In this video, an overview of Ovarian cancer is elaborated under few important buckets – treatment, detection, management by Dr. Nikhil Parwate, consulting gynecology, onco-surgeon at Aditya Birla Hospital, Pune.
Whenever we talk about women everything is set around the uterus, but ovaries are the major reproductive organ in a woman’s body. It is ovaries that make a woman a woman. These are two small, around two to three centimeter tissues which are very adjacent to the uterus.
What are the types of ovarian cancer and how does it affects women?
Ovarian cancers are basically two different types of cancers presenting at two different ages.
- Epithelial ovarian cancer which generally is present in women who are above 40 years
- Germ cell ovarian cancers or tumors which are present in the younger generation generally after 10 years, 20 years and only 30 years.
Detection and treatment of ovarian cancer.
As far as prevention of, many things are put forth something like transvaginal ultrasonography in women above 45 years, ca-125 blood tumor marker tests at the age of 50 years are advised.
- History of ovarian cancer: When we look at the history of how ovarian cancer develops it seems it is correct that it is very difficult to prevent because we cannot predict that it only meets and we have hardly anything to predict it. And once you cannot predict, it is very difficult to then think of prevention. That’s the reason we do not have prevention in ovarian cancer.
- For Detection, very frankly speaking: ovarian cancer patients, of course, they never come to Gynec oncologists, they hardly even go to gynecologist because detection symptomatically, the symptoms are so varied right from pain in abdomen, lump in abdominal, mass in abdomen, vomiting, belching, retching, breathlessness, chest pain, constipation, etc are seen in patients.
- If the patients do not get relief in the beggining our basic investigation is being planned and the basic investigation which picks up this is ultrasonography of the abdomen and pelvis.
- The treatment includes your blood tumor marker test like ca-125 cea, ce19:9 for epithelial ovarian cancers and alpha-fetoprotein LDH that is lactate dehydrogenase and beta HCG for germ cell tumors. So next comes in these blood tumor markers: which probably gives you a faint suspicion for a possibility of cancer and then comes further tests like CT and MR to find out what is really happening with that mass in tumors. Thus, this is how the detection goes so the patient may be coming with a lot of belching, retching, vomiting and she goes to a family physician he gives her some medicine and when she does not get relieved, the pain increases when she’s referred to either gastroenterologist or a general surgeon. After this, they see and evaluate her.
The Treatment plan
The management plan shift towards an ovarian mass. Then this tumor marker test advises and once the tumor marker tests are elevated then probably a CT and MRI scans are advised and that is how a complete diagnosis of ovarian tumors or ovarian cancers are being made
Note: Not all ovarian cysts or ovarian masses are cancers they are non-cancerous also and in between cancer and non-cancer you have something called borderline ovarian tumors.
Whenever you talk of cancer you always obviously stage there stage one, two, three, four, similarly for ovarian cancers also we have the FIGO that is Federation International gyaenic obstetrics we have the figure staging for ovarian cancers and based on the stage we treat these patients as far as epithelial ovarian cancers are concerned which is generally seen in women post forty-five post fifty .
The early-stage cancers the stage one, two and maybe very early three, definitely can be treated by first surgery and later on by chemotherapy. Advanced cancer, generally requires chemotherapy first and then surgery. Radiation has no role in ovarian cancer.
Management Of Ovarian cancer: So ovarian cancers are primarily managed by surgery-chemo or chemo-surgery then chemo so that is how a majority of ovarian cancers that are the epithelial ovarian cancers are managed. Most of these epithelial ovarian cancers are seen in women above 50 years hence there is no need to ask the reproductive needs for a patient as most of them have the families complete. As against this germ cells, ovarian cancers which are generally seen in younger girls say 10 years,20 years, 30 years the management lines are completely different because here a 12 year old or a 13 year old or a fourteen-year-old girl comes with a germ cell comes with ovarian cancer.
The multidisciplinary approach where many times we involve even the IVF persons also if they’re able to freeze out those eggs prior to treatment. Many times if only surgery is done then even after surgery even after starting chemo you can freeze the egg. So all these things need to be spoken to the patients and then manage. For germ cell ovarian tumors there is no role of radiation it’s mostly the surgery and chemotherapy, the surgery, is fertility-sparing surgery which enables that particular young girl to meet her future reproductive needs and most of the treatment is planned accordingly and it is most of the times of a multidisciplinary approach.
What is the Crux of managing Ovarian cancer?
Any women above forty or forty-five years and especially those in menopausal age group who have been diagnosed to have an ovarian cyst which is about above 5 to 7 centimeters needs to be investigated keeping cancer in mind so the idea is you rule out that there is cancer or rule in there is cancer so any 5 to 7 centimeters cyst in a woman about 45 age should definitely be critically evaluated for cancer. It is important to disprove cancer in these patients. Similarly as far as the younger age group is concerned and you need to keep that threshold of around 7 to 8 centimeters, of course, most of them are definitely benign in younger age group but still that part that this could this be cancer should always come to a clinicians mind while you’re evaluating a cyst which is greater than 7 centimeters in this in these goals so this is the crux of managing ovarian cancers.
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