Ovarian cancer cases seeing rising trend, say experts – ET HealthWorld

By Rashmi Mabiyan and Abhishek Bhatia

New Delhi: Often dubbed the silent killer for its vague and confusing symptoms with other conditions, ovarian cancer is the most common cause of death from gynaecological cancers. The disease presents itself with several challenges for making early detection possible. Even though ovarian cancer is less common than other malignancies, research has shown that by 2040, both the prevalence of the disease and its fatality rate will increase dramatically.

On the occasion of World Ovarian Cancer Day, ETHealthworld spoke with medical specialists elucidated on the most critical aspects of the disease and its impact on women’s health. Experts touched upon newer innovations and advocated for better care. Also highlighted that patients have to undergo several confrontations, including the non-specific, vague symptoms, the lack of confirmatory tests, and the rarity of cancer, which makes the disease lethal and life-threatening if it reaches an advanced stage.

Ovarian cancer is the eighth most common cancer in women worldwide; as per estimates, approximately 295,000 new cases were diagnosed globally in 2020. The prognosis for ovarian cancer varies depending on the stage at diagnosis. Experts suggest early-stage detection of the disease has a higher chance of successful treatment and long-term survival, while advanced-stage ovarian cancer is more difficult to treat and has a lower survival rate.

Speaking about the rising trend in women diagnosed with ovarian cancer globally, Dr Mandeep Singh Malhotra, Director- Surgical Oncology, CK Birla Hospital, Delhi, expressed that the primary reason is the lack of awareness about the disease among women. Women often don’t come forward to seek medical attention until the disease has progressed to an advanced stage. Additionally, there is a lack of effective screening programmes for ovarian cancer, which makes early detection difficult.

“There is a rising trend in ovarian cancer due to the changing lifestyle patterns in India. This includes a sedentary lifestyle, increased consumption of processed foods, and exposure to environmental toxins. These factors have been linked to an increased risk of ovarian cancer. It is speculated that around 1/4th of ovarian cancer in India is hereditary in nature due to mutations in the BRCA1 and BRCA2 genes. The genomic mutation complex is known as HBOC (hereditary breast ovarian complex),” Dr Malhotra added.

Women carrying these mutations have around an 80 per cent lifetime risk of getting breast cancer and a 45 per cent lifetime risk of ovarian cancer. According to a recent study done on 1,000 women from 39 countries, the number of women being diagnosed with it is likely to increase to 3,71,000 new cases per year by 2035.

Explaining how obesity can increase ovarian cancer risk, Dr Duru Shah, Scientific Director, Gynaecworld, said, “Obesity leads to anovulatory cycles and also contributes to the derangement of insulin levels. Consumption of processed foodstuffs, red meat, and unhealthy eating habits contribute to further DNA damage.”

Adding to it, Dr Shah underlined that smoking is also an important risk factor that exerts a direct carcinogenic effect on the ovarian follicular cells. According to a study, women who have ever smoked had a six per cent higher chance of having ovarian cancer compared to women who have never smoked.

Why is it called a whisper disease?

The symptoms at the early stage of disease are often vague and can be mistaken for other conditions, resulting in a delayed diagnosis. “The disease presents with raw-value symptoms like abdominal pain, decreased appetite, hyperacidity, and urinary frequency in digestion, which come and go before it becomes troublesome enough for the patient to seek medical help,” remarked Dr Kalpana Kothari, Chief – Gynaec Oncology, Consultant- Robotic Surgery, and HIPEC Surgeon, HCG Cancer Centre, Ahmedabad.

Another challenge in the diagnosis of ovarian cancer is the lack of effective screening methods. There is no routine screening test for ovarian cancer, which makes it difficult to detect the disease in its early stages. The most common screening method for ovarian cancer is a pelvic exam, but doctors do not consider it reliable enough for detecting early-stage ovarian cancer.

