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Ovarian Cancer Treatment in India

Ovarian Cancer

Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries. The ovaries are two small glands, located on either side of your uterus. They produce female sex hormones and store and release eggs (ova).

Treatments for ovarian cancer are more successful when the cancer is found early. But most of the time, cancer has already spread by the time it is found.

Types of Ovarian Tumors

There are more than 30 different types of ovarian cancer which are classified according to the type of cell from which they start. Cancerous ovarian tumors can start from three common cell types:

  • Surface Epithelium – cells covering the lining of the ovaries
  • Germ Cells – cells that are destined to form eggs
  • Stromal Cells – Cells that release hormones and connect the different structures of the ovaries

Causes of Ovarian Cancer

Ovarian cancer is considered as one of the most common cancer among women. Some of its major causes include –

  • The usage of hormone replacement therapy for more than five years especially when only estrogen is used
  • Inherited gene mutation
  • Women who are 50 years or above
  • Obesity
  • Family history of breast cancer or ovarian cancer
  • Having never been pregnant
  • Having had cancer before such as colon, breast or uterine

Symptoms

In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian cancer include:

  • Frequent bloating.
  • Pain in your belly or pelvis.
  • Trouble eating, or feeling full quickly.
  • Urinary problems, such as an urgent need to urinate or urinating more often than usual.

Other symptoms that affect some women with ovarian cancer include:

Stages of Ovarian Cancer

Stage 1

Stage 1 ovarian cancer means the cancer is only in the ovaries. It is divided into 3 groups

  • Stage 1a – the cancer is completely inside one ovary
  • Stage 1b – the cancer is completely inside both ovaries
  • Stage 1c – as well as cancer in one or both ovaries, there is some cancer on the surface of an ovary or there are cancer cells in fluid taken from inside your abdomen during surgery or the ovary ruptures (bursts) before or during surgery

Stage 2

Stage 2 means the cancer has grown outside the ovary or ovaries and is growing within the area circled by your hip bones (the pelvis). There may also be cancer cells in the abdomen.  So stage 2 cancer can be

  • 2a – the cancer has grown into the fallopian tubes or the womb
  • 2b – the cancer has grown into other tissues in the pelvis, for example the bladder or rectum
  • 2c – the cancer has grown into other tissues in the pelvis and there are cancer cells in fluid taken from inside your abdomen

Stage 3

Stage 3 cancer of the ovary means the cancer has spread outside the area surrounded by your hip bones (the pelvis) into the abdominal cavity. Your cancer is also stage 3 if cancer is found in the lymph nodes in your upper abdomen (tummy), groin or behind the womb. So stage 3 cancer can be

  • 3a – using a microscope, cancer growths can be seen in tissue taken from the lining of the abdomen
  • 3b – there are visible tumour growths on the lining of the abdomen that are 2cm across or smaller
  • 3c – there are tumour growths larger than 2cm on the lining of the abdomen, or cancer in lymph nodes in the upper abdomen, groin or behind the womb, or both

Stage 4

Stage 4 ovarian cancer means the cancer has spread to other body organs some distance from the ovaries, such as the liver or lungs. But if ovarian cancer is only found on the surface of the liver and not within the liver itself, then the cancer is still stage 3.

Diagnosis of Ovarian Cancer

Some exams and tests that are done to look for or diagnose ovarian cancer include:

  • A biopsy, which is the only way to know for sure if a woman has ovarian cancer. This usually is done with a laparotomy, through a cut (incision) in the belly.
  • A physical exam, including a pelvic exam and Pap test. An ovarian lump may be felt during a pelvic exam. Arectovaginal exam may also be done to feel the pelvic organs.
  • Blood test: A cancer antigen 125 (CA-125) level, to measure a protein found on the surface of many ovarian cancer cells.
  • A pelvic and transvaginal ultrasound, to look for an ovarian lump.
  • A pelvic or abdominal CT scan or MRI, to check for the spread of cancer.
  • Exploratory Surgery : This surgery is performed for confirming the diagnosis of ovarian cancer.
  • Positron Emission Tomographic Scan (PET) : This test helps in defining those areas that altered blood supply and also helps in identifying cancer.
  • Magnetic Resonance Imaging (MRI): Magnetic energy is used for generating highly detailed images of the anatomy such as tumors.

Treatment of Ovarian Cancer

The main treatments for ovarian cancer are surgery and chemotherapy.

Almost all women with ovarian cancer will need surgery. The amount and type of surgery you have will depend on yourstage and type of cancer

For most women with stage 1 ovarian cancer, you will have surgery to remove your

  • Ovaries
  • Fallopian tubes
  • Womb (including the cervix)

Advanced ovarian cancer

Stage 2, 3 and 4 ovarian cancers are classed as advanced. This means the cancer has spread away from the ovary.

Surgery: Three types of surgeries are involved in treating ovarian cancer such as –

  • Laparoscopy: The use of this minimally invasive surgery depends on the extent of the cancer.
  • Frozen Section Tissue Analysis: The rapid analysis of the tissue is done under a microscope. The nature of the tumor is determined as whether it is cancerous or non-cancerous that also helps surgeons to perform a suitable procedure during the first surgery.
  • Laparotomy: This procedure is used by making a large abdominal incision. This incision is done for removing uterus, ovaries, Fallopian tubes surrounding lymph glands, omentum (a fold of fatty tissue) and tumor. Cytoreductive or debulking surgery is another name for this surgery.

Chemotherapy

After you have recovered from surgery, you will have chemotherapy. If the surgeon was able to remove all your cancer, the aim of chemotherapy is to reduce the risk of the cancer coming back. If the surgeon couldn’t take out all the cancer, then the aim of chemotherapy is to shrink the cancer that has been left behind. Some women may then have further surgery.

Biological therapy

For some advanced cancers, you may have a type of biological therapy called bevacizumab with chemotherapy.Bevacizumab targets a cancer cell protein called vascular endothelial growth factor (VEGF). This protein helps cancers to grow blood vessels, so they can get food and oxygen from the blood. All cancers need a blood supply to be able to survive and grow. Bevacizumab blocks this protein and stops the cancer from growing blood vessels, so it is starved and can’t grow