World Ovarian Cancer Day: Why you should not ignore bloating and dyspepsia?

Most symptoms associated with ovarian cancer are non-specific, like abdominal distension/bloating (46 per cent), dyspepsia & GI disturbances (35 per cent), and unspecific pelvic or abdominal pain in 20 per cent patients though these may also be caused by gastrointestinal, urologic or other conditions as well. Early diagnosis may be made on recognition of these symptoms, incidental radiological findings or on clinical examination done during wellness gynaecological health check-ups.

DID YOU KNOW?

* Ovarian cancer is the eighth most common cancer and also eighth most common cause of death from cancer in women worldwide.
* In India, ovarian cancer is the leading cause of death among gynaecological cancers and is the third most common cancer and fourth most common cause of death in women with a mean age-adjusted incidence and mortality rate of 6.7 and 4.8 per 100,000 women respectively (GLOBOCAN 2020)·
* In Western countries, the median age of diagnosis is 63 years, whereas in India, the median age of diagnosis has been reported to be < 50 years.
* Only 20 per cent of all ovarian cancer cases are diagnosed at the early stage and curable (five year survival rates 80-90 per cent) and nearly 80 per cent women are diagnosed in advanced stage (five year survival reported 40 per cent)
* The Pap test only screens cervical cancer and DOES NOT cover ovarian cancer.

RISK FACTORS

The risk of ovarian cancer increases with age, and is high around the time of menopause.
* A family history of ovarian cancer, colon cancer, stomach cancer, uterine cancer, prostate cancer, pre-menopausal breast cancer or a personal history of pre-menopausal breast cancer places women at a heightened risk of ovarian cancer.·
* BRCA gene mutation in self or any close family member.
* Endometriosis: Infertility and not bearing children are risk factors

RISK REDUCING FACTORS

* Oral contraceptive pills significantly reduce the risk when taken for five years
* Breastfeeding
* Removal of fallopian tubes (Female sterilisation)

CONSULT FOR THESE SYMPTOMS

* Persistent Bloating (swelling or feeling of fullness in the abdomen )
* Difficulty eating or feeling full quickly·
* Dyspepsia for more than 3 weeks
* Pelvic or abdominal pain· Abdominal distension
* Urinary symptoms: Urgency or frequency

Women who have these symptoms almost daily for more than a few weeks should see their doctor to consider ovarian cancer as the possible cause, although it most likely won’t be.

HOW IS OVARIAN CANCER DIAGNOSED

Confirmatory diagnosis of ovarian cancer is made on histopathology after the surgical excision of ovarian mass in the early stages of cancer. In advanced stages, diagnosis is made by cytological examination of ascitic fluid (fluid in the abdomen) for ovarian cancer cells or diseasedomental/peritoneal biopsy before commencement of treatment. Clinical examination, abdominal ultrasound, CT scan and MRI, PETCT aid in the assessment of the obvious spread of the disease and defining the treatment line. Tumour marker – CA125 levels in the blood also add to the information.

HOW IS OVARIAN CANCER TREATED?

The treatment of ovarian cancer is decided based on the existing standard guidelines in order to offer the best results. Usually surgery includes specialised procedures and is the mainstay of treatment for early stage disease, where fertility sparing surgery can be offered in selected cases. Surgery and chemotherapy are the cornerstones in the management of advanced ovarian cancer and the recent advancement of HIPEC (heated intraperitoneal chemotherapy) has added to survival. Recent additions of the targetted maintenance therapy offer survival benefits in these patients based on the status of BRCA mutation. Guidelines recommend such cases being best surgically managed by experienced gynae-oncologists for the best possible results in terms of survival and quality of life. Act in time. Unfortunately, there is no effective specific screening test for ovarian cancer. Therefore, women need to understand the risk and symptoms and take up check-ups as per the advice. If you have any of the aforementioned symptoms that are frequent, persistent or new to you, ask your doctor to consider ovarian cancer as a possible cause.