Bloating in the abdomen and feeling full quickly discomfort in the pelvic area or lower abdomen, abnormal menstrual cycles, gas and constipation are symptoms which any woman could ignore as something trivial. They may also be, but what most women do not know is that having these body changes continuously over a period of time could be indicative of something as serious as ovarian cancer.
Rarely detected in early stages, ovarian cancer is usually quite advanced when diagnosed. The reason – lack of awareness in patients and inattentiveness on the part of the doctor to the early indicators of the disease. This makes it not only difficult to treat but also potentially fatal.
The vagueness of the symptoms for this type of cancer had brought it the notorious distinction of being termed as a ‘silent killer’. It is one of the most common cancers among women and due to its detection in later stages in most cases, it also leads to fatalities. When knowledge can put an end to all fears, awareness about such a disease can actually empower women to overcome it courageously and be free from the dreaded illness.
Ovarian cancer
Ovarian cancer begins in the ovaries – the two female reproductive organs, one on each side of the uterus, that produce eggs. Each nearly the size of an almond, the ovaries also produce the hormones estrogen, progesterone and testosterone.
When abnormal cells grow uncontrollably in one or both the ovaries, ovarian cancer happens and it can spread to other parts of the body.
What to do if you have any worrying symptoms
• Don’t panic
• Don’t read random information on the Internet
• Make an appointment with your doctor
• Write down any persistent symptoms and tell them all to the doctor
• If in doubt, take a second opinion
Some indicators
The symptoms of ovarian cancer are often vague. Most of the times, patients as well as the doctors suspect other health conditions, delaying the diagnosis of cancer. By the time the cancer is detected, it has already spread outside the ovaries.
Many case studies have shown that some signs that could indicate ovarian cancer are bloating or swelling in the abdomen, feeling full quickly, pain or discomfort in the pelvic area or lower abdomen and heaviness in the pelvic.
Indicators that may also be present in other conditions include increased abdominal girth, abnormal menstrual cycles, persistent indigestion or gas, constipation, lack of appetite, nausea, vomiting, unexplained back pain, vaginal bleeding in between periods, unexplained weight gain or weight loss, increased frequency or urgency to urinate.
Though all these signs point to simply a possibility of ovarian cancer, they must still not be taken casually and especially when they last for a long period of time. The biggest sign of this disease could in fact be the worsening of the symptoms and their constancy.
Which tests diagnose ovarian cancer?
If you face any worrying symptoms, simply go to your doctor for a checkup. Firstly, a physical exam will be done by the doctor to check any abdominal or ovarian mass. In advanced ovarian cancer, a swollen belly area and fluid in the area could be revealed.
An ultrasound of the pelvis is also done to investigate the size, shape and configuration of the ovaries. Samples of tissues or an ovary are taken out with surgery for examination.
Imaging tests such as CT scan, MRI of the pelvis or abdomen and positron emission tomography (PET) are conducted to find the spread of the cancer - whether it is present in one or both ovaries, or spread to the uterus and fallopian tubes or beyond the pelvis or other organs outside the abdomen.
CA-125 blood test is also done in this type of cancer. CA-125 is a protein that is abnormally high in ovarian cancer cells and a blood test is done to specify the levels. As its level could be high due to non-cancerous reasons also, it is not a sure-shot test for ovarian cancer. It is generally used to monitor how the treatment is progressing.
Types of ovarian cancer
The type of ovarian cancer helps determine the prognosis of the illness. Epithelial tumours are the most common ovarian cancer type. These begin in the tissue that covers the outside of the ovaries. Younger women tend to have germ cell tumours that begin in the egg-producing cells.
Another type of ovarian cancer begins in the hormone-producing cells that hold the ovaries together and is called stromal tumours.
What if ovarian cancer is detected?
Cancer is a difficult disease – not only on the patient but also on the close ones. But a strong will power and family support can see one through the illness and the treatment. Women who have good emotional support from family and friends tend to have higher survival rates. Knowledge about the disease, treatment options and what to expect is important to understand what lies ahead and meet the challenges on the way headstrong.
Treatment
Early intervention and surgery by a skilled gynaecology oncologist can help control the cancer. If the cancer is diagnosed at a very early stage, surgery may involve removing one or both ovaries and fallopian tube. But an extensive surgery involving removal of the uterus (total hysterectomy), both ovaries and fallopian tube, a part of or complete omentum – the fatty layer that covers the abdomen area – and lymph nodes and other tissues in the pelvis and abdomen is done when the cancer has reached advanced stages. If cancer is present at the time of biopsies itself, the surgeon will remove as much of the cancer as possible immediately.
Chemotherapy is required post-surgery to kill any remaining cancer cells. Radiation treatment that uses high-energy X-rays to kill cancer cells is rarely used for this type of cancer.
Be alert even after treatment
Sometimes ovarian cancer can relapse also and in such a case second-line treatment of chemotherapy is given. An ovarian cancer survivor must get a physical exam done every 2-4 months for the first two years after treatment. After that such a checkup should be done every six months for three years, followed by an annual assessment. CA-125 test should be conducted at each visit if the levels were initially high.
Who is at risk of ovarian cancer?
The causes of ovarian cancer are unknown but there are some factors that can increase the risk of this cancer in a woman, though the presence of any of these does not definitely mean that ovarian cancer will happen.
Inherited gene mutations in breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) cause ovarian cancer in some women. Never being pregnant, never having taken the contraceptive pill, early start of menstruation and late menopause can increase the risk of ovarian cancer. Those with a personal history of breast cancer or a family history of either breast or ovarian cancer have an increased risk of ovarian cancer.
The threat of the disease increases with age, mostly after menopause, though it can occur to women of any age.
But certain factors give some protection from the disease. Women who have more children and give birth earlier in life than others have a lower risk of this type of cancer. This is because a link has been found between the total number of ovulations during a woman’s life and the risk of ovarian cancer.
Studies have shown that women who take birth control pills for a longer period of time reduce their risk of ovarian cancer, though that does not mean one starts popping them as they could have side effects.
Regular pelvic examinations are a must for women over the age of 40. Genetic testing is recommended for those who have a family history of ovarian cancer or a personal history of breast cancer. Those who present with the initial symptoms are also advised such a testing.
Research is ongoing to find ways to detect this type of cancer early so that it can be cured, but till then it is imperative for patients as well as doctors to be alert about the various signs associated with the disease. Aware women and vigilant doctors can nip the disease in the bud, and reduce the mortality rates of the dreaded illness.
Any woman who has the possible symptoms of ovarian cancer must visit an experienced gynaecologist as soon as possible for a checkup and advice. Winning the battle against cancer just requires care for your body and understanding about the disease.
Dr Rupinder Sekhon is senior. consultant, Gynae Oncology, Rajiv Gandhi Cancer Institute (RGCI).