Ovarian Cancer

Ovarian cancer involves abnormal cell growth within the ovary and surrounding tissues
Ovarian cancer can be one of three types:
Epithelial– which can involve either one or both ovaries, where cancer cells grow on the outside of the ovary.

In some occasions, the cancer will be growing along the lining of the abdomen (peritoneal lining).
This type of ovarian cancer is the most common, accounting for approximately 90% of ovarian cancers.

Germ cell – involves the cells that produce the eggs, and account for approximately 4% of all ovarian cancers.
Stromal tumour – involves the tissues that support the ovary in producing oestrogen and progesterone hormones.

Advanced age is a risk factor for development of epithelial ovarian cancer
Lifestyle related risk factors include smoking, obesity and alcohol intake.
Hormone replacement therapy and infertility treatment are associated with risk of developing ovarian cancer

Family history of ovarian cancer is also a risk factor for developing ovarian cancer

The ovarian cancer symptoms include:

Due to vague localizing symptoms, almost 60% of patients present with advanced (Stage III or IV) disease

Basic blood investigations including Tumour markers (CA 125)
USG abdomen /CECT abdomen after a clinical, abdominal and per vaginal examination.
MRI abdomen or PET CT might be necessary in specific cases.
A few patients present with ascites and adnexal mass. Ascitic fluid analysis for malignant cells is done before starting chemotherapy

The main ovarian cancer treatment options include:

Surgery – Most ovarian cancers can be treated by surgery. The extent of surgery required usually depends on how far cancer has spread and also on the general health of the patient. The main goal of the surgery is to remove the cancer completely from the body.

Advanced cancers with peritoneal spread may benefit from CRS+ HIPEC

Chemotherapy – When the cancer is advanced, the patient must undergo Chemotherapy. It is a systematic treatment in which the drugs are given in a way that they reach all parts of the body.
Hormone Therapy – Hormone-blocking drugs are used to fight cancer in Hormone Therapy. This treatment option is helpful in treating ovarian stromal tumours.
Targeted Therapy – Relatively a new treatment type, targeted therapy uses drugs that directly attack the cancer cells while causing less harm to the normal cells.

All treatment options for ovarian cancer including

Laparoscopic staging for ovarian cancer
Open staging laparotomy + omentectomy + bilateral pelvic / para aortic lymphadenectomy
Cytoreductive surgery + Hyperthermic Intra peritoneal Chemotherapy for advanced Ovarian cancers with peritoneal metastasis
Fertility preserving surgeries/ chemotherapy whenever feasible for Borderline ovarian Tumours/ germ cell tumours
Laparoscopic ovarian cyst excision
Chemotherapy for advanced cancers for down staging
Chemotherapy based on cancer stage
Targeted therapy / molecular therapy for advanced cancer