|Women in their 60s and 70s most prone to ovarian cancer|
There are several factors that determine a person’s chance of developing ovarian cancer. The more children a woman has and the earlier in life she gives birth, the lower her risk of getting ovarian cancer. Certain gene defects are responsible for a small number of ovarian cancer cases. Women with a personal or family history of breast cancer or ovarian cancer are at a higher risk. But the highest risk is faced by women in their 60s or 70s.
Ovarian cancer symptoms are often vague and by the time the cancer is diagnosed, the tumour would have spread beyond the ovaries. Like most other cancers, ovarian cancer is also categorised into four stages depending on the extent to which the cancer has spread beyond the ovaries. In the first stage, the cancer is confined to the ovaries with >90 per cent chance of a complete cure. In the second stage, the cancer spreads to the surrounding pelvic organs and in the third stage it reaches the abdomen. In the fourth stage, the cancer spreads outside the abdomen, mostly into the lungs. The chances of a cure in the third and the fourth stage is about 25 per cent. However, most of these patients can expect prolongation of life span with optimal treatment.
1. Surgery is used to treat all stages of ovarian cancer. For early stage cancer, it may be the only treatment. Surgery involves:
Removal of the uterus (total hysterectomy).
Removal of both ovaries and fallopain tubes (bilateral salpin-go-oophorectomy).
Partial or complete removal of the momentum, the fatty layer apron that covers and guards the abdominal viscera.
Biopsy or removal of the pelvic and aortic lymph nodes which are affected especially in the advanced stages.
Excision of all or most of the cancer deposits within the abdomen and pelvis as much as safely possible.
Surgery performed by a specialist in female reproductive cancer (gynaecologic oncologist) will result in a higher success rate as precise and safe excision and removal of the cancer deposits from the various abdominal viscera requires special skill and training.
2. Chemotherapy is used after surgery to treat the remaining diseased cells. It is usually given as a combination of two drugs (Paclitaxel and Carboplatin) once every three weeks for six times. It is extremely important to follow proper chemotherapy schedule. Haphazard timings and dosage of chemotherapy may result in the cancer becoming resistant to further treatment.
Chemotherapy may be given into the veins, or sometimes directly into the abdominal cavity (intraperitoneal). It can also be administered if the cancer comes back (recurrent cancer).
3. Targeted therapy recently, a drug which inhibits the growth of the abnormal blood vessels which provide nourishment to the cancer cells has been approved. This drug mainly targets and inhibits the growth of cancer cells. It is given along with chemotherapy.
4. Radiation therapy is rarely used in ovarian cancer.
Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made (Stage III or IV). With the current surgical techniques and advances in chemotherapy, the overall average survival in the advanced stages is approximately 45-50 months.
Dr. U.D. Bafna, MD, is Prof. and Head Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, Bengaluru.