Ovarian Cancer: Watch out for this silent killer

Ovarian cancer is malignant growth that starts in the ovaries, the female reproductive organs producing eggs and hormones. “The glands are responsible for secreting hormones bearing female characteristics like estrogen and progesterone,” states Dr Sai Lakshmi Daayana, gynaecological oncologist of Apollo Hospitals. Reports reveal that this type of cancer can also affect the fallopian tubes (either of a pair of channels or conduits through which eggs are transmitted from ovaries to the uterus in a female mammal) and peritoneum (the serous membrane forming the lining of the abdominal cavity and covering the abdominal organs).

Spotlight on Creeping Killer

Ovarian cancer is called a silent killer because “until it reaches the advanced stage, it often remains undetected. Thus, it is considered one of the deadliest gynecological cancers due to its late diagnosis,” reasons Dr. Ajay Chanakya Vallabhaneni, ace Hyderabad-based surgical oncologist and robotic surgeon. He is also a member of DocTube,a video-based health education platform.

Ovarian cancer is often asymptomatic in its early stages or the symptoms may be so subtle that they go unnoticed. “It often goes undetected until it spreads expansively within the pelvis and abdomen. By the time it gets diagnosed, it ends up gnawing at most other parts of the body, making treatment more challenging and lowering the survival rate,” informs Dr. Daayana.

Menopausal Perils

There is a particular age bracket of women that is most vulnerable to ovarian cancer. The risk increases with age. Women touching and crossing 50 is the segment most exposed to this ailment. The majority of cases are detected in postmenopausal phase, typically between 50 and 70 years of age.

“It is true that women in the postmenopausal stage are more susceptible to ovarian cancer. They are at a maximum risk due to hormonal changes, a longer lifetime of ovulation cycles and possible genetic predispositions. The use of hormone replacement therapy after menopause may also slightly intensify the problem,” explains Dr Daayana.

“Prolonged exposure to estrogen, declining ovulation (phase of the female menstrual cycle during which eggs or ova are released from one of the ovaries) and family history too are a few chief causes to aggravate this hazard,” seconds Dr. Vallabhaneni.

Treatment

Treatment typically involves a combination of surgery and chemotherapy. “Surgery aims to remove as much of the tumour as possible, while chemotherapy is used to destroy the remaining cancer cells by administering drugs. In some cases, targeted therapy and immunotherapy may be considered,” shares Dr Daayana. Adding radiation therapy to the list in some cases, Dr Vallabhaneni states that “the treatment plan depends on the cancer's stage, type and the concerned patient’s overall health.”

Decision at Terminal Stage

One may be curious to know if the cancer patient reaching an end stage should be spayed or sterilised by getting her ovaries removed. “In advanced stages, surgery to remove the ovaries (oophorectomy) is often recommended to slow down cancer progression, relieve symptoms and improve the patient's quality of life,” admits Dr. Vallabhaneni.

If the cancer spread is extensive, then removing the ovaries may not provide significant benefits, notes Dr. Daayana. “At this incurable stage, the focus is usually on palliative care to manage symptoms and better the patient's daily lifestyle rather than infusing aggressive surgical interventions,” she advises.

PCOD Problem

One wonders if a patient is already afflicted with Polycystic Ovarian Disease (PCOD) is more susceptible to ovarian cancer. Does the presence of multiple cysts warn of the dangers of a cancerous development?

“While PCOD itself does not directly cause ovarian cancer, women with the condition may have an augmented risk due to irregular ovulation, prolonged exposure to unopposed estrogen (imbalance of estrogen and progesterone hormonal proportions in the body, which occurs due to the body’s insufficient production of progesterone or when estrogen is taken without progesterone) and metabolic imbalances. Multiple cysts does not indicate a higher likelihood of cancer development,” asserts Dr Daayana.

Symptoms

Symptoms can be vague and may include bloating, pelvic or abdominal pain, stomach feeling full quickly after eating, frequent urination, fatigue, unexplained weight reduction, loss of appetite,irregular menstrual cycles and changes in bowel habits.

Causes

The exact source of this malignant malady is unknown but multiple risk factors, such as genetic mutations (a permanent change in the DNA sequence of an organism, inherited or acquired, and inducing harmless or adverse effects), family history, advancing age, hormone replacement therapy, obesity, endometriosis (a tissue similar to the lining of the uterus grow outside the uterus causing severe pelvic pain and making it difficult to get pregnant) and certain reproductive issues like never having children may increase the prospects of an ovarian cancer development.

Manisha Koirala was diagnosed with stage IV ovarian cancer in 2012. She received treatment at Memorial Sloan Kettering in New York in 2012 and 2013, and recovered in 2014.