Ovarian Cancer

Our specialists use multiple testing methods for the detection and diagnosis of ovarian cancers. From simpler blood tests to advanced imaging tests such as PET/CT scans are employed to arrive at an accurate diagnosis. Personalised treatment plans are devised based on the diagnostic information available.

a. Physical Examination: During the physical examination, the doctor enquires on the patient’s health condition, medical history and other aspects to determine the possible risk factors. Patients may also be asked about the symptoms that they have been experiencing. The doctor may also likely conduct a pelvic examination to look for signs of enlarged ovary or fluid in the abdomen (ascites).

b. Blood test (CA125): A blood test may be performed to look for a biomarker called CA125 in the blood. High CA125 levels in the blood may be an indicator of ovarian cancer development. However, this molecule is not exclusive to ovarian cancer, and the elevated levels of this biomarker can be caused due to other illnesses too.

If symptoms such as frequent bloating, feeling of fullness, reduced appetite, or pelvic or abdominal pain are frequently experienced, a CA125 blood test should be carried out as per the National Institute for Health and Care Excellence (NICE).

c. Imaging Tests: Imaging tests help in finding if ovarian cancer has spread to nearby organs. They may also provide other information, such as the size of the tumour, its exact location, stage and grade. Apart from this, the results from imaging tests may also aid in treatment planning and therapy monitoring.

• Ultrasound: Ultrasound is one of the most commonly used imaging tests for ovarian cancer detection. It employs high-energy sound waves to detect abnormalities such as solid masses or fluid-filled cysts. A transvaginal ultrasound can reveal the size of the ovaries and any abnormalities in the structure of the ovaries and the nearby structures, namely vagina, uterus, bladder, or fallopian tubes.
• PET/CT scan or MRI scan: PET/CT scan or MRI scan may be recommended to look for signs of ovarian cancer that may have spread to abdomen and pelvis.
• Chest X-ray: Chest X-ray is recommended to check if ovarian cancer has spread to the lungs or caused a build-up of fluid around the lungs.

d. Abdominal fluid aspiration: It’s possible that ovarian cancer has spread if there’s a build-up of fluid in the abdomen and it appears enlarged. A tiny needle is inserted into the abdomen to collect a sample of fluid, which will be later examined for cancer cells.

e. Laparoscopy: This technique involves a doctor examiningthe ovaries and other pelvic organs and tissues using a thin, lit tube. The tube is insertedthrough a minor incision (cut) in the lower abdomen, and ittransmits images of the pelvis or abdomen to a video monitor. The results from laparoscopy may help in disease staging and treatment planning.

Treatment

Treatment planning for ovarian cancer is made based on numerous factors, namely the cancer type and stage, the potential side effects, the woman’s age and whether she’s planning to have children after the treatment. Surgery is often the first treatment recommended for ovarian cancer and may involve the removal of the ovaries and fallopian tubes, uterus, lymph nodes in the area and surrounding tissues and organs. Chemotherapy is usually recommended after surgery.

a. Surgery

Surgery can be done to confirm the diagnosis, determine the stage of cancer, and operate the tumour. There are multiple surgical approaches that are considered by specialists to manage ovarian cancers successfully.

• Biopsy: Lymph node biopsy or the removal of all or part of a lymph node is performed to analyse the tumour.
• Unilateral Salpingo-oophorectomy: This procedure involves the removal of one ovary and one fallopian tube.
• Bilateral Salpingo-oophorectomy: This is the procedure where both ovaries and fallopian tubes are removed.
• Omentectomy: This surgery involves the removal of the tissue in the peritoneum (called the omentum), which includes lymph nodes.
• Hysterectomy: This is the procedure where the womb is completely removed. There are different subtypes of hysterectomy and the right procedure is employed based on the stage of the disease.
  • Partial hysterectomy removes the uterus
  • Total hysterectomy is performed to remove the uterus and cervix
  • Total hysterectomy with salpingo-oophorectomy removes the uterus, cervix and one ovary and fallopian tube (unilateral salpingo-oophorectomy) or both ovaries and fallopian tubes (bilateral salpingo-oophorectomy)
  • Radical hysterectomy removes all of the above, along with the nearby tissues.

b. Chemotherapy

Chemotherapy has been the accepted standard of care for ovarian cancers. Chemotherapy may also be administered following surgery, as adjuvant therapy, to treat any residual disease and bring down the risk of a relapse, particularly in advanced stages of ovarian cancer.

c. Targeted therapy

Targeted therapy uses drugs that can target specific protein particles present in cancer cells, particular genes and the tumour environment. Targeted therapy drugs are generally reserved to treat relapsed ovarian cancers or those that resist other treatments. Before administration, cancer cells will be tested to determine which targeted therapy is most likely to be effective.

d. Radiation therapy

Since important organs are in the radiation field, a large dose cannot be safely delivered in the case of ovarian cancers. Also, radiation therapy may not be useful for advanced-stage ovarian cancers. Radiation therapy is, therefore, frequently avoided because the important organs may be unable to endure the complications.