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Ovarian Cancer Treatment

Ovarian Cancer Surgery Treatment in India

Ovarian Cancer Treatment

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Cancer of the Ovary, a female reproductive gland, is referred to as an Ovarian cancer. The seventh most common cancer in the women worldwide. Ovaries are two almond shaped organs present on either side of the uterus or womb. They are located deep in the abdominal cavity. 

Q1 How is Ovarian Cancer diagnosed?

 

A1 Ovarian cancer diagnosis is easily missed during its early stages due to absence of acute or aggressive symptoms. On the contrary the symptoms are usually vague. Careful attention may lead to its early detection, hence timely and successful treatment resulting in better survival rate. The following tests are often done as screening tests for detecting Ovarian Cancer in women, especially women at high risk of developing ovarian cancer.

  • Pelvic Examination: Enlarged and/or tender ovary/ies can be felt through this examination done by your doctor. 

  • TVUS, Transvaginal Ultrasonography: A type of ultrasound in which a small instrument is inserted through vagina.

  • CA-125: A simple blood test that measure the level of a protein, CA-125, released by the ovarian cancer cells. If the test result indicates high level of CA-125 protein, it points to the possible presence of ovarian cancer.

​None of the above tests is a reliable marker for the detection of ovarian cancer, yet they are done. Research is going on to come up with a reliable screening test for ovarian cancer, however, not much success is achieved until now.

 

Q2 Is PAP test useful in the diagnosis of Ovarian Cancer?

 

A2 No.

PAP test is for early detection of cervical cancer, not ovarian cancer. On rare occasions, ovarian cancer in its advanced stages may  be detected through PAP test.

 

Q3 What are the symptoms of an Ovarian Cancer?

 

A3 Although in initial stages there are no noticeable symptoms, so most of the time the cancer goes undetected. However, when the symptoms develop or are noticed in relatively advanced stages, they are usually vague which are not specific to just ovarian cancer but may be found in other illnesses as well.

The symptoms can be summarized as the following:

  • Excruciating pain in the pelvis or abdomen

  • Abdominal swelling or bloating due to presence of a mass or accumulation of fluid.

  • Excessive fatigue

  • Lower Back pain

  • Change in the bowel habits

  • Pain during sex(Dyspareunia)

  • Changes in the menstrual cycle

  • Indigestion

  • Trouble eating or feeling full too early

  • Urinary symptoms such as increased frequency or urgency

When the symptoms draws your or your doctor 's attention towards the possibility of existence of ovarian cancer, the disease has spread too far. Sometimes, cancer spreads very quickly to affect the surface of the neighbouring organs. Careful attention paid to the symtoms may lead to timely detection of the ovarian cancer, its successful treatment and hence better survival rate for the patient.

 

Q4 When to see a doctor?

 

A4  When the above symptoms persist for more than two weeks inspite of usual interventions such as diet changes, laxatives, exercise, rest. It is highly recommended that the woman must go and see her Gynecologist and in case cancer is suspected, then she must take the consultation of Gynecologic Oncologist for further course of action.

 

Q5 Who is Gynecologic Oncologist?

 

A5 The Gynecologist who further specializes in the medical field of Oncology(study of cancer). They deal with the diagnosis and treatment of the cancer affecting the organs of the reproductive system in the women. 

 

Q6 What are the risk factors that increase the likelihood of ovarian cancer?

 

A6 Risk factors that make a woman more vulnerable to the development of Ovarian cancer are the following:

  • Older age: The older a woman, the more chances of her developing ovarian cancer. Although ovarian cancer can occur at any age. However, its likelihood increases with increasing age, more common in women between 50 to 60 yrs of age.

  • Inheritance of mutated genes: BRCA1 and BRCA2 are the genes that are associated with ovarian cancer and breast cancer. These genes are inherited from parents.

  • Family history of ovarian cancer

  • Early menarche and late meopause increase the likelihood of ovarian cancer

  • HRT, Hormone replacement therapy with estrogen for prolonged period and that too in large doses.

Q7 What are the different types of Ovarian cancer?

 

A7 Ovarian cancer is mainly of three types based on the type of ovarian cell it affects. They are:

  • Epithelial tumors: The most common type. Constitutes nearly 90% of all ovarian cancers. 

  • Stromal Tumor: Affect hormone producing ovarian cells. Constitutes a small percentage of ovarian cancer. Generally, they are diagnosed earlier than other types of ovarian cancers.

  • Germ cell tumor: Rarest type. Affect ovum producing ovarian cells. Usually younger women are affected.

Q8 What is the treatment for Ovarian Cancer?

