By Dr. Ranjana Dhanu
Ovarian cancer, though not as common in occurrence compared to the breast or cervical cancer, makes it a dreaded disease only because of the late detection. The incidence is highest in the 5th to 6th decade of life. But there are cases detected even at an early age of 35 years in women who have been smokers. The lack of specific symptoms makes it difficult to detect the disease in its early stages.
The breast may present with a palpable lump or cervical disease with abnormal or post-coital bleeding but the ovaries are like two small cashew nuts in a shopping bag and that’s in the abdomen. Now even if the ovaries increase to the size of 2 tomatoes or apples it doesn’t really cause gross symptoms because there is ample space that the surrounding structures provide and hence it is only when the disease spreads to the surrounding organs in an advanced stage that the symptoms get more obvious. The general symptoms of early disease in the ovaries are vague like abdominal bloating, feeling of fullness may or may not be frequent urination and these are symptoms that could be seen in benign disease of the bowel or ovaries as well.
There are few ways in which the ovarian cancer can be detected like – identifying high risk groups- women with a family history of ovarian disease, women with a previous history of breast disease, women who have been treated with fertility inducing drugs during the reproductive age.
The diagnostic tests for ovarian cancer can be classified into:
Clinical examination: Where a woman after 35 seeks an annual pelvic examination from her gynaecologist.
Imaging: With the advent of transvaginal sonography with a doppler the detection of ovarian disease in the early stages has been possible. In suspicious cases, the sonography is then followed up with an MRI (Magnetic Resonance Imaging) with a contrast which reveals the nature of a suspicious lesion in the ovary. Certain advanced imaging modalities like a Positron Emission Tomography (PET scan) are only used in cases of advanced disease.
The test Ca 125 by itself is not predictive of ovarian disease. If coupled with imaging modalities like Ultrasound and MRI can definitely add as an adjunct to arrive at a diagnosis. Genetic screening with BRCA 1 & 2 (Breast Cancer Gene Test) can be used to identify a woman at risk.
To conclude, every woman should seek an annual check-up which comprises a pelvic examination, an ultrasound abdominal and transvaginal (note if a woman is unmarried or not sexually active a pelvic ultrasound is equally good), also, tumour markers or an MRI in suspicious lesions detected on ultrasound. Remember early diagnosis can drastically influence the survival rate in ovarian malignancies.
About Dr. Ranjana Dhanu: Dr. Ranjana Dhanu, a laparoscopic and robotic surgery specialist, is currently practicing at well-known hospitals in Mumbai, including Hinduja Healthcare Surgical, Khar.