Ovarian cancer: Women should watch out for these warning signs

It is important to note that most female cancers like breast, ovarian and cervical cancer are usually detected at late stages and if a women is undergoing routine health check ups with her gynaecologist, these cancers can be detected at an early stage when they are fully curable. After breast cancer and cervical cancer, ovarian cancer is the third most common gynaecological cancer in Indian women and is a very silent cancer.

According to Cancer Research UK, ovarian cancer is when abnormal cells in the ovary begin to grow and divide in an uncontrolled way. They eventually form a growth (tumour) and if not caught early, cancer cells gradually grow into the surrounding tissues and may spread to other areas of the body.

In an interview with HT Lifestyle, Dr Priya Tiwari, Senior Consultant – Medical Oncology (Unit II) at Artemis Hospitals in Gurgaon elaborated, “llama ovary is the most lethal gynaecological cancer. It is a cancer of females which is seen more commonly with increasing age. The incidence of many, cancers including ovarian cancer is on the rise in Indian subcontinent. It is one of those cancers which actually which is detected late and that is why the mortality rate is higher in this cancer.”

Factors:

Dr Swarupa Mitra, Chief of Gynaecological and Genito Urinary Radiation Oncology at Rajiv Gandhi Cancer Institute And Research Centre (RGCIRC), shared, “The predisposing factors for ovarian cancer are very different from cervical cancer or many other cancers. It is generally seen in the upper socio economic strata. Obesity, sedentary lifestyle, intake of fatty food, diabetes, late marriages, less number of children or no children, early menarche and late menopause, post-menopausal hormone therapy etc are generally the predisposing factors.”

She added, “In view of fast acceptance of this lifestyle, which is more prevalent in the western countries, the incidence of ovarian cancer is rising in India too. However, there is an important genetic factor also which should not be ignored. There is a lot of genetic counselling done these days in most good hospitals. Carriers of the BRCA1 and BRCA2 gene mutations have a higher risk of developing ovarian and breast cancer. Families with LYNCH II syndrome are also at high risk of developing ovarian cancer.”

Echoing the same, Dr Priya Tiwari explained, “Five to 10% of cancers are hereditary in nature. This means that the cancer causing genes run in families so, we can say this is one such cancer which can run in families. Secondary factor is it happens because of the hormonal changes in the body. So, it’s more common in females who don’t have kids. Then, it has been also seen that obesity, which can also cause hormonal imbalances can predispose for this cancer.”

Warning signs of ovarian cancer that women should check for:

Dr Swarupa Mitra revealed, “There are no distinct and early warning signals. There are no effective screening strategies for ovarian cancer. However women need to watch out for any kind of unusual bleeding, abdominal distension, mild abdominal pain that doesn’t go away, irregularities in menses, weight loss, some change in bowel habits, indigestion, tiredness, loss of appetite and especially a family history of breast, ovarian or endometrial cancer.”

She added, “These symptoms present themselves in several other abdominal diseases too so need to be confirmed for ovarian cancer by a specialist. As a thumb rule, any symptom, which is persisting for three weeks and is not responding to conventional treatment, needs to be thoroughly examined. For any ovarian symptoms, it is better to go to a trained gynaecologist first who would get all tests done and in case of doubt will refer one to a cancer hospital.”

Dr Priya Tiwari shared, “If you notice, weight gain also up distension of the abdomen early satiety that means that if you eat and you start feeling full easily then persistent bloating sensation combined with dyspepsia. So, a lot of the complaints along with if you have abdominal distension and weight gain and sometimes nausea vomiting, these could be all signs of abdominal ovarian cancer. Ovaries are situated in the abdomen and that is why abdominal symptoms are very common and there is also fluid formation in the abdomen that causes death medically called as ascites, which causes abdominal distension. Sometimes there could be fluid formation in the lungs also. So patient can experience breathlessness that is shortness of breath, cough and chest pain too. All these are signs of ovarian cancer that one should look for.”

Echoing the same, Dr Tejinder Kataria, Chairperson Radiation Oncology at Cancer Center in Medanta – The Medicity, quipped, “Ovarian cancer does not have any specific symptoms or signs in an affected person at an early stage. The symptoms are non-specific and may pre-date a diagnosis from 3-6 months. A patient may have a sense of indigestion or early satiety and feeling full after taking small amount of food. She may experience pain after taking food. Sometimes the only presenting complaint may be swelling of the feet and legs along with some distension of abdomen or paradoxically weight gain in spite of reduced appetite. This happens due to retention of water in the body and around the abdominal organs. A few patients may present with vomiting and nausea after taking meals. In case the symptoms persist for a long time >6 months patients start losing weight due to reduced nutritional intake or lack of appetite.”

She added, “Very rarely a patient may have pain in the lower abdomen or while passing urine. She may experience increased frequency of urination with passage of small amount of urine (poly-urea) due to bladder irritation. A few women experience increasing constipation and difficulty in passing stool. In advanced cases a woman may have breathlessness for which a cardiac or respiratory cause is being investigated. This happens due to water in the pleural cavities secondary to ovarian cancer. On clinical examination a gynaecologist may find ascites (fluid in abdomen) or ovarian enlargement or sometimes there may be a firm fullness due to omental thickening. A clinical examination may show pleural fluid(fluid outside the lungs), anemia,low protein level or deranged kidney functions. A blood test may reveal high CA-125 or CEA level which are the tumour markers elevated in some cases of ovarian cancer. Confirmation of a diagnosis is made with a biopsy and staging with either CT scan or PET-CT before recommending the treatment.”

Prevention tips:

Stressing that a healthy lifestyle is key to prevent any cancer and that helps in the prevention of ovarian cancer, Dr Priya Tiwari advised, “Exercise regularly at least half an hour per day at least five days in a week. Brisk exercise, brisk aerobic exercises should be done, combined with dietary modifications. Eat healthy, exercise regularly and decrease your chance of ovarian cancers.”