 

A8 There are different treatment modalities that are used either alone or in combination, concurrently or one after the other in order to treat the ovarian cancer effectively. Your team of specialists will determine the best treatment protocol for you depending upon your general health, type of ovarian cancer and its stage.

 

The treatment modalities fall into the following categories:

 

  • Surgery: Surgery is the mainstay of treatment for most of the ovarian cancers. Type and extent of surgery depends upon the stage of the ovarian cancer and general condition of the patient. The goal of the surgery is to stage the cancer and debulk it.i.e., to remove it as much as possible.

  • Radiation therapy: Radiation therapy utilizes high energy X rays to kill cancer cells. It can be given from the radiation source placed outside the body(External Beam Radiation therapy) or the radioactive source placed inside the body near the cancer area(Internal Radiation;Brachytherapy).

  • Chemotherapy: When drugs or medicines are used to kill cancer cells. Drugs get into the bloodstream and reach nearly entire body. Therefore, it is often referred to as a systemic treatment, contrary to local treatment that includes surgery and radiation therapy. The goal of chemotherapy is to kill the cancer cells that have remained even after the surgery, to treat the cancer that has spread or technically metastasized and often to reduce or shrink the size of a large tumor so that it becomes convenient to get rid of the cancer through surgery, as now the tumor has shrunk. The drugs may be given either through vein(Intravenous injection) or administered orally (by mouth). When the drug is administered with the help of a thin catheter directly into the abdominal cavity, this type of drug administration is called Intraperitoneal Chemotherapy.

  • Hormonal Therapy: This therapy involves use of hormones or hormone blocking drugs to treat ovarian cancer. It is usually given in case of stromal ovarian tumors.

  • Targeted Therapy: This type of therapy ensures that the normal tissue is protected in the best way possible. It identifies and target only cancer cells. It utilizes various drugs or other chemicals that make it unfavorable for cancer cells to survive or grow. They all work in different ways to target cancer cells.

 

Q9 What does surgery for ovarian cancer involve?

 

A9 Surgery for ovarian cancer has two goals to meet. Firstly, to stage the ovarian cancer which means to see how far the cancer has spread beyond ovary so that the ovarian cancer can be treated most effectively according to the findings. Secondly, debulking the tumor, which means to remove the tumor as much as possible.

 

Uterus is removed(Hysterectomy), along with both ovaries and fallopian tubes(Bilateral Salpingo Oophorectomy) and omentum(Omentectomy) is also removed. Omentum is a layer of tissue enveloping the abdominal organs, sometimes it is also affected by the cancer and therefore it is also removed as part of the surgery.

 

Lymph nodes biopsy is done to see for the spread of the ovarian cancer. Pelvic and abdominal lyph nodes are biopsied. In case of fluid collection in the abdominal cavity, it is also sent for lab testing. In nutshell, the tissues and fluid are sent for lab testing to stage the cancer. It is a mandatory part of the surgery as it will help the surgeon decide the best course of treatment for better clinical outcome or prognosis as different stages of ovarian cancer call for different treatment.

 

Next goal of the surgery, debulking, ensures that there is no visible cancer or tumor beyond 1 cm. Debulking may encompass removal of other affected organs as well which may be colon, small intestine etc.

 

Talk to your specialist and actively participate in your treatment plan and achieve the best possible and timely treatment.

 

Q10 How is ovarian cancer staging done?

 

A10 Ovarian cancer staging is done based on three components or factors referred to as TNM staging system

where

T denotes size of the tumor, its spread beyond ovary to nearby pelvic organs such as uterus, fallopian tubes

N denotes if the regional lymph nodes have been affected

M stands for metastasis, spread of the cancer to the distant sites.

 

These three components or factors of the staging system reveal a lot of infomation about the extent or spread of the ovarian cancer. 

Stage 1

 

The cancer is confined to ovary. No spread to the lymph nodes or distant sites(metastasis).

 

Stage 1a

 

The cancer is confined to the inside of one ovary. Surface of the ovary is not affected. No spread to the lymph nodes or distant sites(metastasis).  No cancer cells are detected in the fluid or washings from the abdomen/pelvis.

 

Stage 1b

 

Both ovaries have cancer. Their outer surface is not affected. Surface of the ovary is not affected. No spread to the lymph nodes or distant sites(metastasis).  No cancer cells are detected in the fluid or washings from the abdomen/pelvis.

 

Stage 1c

 

The cancer is present in either or both the ovaries along with any one of the following:

 

  • The capsule or tissue covering surrounding the tumor broke and the cancer cells spread into the abdomen or pelvis.

