When a 26-year-old IT professional from Bangladesh experienced increasing abdominal pain and swelling, she first approached a general physician who suspected gastric issues. The medicine she was given made no difference and within two months, the abdominal pain only worsened. She also had fatigue and weight loss. She consulted a gynecologist who suspected tumor in the ovaries. The ultrasound scanning followed by CT (computed tomography) scan and blood tests confirmed ovarian cancer.
Having been detected with ovarian cancer in the prime of her youth, the woman came to Mumbai’s Jaslok Hospital & Research Centre seeking further treatment. “When the woman came to us she was already in stage-3 of cancer. The cancer had spread to other parts and we had to remove her ovaries. The silent symptoms of ovarian cancer can be deceiving, and it was one such case,” says Dr Vishnu Agarwal, onco-surgeon at Jaslok Hospital & Research Centre, Mumbai. This was a rare case as usually ovarian cancer is seen in women above the age of 65.
What causes ovarian cancer?
According to experts, the growth of abnormal cells in the ovaries and the fallopian tube leads to the formation of tumors. Doctors also point out that the manifestation of the cancer cells in the ovary is not easily traced in the initial stages.
Experts explain it is impossible to pinpoint the specific causes of ovarian cancer. Nevertheless, Dr Sai Lakshmi Daayana, consultant – surgical gynec-oncology, Apollo Cancer Centres, Hyderabad, explains that the following reasons can put a woman at risk of developing ovarian cancer:
- Family history of breast or ovarian cancer
- Medical history of fertility treatment
- History of endometriosis or obesity
Dr Daayana adds that women who have not had children also fall under the risk groups.
Early signs and symptoms
The symptoms of ovarian cancer are subtle, says Dr Agarwal. “In the case of uterus cancer, continuous menstrual bleeding is an early sign. But in ovarian cancer, the tumor grows silently,” he adds.
One must be extremely vigilant to recognise the subtle signs of ovarian cancer, explains Dr Daayana. Some of the symptoms include:
- Abdominal bloating
- Loss of appetite and weight
- Feeling full too quickly
- Change in bowel habits
- Pelvic pain
- Frequent urination
“If these symptoms persist for more than two weeks at a stretch, one must consider an ultrasound scan of the abdomen,” says Dr Daayana.
Ovarian cancer: Who is at risk?
Dr Sanath Kumar Hegde, an oncologist from Mangaluru says, “Most cases of early detection are often incidental, but a vague pain in the lower abdomen, for a long period, can be indicative of ovarian cancer.”
“Although ovarian cancer is rare at a young age, we urge girls and women to be cautious and aware in order to catch symptoms early,” says Dr Agarwal, adding that the need is to ensure early diagnosis and treatment.
Dr Agarwal suggests the following tests for cancer identification:
- Sonography to know if there is an ovarian mask (lesions).
- Blood test (CA 125 blood test): High levels of tumor markers in the blood suggest cancer. For ovarian cancer, high levels of CA 125 (cancer antigen 125), a protein in the blood, suggests ovarian cancer.
- CT scan: a form of X-Ray to understand the level of metastasis (cancer spreading to parts)
Ovarian cancer: Stages
Cancer is a malignant tumor that grows in a specific area of the body. Dr Agarwal explains that cancer staging (determining the stage of the cancer) is based on the following factors:
- Size of the cancer (or malignant tumor)
- Spread into the nearby lymph nodes
- Metastasis (the spread into distant body parts)
Accordingly, ovarian cancer staging is categorised into four distinct stages wherein stage 1 is least critical and stage 4 is highly critical, says Dr Agarwal.
Cancer staging helps determine the mode of treatment and predict the survival chances, say experts. Dr Hegde explains that the chances of survival vary depending on the state when the cancer was detected and treatment initiated. “If the treatment begins at stage 1, the chances of survival is 70-80 per cent. In stage-2 it reduces to 50-60 per cent and in stage-3 it further declines to 30-40 per cent,” he says.
In the case of the woman from Bangladesh, the cancer was in the third stage. Her ovaries and uterus were infected. Thus doctors recommended immediate surgery to prevent the further spread of cancer.
“Most often, ovarian cancer treatment, in every stage, demands the removal of both the ovaries,” says Dr Agarwal.
Along with surgery, ovarian cancer is also treated with a combination of the following treatment procedures:
- Radiation therapy: A localised treatment to destroy the cancer cells through x-rays, or gamma rays.
- Chemotherapy: A therapy that uses anti-cancer drugs to reduce the symptoms.
- Targeted drug therapy: A cancer treatment that attacks specific cells to prevent further growth and spread. This is recommended in the last stages.
Dr Agarwal explains the Bangladeshi woman’s cancer had reached metastasis (by spreading to the uterus). Thus, she was treated by surgically removing the ovaries. Next, she underwent three cycles of chemotherapy which prevented the further spread of the cancer.
There are provisions for oocyte preservation (freezing eggs for reproduction) before beginning chemotherapy for young women affected by ovarian cancer.
What not to ignore
The symptoms of ovarian cancer are subtle, vague and latent. However, closely examining one’s body and the physical changes that happen can help in early identification, say experts. Also, experts ask women to be aware of the subtle symptoms within the body.
Dr Daayana recommends women with a family history of cancer or medical history of endometriosis or obesity undergo ultrasound scans every year from age 35.
- Ovarian cancer most often affects women above 65.
- The symptoms of ovarian cancer are vague and subtle.
- Abdominal swelling, fatigue, back pain and weight loss are some of the symptoms.