Spotting it early

Key symptoms and appropriate diagnostic methods for early treatment of ovarian cancer

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One of the keys to early recovery for any disease is early diagnosis. However, ovarian cancer is known to be very hard to detect. Most women overlook the early signs of ovarian cancer due to the vague symptoms. Symptoms are often similar to those associated with common illnesses such as indigestion, fatigue, constipation and heartburn. Ovarian cancer is considered to be the sixth most common cause for cancer deaths among women. Most women with ovarian cancer are diagnosed at an advanced stage, reducing the chances of survival.

The number of ovarian cancer cases has shown an increasing trend in India in the last 20 years. There are no diagnostic screening tests for ovarian cancer. It is hard to detect the root cause of the disease, but identifying certain symptoms at the right time can help initiate the right treatment.

Symptoms

* Frequent abdominal bloating, pressure and pain

* Abnormal fullness after eating, or loss of appetite

* Frequent urge to urinate

* Fatigue and nausea

* Indigestion and constipation

* Severe back pain and heartburn

* Irregular menstrual cycles

When the symptoms seem to feel unusual or persistent, it is necessary to approach a gynaecologic oncologist, who will provide the right guidance to diagnose and treat ovarian cancer. Almost 70 per cent of women suffering from ovarian cancer are unaware of the disease until the last stage. If the cancer is detected at stage one, the five-year survival rate stands at 90 per cent.

Risk factors

* Family history of ovarian cancer

* Genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2

* A person with a history of breast, uterine or colon cancer

* Obesity

* The use of certain fertility drugs and hormone replacement therapies after menopause

* Women who have never been pregnant

The ovaries are situated deep within the abdominal cavity, which is why it is hard to feel or detect the disease unless the tumour swells up. Researchers and medical experts are making consistent efforts to find the right method to detect the cancer. Meanwhile, doctors use various techniques and mediums to get the right diagnosis.

Tests to confirm ovarian cancer

Pelvic test: A pelvic examination is usually the first step adopted by the doctor to evaluate the patients for known or suspected diagnosis of ovarian cancer. During a pelvic examination, the doctor manually examines the pelvic area and abdomen to check for nodules and bumps. This helps in early detection of ovarian tumours, however it is difficult to confirm without additional diagnostic tools.

Imaging tests: The role of imaging is to detect the disease, characterise it and know the extent of its spread to other tissues and organs. Tests such as CT scans or ultrasound show the internal picture of the pelvis to reveal mass present in the ovary that has turned malignant.

Ultrasound is the first imaging test suggested by the doctors to detect the problems in the ovaries. It is used to get a clear understanding and a better look at the growing solid mass (tumour) or fluid-filled cyst. This helps the doctor to identify whether the mass or the cysts in the pelvic area are worrisome.

Once the doctor identifies the tumour in the body, they recommend a CT scan to understand the stage of cancer. A CT scan is an X-ray that shows cross-sectional images of the body. This test is helpful in identifying the sites of the disease, finding lymph nodes and to note any signs of cancer spreading to other organs like the kidney or bladder.

Blood tests: The doctor recommends the patient to get CA-125 tests done. This test measures the amount of a protein called CA-125 that is found on the surface of the ovarian cancer cells. CA-125 levels are high in many women with ovarian cancer. If the count is higher than the standard, the doctor refers the patient to a gynaecologic oncologist for further observation.

Biopsy: When a doctor is uncertain about the diagnosis, a biopsy is done to confirm whether the tumour is cancerous or not. A small bit of the tumour is removed and used for further testing.

In rare cases, suspected ovarian cancer is biopsied during a laparoscopic procedure or with a needle placed directly into the tumour through the skin of the abdomen. This method is used when the doctor cannot perform the surgery because the cancer reaches the advanced stage or due to serious medical condition. Usually it is considered risky to perform a biopsy as it may spread the cancer.

The doctors also recommend alternative testing methods to plan for better treatment and confirm the stage of cancer. Based on the symptoms and severity of the situation, the doctor recommends the treatment.

Laparoscopy: This procedure requires a thin, lighted tube through which a doctor can look at the ovaries and other pelvic organs areas. The doctor inserts a tube through a small incision to examine the lower abdomen, which gives the detailed images of the pelvis or abdomen to a video monitor. Laparoscopy provides the internal view of the organs that helps the doctor to plan surgery or find an alternative treatment method. Also, this procedure allows a doctor to manipulate small instruments through the laparoscopic incision(s) to perform biopsies.

Colonoscopy: This method is used by the doctor to examine the patient’s large intestine or colon, if the patient raises a concern of frequent constipation or bleeding from the rectum. A long flexible tube with a camera is inserted into the rectum, allowing the doctor to view the entire internal colon area. This method helps in screening for colon and ovarian cancer and investigates the signs and symptoms of other intestinal problems.

Genetic counselling and tests

Patients who have a family history of ovarian cancer are recommended for genetic counselling. This counselling helps in deciding whether to get testing done for certain inherited gene changes, such as a mutation in the BRCA1 or BRCA2 gene. There are certain ovarian cancers which are linked to mutations in these or other genes. If a patient is found to have a gene mutation, it is likely that the patient may suffer from other types of cancer as well. This test may help in learning more about the possible cancer risks.

Treatment

Once the disease is diagnosed, there are certain treatment methods adopted by the doctor for a better recovery. Usually, treatment of ovarian cancer involves a combination of surgery and chemotherapy. If the patient is diagnosed with early stage cancer, wherein it has not spread beyond one or both ovaries, then the doctor operates and surgically removes the ovaries and fallopian tubes. This procedure leaves the uterus intact and helps women to conceive with the help of frozen embryos or eggs or with eggs from a donor.

If the patient is detected with an advanced stage of ovarian cancer, the doctor recommends chemotherapy followed by surgery to remove as much of the cancer as possible.

Chandrashekhar is consultant, obstetrics, gynaecology and gynaec oncology, BGS Gleneagles Global Hospitals, Bengaluru.

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