  • Cancer present on the surface of one/both ovaries

  • Cancer cells found in the fluid or washings from the abdomen or pelvis.

 

No spread to the lymph nodes or distant sites(metastasis).

 

Stage 2

The cancer is present in one/both ovaries and has spread to other pelvic organs such as uterus, bladder,sigmoid colon or rectum.

 

No spread to the lymph nodes or distant sites(metastasis).

 

Stage 2a

 

The cancer has spread on the surface or inside of uterus or fallopian tubes.

No spread to the lymph nodes or distant sites(metastasis).

 

Stage 2b

 

The cancer has spread on the surface or inside of surrounding pelvic organs such as rectum,sigmoid colon or bladder.

No spread to the lymph nodes or distant sites(metastasis).

 

Stage 3a1

Cancer in one/both ovaries. Spread to surrounding pelvic organs. Pelvic lymph nodes are affected but the cancer has not yet spread to distant sites.

 

Stage 3a2

 

Cancer in one/both ovaries. Spread to organs outside pelvis. At the time of surgery, no cancer can be seen by the naked eye. However, when examined in the lab cancer can be detected in the abdominal lining. Cancer may or may not have affected pelvic/paraaortic lymph nodes. Cancer has not yet spread to distant sites.

 

Stage 3b

 

Cancer in one/both ovaries. Spread to organs outside pelvis. At the time of surgery, cancer can be seen by the naked eye but it is not beyond 2 cms in size. Cancer may or may not have affected pelvic/paraaortic lymph nodes. Cancer has not yet spread to distant sites or liver/spleen.

 

Stage 3c

 

Cancer in one/both ovaries. Spread to organs outside pelvis. At the time of surgery, cancer seen is beyond 2 cms in size and may affect outside covering of the liver/spleen. Cancer may or may not have affected pelvic/paraaortic lymph nodes. Cancer has not yet spread to distant sites or inside of liver/spleen.

 

Stage 4a

 

Cancer cells are found in the fluid surrounding lungs. No cancer spread to other organs or lmph nodes beyond that of pelvis.

 

Stage 4b

 

The cancer has spread to all the organs such as inside of liver and spleen; organs beyond peritoneal or abdominal cavity such as lungs or bones and lypmh nodes outside pelvis.

 

 

Benefits of Ovary Cancer Treatment in India

 

  • Team approach- Holistic approach is taken with multidisciplinary team of specialists contributing their expertise right from the screening,diagnosis,treatment and follow up.

  • Most affordable cost coupled with high quality treatment.

  • World class hospitals with state of the art infrastructure.

  • Most advanced diagnostic and treatment methods are employed for optimal results.

  • Globally trained doctors with decades of experience in carrying out the surgery with competence and ease.

  • Great ambience

  • Compassionate staff to look after

  • Hospitals accredited with international organizations such as JCI(Joint commission International) for quality standards.

  • Language no barrier. English speaking people and if required, translators are available for your convenience

  • Most economical accommodation available at a walking distance from the hospital. Wide range of options starting from guest house, service appartments to five star hotels, best suited to your budget and choice.

  • Good flight connectivity

  • India has a diverse and rich cultural heritage. You can witness its beauty and uniqueness. It offers most conducive environment for recuperation.

Dr Sabhyata Gupta

MBBS,MD(Gynaecology)

Trainings:

  • Robotic Gynaecological surgery training ( France)

  • Observership training programme in Uro-gynaecological Oncology at Tata Memorial Cancer Hospital, Mumbai, India

  • Diploma-Gynaecological Endoscopic Surgery University Hospitals Schieswig–Holstein, Kiel (Germany) 

  • Indo German Training Course in “Advanced Endoscopic Surgery in Gynecology at Giessen School of Endoscopic Surgery (Germany)

Director, Department of Gynaecology and Gynaec-Oncology

Medanta The Medicity, Gurgaon, Delhi-NCR

 

Dr Kanika Batra Modi

MBBS, DNB,MS

Fellowship Gynecology Oncology

Fellowship(IGCS) Gynecology Oncology,Royal Hospital for Women, Sydney, Australia

Associate Consultant

Max Super Speciality Hospital, Delhi

 

Dr Kanika Gupta

MBBS, MS(Obstetrics& Gynecology)

Fellowship in Gynae cancer surgeries, Royal Hospital for Women, Sydney, Australia

Principal Consultant

Max Super Speciality Hospital, Delhi

Dr Sarika Gupta

MBBS, MD(Gynae & Obs)

Clinical Fellowship in Gynae oncology, USA

Indraprastha Apollo Hospital, Delhi

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