– Dr. Preetam Jain, Medical Oncologist, Bhatia Hospital, Mumbai
Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries (cervical cancer is the most common). The majority of ovarian malignancies (95 percent) are epithelial; the remainder arises from other ovarian cell types (germ cell tumours, sex cord-stromal tumours.
- The average age at diagnosis is 63 years old. The age at diagnosis of ovarian cancer is younger among patients with hereditary ovarian cancer syndrome. The lifetime risk of developing ovarian cancer is 1.3 percent.
- Increased risk are:
– polycystic ovarian syndrome uses an intrauterine device
– cigarette smoking
*Decreased risks are:
– previous pregnancy
– history of breastfeeding
– oral contraceptives
– tubal ligation.
– BRCA1, BRCA2 Gene mutation
– Lynch syndrome
- Early stages: No symptoms or non-specific complaints that mimic other conditions
- Advanced stages: Most common presentation is stage 3.
- Abdomen distension/ pain/bloating
- Back pain or pelvic pain
- Loss of appetite
- Abnormal vagina discharge
- Fluid collection in the abdomen
- Weight loss
- Difficulty in breathing
- Clinical examination
- Sonography of abdomen
- CT scan of abdomen/pelvis and thorax is a sensitive test
- Biopsy of the ovarian masses or the peritoneum is confirmatory
- Ascitic fluid cytology
- Ca 125 levels are elevated in epithelial types
- AFP and Beta HCG are elevated in Germ Cell tumour
Screening: No screening method is proven effective and hence not recommended. Ca 125 levels is neither sensitive nor specific to cancer
- Early stages: Surgery is the treatment of choice and gives the best chance of cure.
Surgery is followed by ADJUVANT Chemotherapy that significantly provides a survival benefit.
- Advanced stage:
– It is the *Treatment of choice in advanced disease.
-it gives excellent results and prolongs the survival of the patient when taken under the supervision of a Medical Oncologist.
– In India, Medical oncologists with D.M. Degree are qualified superspecialists and well versed in Planning and management of Chemotherapy, Targeted Therapy, and Immunotherapy.
A combination of Carboplatin and paclitaxel is the choice of regimen. It is given every 21 days or weekly for 6 cycles.
– Chemotherapy shrinks the tumour in size, makes the patient symptom-free, can cause pathological remission, and therefore can convert the patient for cytoreductive surgery. Post-surgery, further adjuvant chemotherapy is given to eradicate the micrometastasis
– Chemotherapy combined with Targeted therapy like Bevacizumab can produce an excellent response with complete remission
– Maintenance treatment with Bevacizumab and Or PARP inhibitors in patients with excellent response
– Recent advances in medicine:
PARP inhibitors: Drugs like Olaparib, Niraparib, and Rucaparib are now used in both BRCA Positive and BRCA negative patients. They have produced excellent results with significant PFS benefits.
The risk of relapse is 60 to 85 percent.
Chemotherapy, Targeted therapy is the main line of treatment