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Ovarian Cancer
Ovary is important organ for harmone production and production of eggs (oocyte) in females.
Ovarian cancer is aggressive form of cancer in female, unfortunately involving young females. Most present in advanced stage.
What are symptoms of ovarian cancer?
Unfortunately symptoms are vary vague in ovarian cancer. High degree of suspicion is very important.
Gas trouble, bloating, fullness in abdomen, abdominal distension, loss of appetite are main symptoms. If any of them is persisting for more than 3 weeks, please consult oncologist
Some ovarian tumor secrete harmones which may cause masculisation or sometimes early puberty changes
How is ovarian carcinoma diagnosed?
If any of above symptoms, first step is sonography of abdomen pelvis. If free fluid present in abdomen, tapping of fluid under sonography guidance and checking for cytology is important.
CT scan of abdomen pelvis is first step for assessment of any ovarian mass.
Any enhancing/solid cystic mass to be taken as suspicious unless proved otherwise.
Sometimes diagnostic laparoscopy and biopsy is required to confirm If ovarian mass with no spread, operation to remove ovarian mass intact and check on table by frozen section pathological examination is done to confirm cancer CA 125 ,HE4 antigen are important tumor markers for cancer ovary, although not confirmatory. They are used in suspecting and mainly for follow up.
How do we treat ovarian cancer?
CT scan is very important for deciding treatment of ovarian cancer Treatment by oncosurgeon is most crucial as it affect cure. He/She will decide after assessing scan whether to operate upfront or give chemotherapy first to downstage disease. Possibility of complete removal is important in deciding further action.
What is surgery for ovarian cancer ?
Removal of ovarian mass with uterus, fallopian tubes, both ovaries (except very early stage), fat layer called omentum, peritoneal removal and all visible tumor need to be removed. If lymph nodes involved on scan, we need to remove pelvic and abdominal lymph nodes. Sometimes cytoreductive surgery is combined with hyperthermic intraperitoneal chemotherapy to optimize cure, although it is not necessary in all patient. Complete removal (100%) of all visible tumor is one of the most important factor for cure hence surgery by trained oncosurgeon is very very important.
What is role of chemotherapy?
All except stage 1a, tumor require chemotherapy 6 cycles in total. It is given as 6 cycles postsurgery or 3 cycles before and 3 cycles after surgery.
Recurrent tumor require palliative chemotherapy &/Targeted therapy.