Introduction

Ovarian cancer, one of the most dangerous gynecological malignancies, is often diagnosed at advanced stages due to its subtle and inconclusive early symptoms. This late diagnosis complicates treatment and adversely affects survival rates.

Ovarian cancer is an abnormal growth in the ovaries. The disease can be classified into epithelial and non-epithelial malignancies, with epithelial tumors being the most common, accounting for about 95% of cases. Non-epithelial ovarian cancers, which include germ cell and stromal tumors, are less common.

Ovarian cancer is the third most common type of cancer among women in India and eighth overall globally. According to the Indian Council of Medical Research (ICMR), the age-adjusted incidence rate of ovarian cancer in India is estimated to be around 0.9 to 8.4 per 1,00,000 women. While 5-year survival from ovarian cancer is 94% when diagnosed in Stage I, only 15% of cases are diagnosed at this stage. Most (62%) of cases are diagnosed in Stages III and IV, when 5-year survival is only 28%.

Risk factors

According to IARC, risk factors include 

• Family history of ovarian cancer

• Presence of BRCA1/BRCA2 gene mutations

• Estrogen hormone replacement therapy (HRT)

• Tobacco smoking 

• Exposure to asbestos

• Perineal use of talc-based body powder 

• Prolonged use of hair dyes

• Frequent use of hair straighteners, relaxers, or pressing products that release formaldehyde gas - known carcinogen

• Exposure to X-radiation and gamma radiation

• Long estrogen window (early menarche and late menopause)

• Nulliparity and older age at first childbirth

• Obesity

• Infertility

• Endometriosis

• Sedentary lifestyle

• Alcohol consumption 

Symptoms 

Most patients exhibit nonspecific symptoms. While these symptoms are not definitive, it’s important to consult a gynecologist if they occur alongside certain risk factors.

• Symptoms of bloating, dyspepsia, nausea, changes in bowel habits (constipation or diarrhoea), early satiety, distension, abdominal or pelvic pain or discomfort, urinary frequency or urgency, constipation, dyspareunia 

• In premenopausal women, changes in the menstrual cycle pattern 

• Palpable pelvic or abdominal mass 

• Symptoms of intestinal obstruction

• Ascites / pleural effusion causing cough, breathlessness etc. 

Major investigation for the diagnosis

• Proper medical history and pelvic examination

• Transvaginal imaging, MRI, etc.

• Blood test for markers like CA125 

• Biopsy to confirm

Prevention 

• Use of oral contraceptives, dietary changes and lifestyle modifications

• Genetic testing for BRCA1 and BRCA2

• Prophylactic salpingooophorectomy after the completion of childbearing in high risk women, i.e., carriers of BRCA1/BRCA2 gene mutations

Treatment

Treatment depends on the stage of the cancer. It may be surgery, chemotherapy like targeted drug therapy etc. 

Reference:

Pubmed article.