Medicosnext
Words by Prof Dr Arju Chand Singh
Ovarian cancer is not totally silent. It whispers and needs to be heard.
Don’t ignore any symptom, no matter how vague. Listen to your body.
Cancer is not a death sentence, but rather it is a life sentence; it pushes one to live.
Numerous notable individuals have faced the diagnosis of ovarian cancer and emerged triumphant in their battle against the disease. A compelling example is Manisha Koirala, whose name needs no further introduction to us Nepali people. In 2012, she received the startling news of being in the advanced stage IV of ovarian cancer, prompting her to embark on a remarkable journey toward recovery. Struggling with the initial shock and a sense of hopelessness, Manisha sought a second opinion in Mumbai, where a renowned doctor recommended a combination of chemotherapy and surgery to combat the aggressive cancer. Later she choose to undergo treatment at Memorial Sloan Kettering in New York, renowned for its specialization in gynecologic cancers, Manisha entrusted her care to Dr. Dennis Chi, a seasoned specialist with extensive experience in combating ovarian cancer. The innovative approach of MSK’s ovarian cancer team, particularly their proficiency in radical debulking surgery, played a pivotal role in her successful fight against the aggressive disease. This bold decision, coupled with her enduring spirit, has not only enabled Manisha to overcome ovarian cancer but has also empowered her to lead a vibrant and active life, inspiring others facing similar challenges. From her successful treatment at MSK to hiking with friends at the base of Mount Everest, Manisha Koirala’s story serves as a beacon of hope for those grappling with ovarian cancer, emphasizing the importance of seeking the best available care to triumph over adversity.
Introduction
Ovarian cancer is one of the most common gynecological cancers that rank third after cervical and uterine cancers. It is the leading cause of death in women diagnosed with gynecological cancers and fifth most frequent cause of death in women in general. A women’s risk of getting ovarian cancer during her lifetime is about 1 in 78.
The high mortality rate of ovarian cancer is caused by asymptomatic and secret growth of the tumor, delayed onset of symptoms and lack of proper screening that result in its diagnosis only in advanced stages. Most of the cases are diagnosed at an advanced stage, which leads to poor outcomes of this disease. Effective screening strategies for the early detection of ovarian cancer do not exist, but individual at high risk of developing this disease can be identified .
Biomarkers- CA125 & HE4
Symptoms of ovarian cancer are non specific and hence they can be easily missed at an early stage as the symptoms can be attributed to other possible disease processes. Measurement of CA125 level is usually done in adjunction with the imaging. CA125 is elevated in most of the epithelial ovarian cancer overall but only half of the early stage epithelial ovarian cancer. Specificity and positive predictive value is found to be higher in postmenopausal women than in premenopausal women. Human epididymis protein 4(HE4) is the new biomarker that is currently being evaluated and found to be more sensitive for ovarian cancer and found in 100% of serous and endometrial subtypes.
Risk Factors
There are several risk factors that might increase a woman’s chance of developing epithelial ovarian cancer which does not apply to other less common types of ovarian cancer like germ cell tumors and stromal tumors.
- Older age
- Obesity
- Having children later after age 35 years or never having full term pregnancy
- Hormone therapy after menopause
- Family history of ovarian , breast or colorectal cancer
- Having family cancer syndrome like hereditary breast and ovarian cancer syndrome
- Genetic factors: Gene associated PALB2 mutation in BRCA1 and BRCA2 , ATM,BR1P1,RAD51c,RAD51D
- Hereditary nonpolyposis colon cancer
- Peritz-Jeghers syndrome
- MUTYH-associated polyposis
Ovarian cancer is not totally silent. It whispers and needs to be heard.
Don’t ignore any symptom, no matter how vague. Listen to your body.
Ovarian cancer symptoms every woman needs to know.
Symptoms
The symptoms occur vaguely months before the diagnosis of ovarian cancer.
- Abdominal bloating or distension
- Early satiety
- Fatigue
- Change in bowel habit (Constipation /Diarrhoea)
- Urinary symptoms
- Back pain
- Loss of weight
- Loss of appetite
- Dyspareunia
- Menstrual disorder
Prevention of Ovarian Cancer
- Maintaining parity (giving birth to babies)
- Breastfeeding
- Use of oral contraceptives
- Regular exercise
- Healthy dietary habits
- Cessation of smoking habits and tobacco use
- Tubal ligation
- Hysterectomy
- Bilateral oophorectomy
Treatment
Treatment of ovarian cancer includes surgical removal of the tumor optimal staging with exploratory laparotomy TAH + BSO with para aortic and pelvic lymph node dissection and omentum and systemic chemotherapy. Patients are usually administered six to eight cycles every 21 days. In some cases with advanced ovarian cancer (stage III-IV), treatment starts with preoperative (neoadjuvant) chemotherapy followed by surgery in whom radical removal is not possible or if a patient is not fit for surgery due to comorbidities. The same combination of drugs is used for three to six cycles with interval surgery followed by three to four cycles of postoperative systemic therapy is applied.
The prognosis of ovarian cancer is directly dependent on the disease stage at the time of diagnosis. The median survival of ovarian cancer is around 40 % to 50% at 10 years with stage related survival for stage 1 between 70% to 92% compared to stage IV being less than 6%.
Patient should be explained and counseled about the treatment options available, the recent ongoing clinical trials if pertinent to their particular case along with prognosis at the time of diagnosis depending on the stage of presentation. The palliative care team and other related consultants involvement should be sought timely to enable comprehensive care, anticipate the disease course and make a great impact on the quality of life of the patients. We are still in need of the development of effective strategies to diagnose ovarian cancer at an earlier and more curable stage.
Cancer is not a death sentence, but rather it is a life sentence; it pushes one to live.
Conclusion
In conclusion, ovarian cancer, often referred to as a silent killer, demands our attention and vigilance. Manisha Koirala’s triumphant journey exemplifies the importance of timely intervention and advanced treatments in ovarian cancer. It whispers its presence through subtle symptoms, urging us to listen to our bodies and seek medical attention at the slightest hint of discomfort. Not all ovarian cancer are the same, but the most common, Epithelial cell carcinoma are still it is a very lethal disease. There has been an improvement in the survival of patients with ovarian cancer as a result of better chemotherapy drugs. Genetic testing of all high risk patients should be performed. Performing prophylactic salpingectomies during a benign operative procedure is considered a reasonable course of action.
While ovarian cancer may not be a death sentence, it undeniably transforms into a life sentence, compelling individuals to live with resilience, courage, and a proactive approach to their health. With continued research, awareness, and a commitment to early detection, we can turn the tide against ovarian cancer, offering hope and empowerment to those who navigate this challenging path.