Dr Malhotra highlighted that nowadays, for high-risk women, especially those with a family history or previous history of breast, pancreatic, or peritoneal cancers, doctors recommend a half-yearly or yearly trans-vaginal ultrasound with assessment Serum CA 125; a tumour marker for detecting ovarian cancer at an early stage. Women proven to have mutated BRCA genes are suggested to undergo risk-reducing or prophylactic salpingo-oophorectomy when nearing menopause or after menopause. The risk-reducing surgery reduces the risk of death from ovarian cancer by 95 per cent.

Preferred diagnostic methodology for ovarian cancer

Screening for OC has always been very preliminary. Most women are never screened, especially in low socio-economic countries, said Dr Shah, adding that “In spite of the available tests, a confirmatory diagnosis can be difficult due to the many false-positive cases and decreased sensitivity of these tests. Moreover, only a few tumours reach a sonographically detectable size before they start to spread; hence, annual screening may fail to detect them.”

Experts talked about how various methods can be combined to facilitate the detection and effective diagnosis of ovarian cancer, including ultrasonography (TVS) and color Doppler of the pelvis, followed by an MRI or CT scan, and genetic blood tests (screening for BRCA 1 and 2) to determine the presence of genes that increase the risk of ovarian cancer. This can be done if you have a strong family history of ovarian, breast, or uterine cancer. In advanced cases, especially in patients with ascites, an ascitic fluid cytology along CA-125 levels can be used to confirm the diagnosis of ovarian cancer. Blood tests like CA-125, coupled with the recent HER-4 marker, can help conclude a diagnosis.

“Many algorithms have been developed to evaluate the risk of malignancy, but their diagnosis efficacy needs further improvement. The recent development of newer cancer biomarkers, advances in imaging technologies, and genetic-based diagnostic approaches seem very promising in the near future,” suggests Dr Shah.

Efficacy & availability of treatment options for ovarian cancer

Underscoring that treatment options available for ovarian cancer give the best results if diagnosed at an early stage, Dr Kothari said, “However, today, even in advanced and recurrent diseases, extensive surgery in the form of CRS means completely removing all complicated visible tumours from the abdomen by HIPEC wherever feasible. Targeted and immunotherapy can also help in advanced disease.”

The stage at which these treatments are most effective depends on the extent and location of the cancer, said Dr Malhotra, adding that, “Surgery is most effective in early-stage ovarian cancer when the cancer is confined to the ovary. Chemotherapy is most effective in advanced-stage ovarian cancer when the cancer has spread beyond the ovary.”

Doctors use surgery as a first-line treatment as it involves the removal of the tumour and surrounding tissue. Chemotherapy is used after surgery to destroy any remaining cancer cells. Radiation therapy may be used in some cases, but it is not as commonly used for ovarian cancer.

“It is important to ensure the sensitivity of the drug before administration to ensure the optimisation of the treatment protocol. A type of regional chemotherapy in OC is called intraperitoneal chemotherapy, wherein the drugs are directly injected into the peritoneal cavity (space containing abdominal organs). Removal of cancerous tissue via surgery followed by chemotherapy is the most ideal cure for ovarian cancer,” said Dr Shah.

Signs to look for in ovarian cancer

Apart from the risk factors for ovarian cancer such as age, family history, a personal history of breast cancer, tobacco consumption, and certain genetic mutations, the symptoms are usually classified as vague and confusing. The signs and symptoms of ovarian cancer include bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms such as urgency or frequency, making it difficult to diagnose.

There are some India-specific findings related to ovarian cancer as well, suggests Dr Kothari, referring to studies that have found that women in India tend to develop ovarian cancer at a younger age compared to women in Western countries. “Additionally, some studies suggest that certain genetic mutations that are more common in the Indian population may be associated with a higher risk of ovarian cancer,” she added.

Studies have shown that symptoms in women with ovarian cancer are more severe and occur 20–30 times per month than in women with non-malignant ovarian tumours. Back pain, prolonged abdominal or pelvic pain, and menopausal bleeding are the most typical symptoms. Early detection of ovarian cancer is not a choice but a necessity for survival.

  • Published On May 8, 2023 at 08:38 PM IST

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