OPINION: Ovarian cancer

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Study shows experimental screening test can detect endometrial and ovarian cancers. Picture: https://www.cancer.gov/news

Ovarian CA is the eighth most common occurring CA in women and the 18th most common type of CA overall (World Cancer Research Fund).

According to the American Cancer Society, one in 75 women will develop some form of ovarian cancer in their lifetime.

In women aged 35-74, ovarian cancer is the fifth leading cause of cancer related deaths (American Cancer Society). The incidence starts increasing in the 30s and peaks at the 70s Because of non-specific symptoms and lack of early detection tests, only 20 per cent of ovarian CA is detected early, i.e. stage I and II. Fiji happens to have the 8th highest rate of ovarian CA globally, 12.2 per 100,000 age-standardised rate (World Cancer Research Fund). Several factors may increase a woman’s risk for ovarian cancer, such as:

 Increased age;

 Close relatives with Ovarian CA, 5 per cent risk with 1, 25 per cent risk with 2;

 Genetic mutations with BRCA1 and BRCA2 genes, or one associated with Lynch syndrome;

 Nulliparity, early menarche, late menopause;

 Obesity, high fat diet, smoking;

 Endometriosis; and

 Breast, uterine or colorectal cancer. Histopathologically there are more than 30 different types of ovarian tumours. They are best classifi ed based on the type of cell from which they arise:

 Epithelial tumours, usually found in postmenopausal women, account for 70-75 per cent of ovarian tumours, and 90-95 per cent of ovarian malignancies;

 Germ cell tumours, usually affects young women in the late teens and early 20s, 15-20 per cent;  Sex cord-stromal tumours, more common in the 4th and 5th decade of life, 5-10 per cent; and

 Metastatic tumours which usually account for <5 per cent, usually arise from cancer of the breast, colon, stomach, endometrium and cervix. Ovarian CA can present with the following:

 Vaginal bleeding (especially in postmenopausal women) or abnormal vaginal discharge;

 Pressure or pain in the pelvic region;

 Abdominal and/or lower back pain;

 Bloatedness with early satiety;

 Increased urinary urge/frequency plus constipation;

 Abdominal swelling results from enlargement of the tumour;

 Upper abdominal metastases or ascites cause nausea, heartburn, bloating, weight loss and anorexia; and

 Shortness of breath is a symptom of patients with ascites or hydrothorax. Investigation modalities available to help diagnose Ovarian Cancer include:

 Serum tumour markers;

 CA125, elevated in about 80 per cent of epithelial ovarian tumours. Valuable as an early marker of disease recurrence, response to treatment;

 CA19-9, low sensitivity;

 CEA, elevated in about 60 per cent who have stage III disease;

 AFP and BHCG, useful in <30yrs of age to differentiate germ cell tumours;

 Ultrasound, transvaginal;

 Classic sonographic fi nding of a malignancy is a complex cyst, with both solid and cystic components, sometimes with septations and internal echogenicity;

 CT/MRI; and

 Useful preoperatively in advanced disease and assessment of retroperitoneal nodal involvement. Treatment options for ovarian cancer are dependent on the staging/spread of the disease. They include:

 Stage IA and IB (grade 1);

 Premenopausal women, undergo unilateral oophorectomy, follow up regular pelvic exams and CA125 is performed. Remaining ovary and uterus can be removed after child bearing age;

 For postmenopausal women, all must undergo TAH BSO;

 Stage IA and IB (grade two or three);  Undergo TAH and BSO followed by chemotherapy;

 Stage II, III and IV; and

 TAH and BSO with cytoreductive surgery followed by chemotherapy.

 

 DR RAYNEEL SINGH is a general practitioner at Oceania Hospitals Pte Ltd. The views expressd are the author’s and do not reflect the views of this newspaper

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