted risk (AAR) of ovarian cancer is 5.3 in Nagpur and 4.9 in Wardha District of Maharashtra. The Papum Pare district of Arunachal Pradesh has an AAR of 13.7, the highest in the country.  Meghalaya’s AAR of ovarian cancer is 2, the lowest in the country. In the national capital, the AAR of ovarian cancer is 9.8. 

Understanding ovarian cancer

The ovaries are gonads in the female reproductive system. Ovaries produce and store eggs, and create hormones (mainly estrogen, and progesterone) to control menstrual cycles and pregnancy. During ovulation, one of the ovaries releases an egg. 

Around 90 per cent of all ovarian cancers develop from cells of the coelomic epithelium or modified mesothelium. These cells are part of primitive mesoderm, which undergo metaplasia. Malignant transformation can happen once these cells are genetically predisposed to oncogenesis or due to exposure to oncogenic agents. 

There are various risk factors associated with ovarian cancer. The strongest risk factors are a history of breast and ovarian cancer in the family and a personal history of breast cancer. Women without a significant family history or known genetic mutations have a one to two per cent lifetime risk of developing ovarian cancer.

Genetic risk of ovarian cancer

The most common genes associated with ovarian cancer are BRCA1 and BRCA2. BRCA1-positive patients may have a 39 to 58 per cent risk of developing ovarian cancer, and a greater than 60 per cent risk of breast cancer. BRCA2-positive patients may have a 13 to 29 per cent risk of developing ovarian cancer and a higher than 60 per cent risk of breast cancer.

Types of Ovarian Cancer

The different types of ovarian cancers include epithelial ovarian cancer, germ cell tumours, and stromal cell tumours. 

Epithelial Ovarian Cancer

This is the most common type of ovarian cancer, accounting for around 85 to 90 per cent of ovarian cancers. The cancers originate from the surface cells (epithelial tissue) of the ovary. 

They can spread to the lining and organs of the pelvis and abdomen before possibly reaching other parts of the body.

Germ Cell Tumors

This is less common, accounting for around 10 per cent of ovarian cancers. It normally affects younger women, particularly those under 30 years of age.

The cancers develop from the egg cells (germ cells) of the ovary. They can sometimes produce hormones that cause bizarre symptoms like breast growth or menstrual irregularities.

Stromal Cell Tumors

This is the rarest type of ovarian cancer, accounting for less than five per cent of ovarian cancers. It arises from the conjunction tissue (stroma) of the ovary. The cancer can be benign or malignant.

Warning signs of ovarian cancer

The following are some warning signs of ovarian cancer.

• Problem with eating or feeling full quickly
• Frequent bloating 
• Feeling the need to urinate repeatedly or urgently 
• Constant abdominal discomfort or pelvic pain
• Changes in bowel habits such as constipation or loose motions
• Vomiting and nausea 
• Vaginal bleeding or abnormal discharge
• Unexplained weight loss or weight gain 

Diagnosis of ovarian cancer

There are several tests to diagnose ovarian cancer. The following are some examples.

• Pelvic Examination: This physical check-up allows the doctor to evaluate the patient.
• Imaging Tests: Ultrasound, CT scan, or MRI Scan can provide comprehensive pictures of the disease. 
• Blood Tests: Certain blood tests, like tumor markers, can be helpful in combination with other tests. 

Treatment of ovarian cancer

Treatment options for ovarian cancer vary on several factors like the stage and type of cancer, one’s overall health, and personal preferences. The following are some treatment options. 

• Surgery: This is a commonly preferred treatment option. It involves removal of the affected ovary or both ovaries and fallopian tubes and at times the uterus, with proper comprehensive staging. Frozen sections of diseased ovarian mass play a major role intraoperatively if surgery is the primary treatment (known as Staging Laparotomy). The fertility-sparing surgical approach is an option that is chosen depending upon treatment needs. Interval Cytoreduction is another type of surgery advised after a few cycles of primary chemotherapy (Neoadjuvant chemotherapy) in case of certain advanced diseases after biopsy confirmation of ovarian cancer.
• Risk-Reducing Surgery: It plays an important role when one has a genetic risk of breast and ovarian cancers.
• Chemotherapy: This uses effective and powerful medications to terminate cancer cells throughout the body. Chemotherapy settings are of different types. These include Neoadjuvant chemotherapy (NACT), Adjuvant chemotherapy, Palliative chemotherapy, and Second-line Chemotherapy.
• Targeted Therapy: These drugs target specific irregularities in tumor cells, posing a more specific approach to treatment.
• Hormone Therapy: This may be used in specific types of ovarian tumors to stop the growth of cancer cells. 

Ovarian cancer presents a unique challenge due to its silent nature. However, identifying the warning signs, seeking timely medical assistance, and being informed of the potential diagnostic and treatment options can encourage one to navigate the journey towards optimal health and well-being. One must remember that early detection and intervention can greatly increase the chances of successful treatment.

(The author is a consultant gynaecological oncologist at the HCG Cancer Centre in Nagpur).

[Disclaimer: Information provided in this article is for general guidance only. Individual results may vary. It is important to consult a healthcare professional, who knows your body type and medical history, before implementing the suggestions and information provided herein].