Ovarian cancer: Detecting the silent killer

Oct 11, 2011

Of all the gynaecological cancers, ovarian cancer remains the most difficult to diagnose and treat. It has one of the highest mortality rates of gynaecological cancers because it neither produces telltale signs and symptoms, nor are there any reliable screening tests that can diagnose it early.

By Partha Mukhopadhyay

Of all the gynaecological cancers, ovarian cancer remains the most difficult to diagnose and treat. It has one of the highest mortality rates of gynaecological cancers because it neither produces telltale signs and symptoms, nor are there any reliable screening tests that can diagnose it early.

But with increasing awareness, doctors are frequently faced with the question of and insistence from healthy females to screen for ovarian cancer. To date, there is no evidence that any of the various screening tests that are performed, including pelvic examinations, trans-vaginal ultrasounds and a CA-125 assay (a tumour marker test that measures the level of CA-125 in the blood to see if it is elevated), leads to a decrease in ovarian cancer deaths.

These tests have not been shown to diagnose ovarian cancer early, and the risk of falsely calling a benign mass a cancer when it is not present is unacceptably high.
This can lead to unnecessary surgery, treatments and stress for patients. CA-125 is raised in many non-cancerous conditions and its only reliable use in the clinical setting is to monitor the response to treatment and to pick up a recurrence early in a patient proven to be suffering from ovarian cancer.

Symptoms
These are fairly non-specific, therefore only about 10-15% of all cases are detected at an early, localised stage. The percentage may be slightly better in the more developed countries but certainly there is nothing to feel elated about.

What does the treatment procedure entail?

The primary surgical objective in treatment is removal of the tumour. It has been shown consistently that the more complete the removal of the tumour, the better the clinical outcome since the surgical aim is removal of disease to the point that there is no visible disease present. The surgical approach consists of:

  •  A surgical procedure to remove the uterus, cervix and both ovaries and fallopian tubes.
  •  A surgical procedure to remove the omentum (a piece of the tissue lining the abdominal wall). 
  • A surgical procedure in which as much of the tumour as possible is removed. Some tumours may not be able to be completely removed.
  • Ovarian cancer staging during surgery (to find out whether the cancer has spread), and generally involves removing lymph nodes.
  • A complete exploration of the entire abdominal cavity is carried out including the upper surface of the liver, under surface of the diaphragm and the space on both sides of the ascending and the descending colon — the large gut.
  • The entire abdominal cavity is washed with sterile saline water and sent for pathological examination to determine whether there is any spillage of malignant cells. However, not every woman can undergo such surgery upfront. It is always better to do a medical cytoreduction (decreasing the tumour load and its size) rather than to attempt an incomplete surgery.

Chemotherapy: The combination of cisplatin or carboplatin and paclitaxel drugs has now become the standard recommended therapy for treatment for women with ovarian cancer who may benefit from chemotherapy.

The writer is a consultant clinical oncologist at Nakasero Cancer Care Centre, Nakasero Hospital

Screening of ovarian cancer

As there are no screening tests for ovarian cancer, it is best to adopt the policy of “Learn - Listen - Act” under these circumstances.

Learn

  • Ovarian cancer is the leading cause of death among the gynaecological cancers and the fifth leading cause of cancer death in women. 
  • Only 15% of all ovarian cancer cases are detected at the earliest, most curable stage.
  • One in 71 women will develop ovarian cancer in her lifetime (USA data).
  • The risk of ovarian cancer increases with age, especially around the time of menopause. 
  • A family history of ovarian cancer, fallopian tube cancer, primary peritoneal cancer or premenopausal breast cancer, or a personal history of premenopausal breast cancer place women at heightened risk for ovarian cancer. 

Infertility and not bearing children are risk factors while pregnancy and the use of birth control pills decrease risk.

Listen

  • Bloating
  • Pelvic or abdominal pain 
  • Difficulty eating or feeling full quickly
  • Urinary symptoms, urgency or frequency

Women who have these symptoms almost daily for more than a few weeks should see a doctor, preferably a gynaecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early-stage diagnosis is associated with an improved prognosis.

Act
- Women need to understand their risk and listen to their bodies for symptoms.
- If you have symptoms of ovarian cancer that are frequent, persistent and new to you, ask your doctor to consider ovarian cancer as a possible cause. If ovarian cancer is suspected or diagnosed, seek care first from a gynaecologic oncologist (qualified in diagnosing and treating cancer).

(The writer is a consultant clinical oncologist at Nakasero Cancer Care Centre, Nakasero Hospital)

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