OVARIAN CANCER – THE SILENT KILLER
INTRODUCTION
- 2 peaks of presentation - 10-30 age and 6th and 7th decade
- More than half of patients present in stage 3 and above
Risk factors
- Nulliparity
- Obesity
- Smoking
- Genetic factors - BRCA gene - 20 - 40% chances
Symptoms
Non specific
- Bloating
- Pelvic / abdominal pain
- Early satiety
- Urinary symptoms
- Menstrual disturbances
Present for >12 days a month
What are the tests ?
- USG abdomen
- CT scan/MRI
- Blood markers -
- CA 125
- B- HCG
- Alpha fetoprotein
- LDH
Types of ovarian cancer
Epithelial ovarian carcinomas
- Most common
- Usually Occurs in post menopausal age
- Serous, mucinous, endometroid and clear cell
Germ cell tumors
- 10- 30 age group
- Dysgerminomas, teratomas, embryonal tumors and yolksac tumors
- Candidates for fertility sparing surgery
Sex cord stromal tumors
- 15-30 age group
- Granulosa cell tumors, Sertoli Leydig tumors
- Symptoms of hormonal production – hirsutism, virilization, precocious puberty or menstrual changes
- Candidates for fertility sparing surgery
What are the stages ?
In what way ca ovary is different from others ?
- Usual spread is through blood / lymphatics
- Ca ovary – spreads as single cell/ spheroids in peritoneum and omentum
- Detailed examination and removal is very essential part of surgery.
- Fluid collection in abdomen (ascites )is common in advanced stages
Treatment of ovarian cancer?
- Surgery is the main modality in planning for cure
- Surgery should ensure complete removal of all the disease. (R0 resection)
- To be done by a qualified cancer surgeon as there is no alternative for good surgery.
- Chemotherapy is given based on stage of the disease
What is the surgery done?
Cancer in young
- Fertility sparing surgery.
- Possible in stage 1 epithelial tumors, germ cell and sex cord stromal tumors
- Tumor with ovary is removed with surgical staging
- Uterus and normal ovary is left
Cancer in elderly
- Removal of uterus with ovaries
- Omentum
- Pelvic and paraaortic nodes
- Peritoneal sampling/removal
- Bowel and any other viscera if involved
What is CRS+HIPEC?
- Done in advanced cases as upfront surgery or after giving chemotherapy
- Also an option in recurrent cases
- Has better chances of cure than traditional surgery and chemotherapy
- Involves surgery to remove all cancer from the abdominal cavity
- Chemotherapy is circulated inside the abdominal cavity at higher temperature 41 c for around 90 min
- This takes care of cancer cells which are not visible to naked eye.
What is ca 125 ?
- It’s a tumor marker used in management of ca ovary
- It’s a supportive test and not confirmatory
- Once the treatment is finished, follow up is done with ca125 levels.
- Rising levels suggests a recurrence.
What to do if cancer comes back ?
- The chance of cancer coming back is determined by tumor biology and stage of cancer
- Cure is still possible if surgery can be done to remove all of recurrent cancer
- If not, chemotherapy is given to control the disease.
Is there any way to detect or prevent the ovarian cancer ?
- No screening method is approved for routine use
- No effective measures to prevent the cancer
- In patients with genetic predisposition - BRCA gene
Take home message
Proper treatment with team of oncologists is the corner stone for chance of cure
No alternative for complete surgery