OVARIAN CANCER

Ovarian cancer is the seventh most common cancer in women worldwide (18th most common cancer overall), with 239,000 new cases diagnosed in 2012

Ovarian cancer often has no symptoms at the early stages, so the disease is generally advanced when it is diagnosed. The five-year survival rate (which compares the five-year survival of people with the cancer to the survival of others at the same age who do not have cancer) ranges from approximately 30 to 50 per cent.

Clinical Features

  • Usually occurs in women aged 40 years and above.
  • Usually presents late with mass in lower abdomen.
  • Pain and irregular vaginal bleeding are late features.
  • Ascites and wasting are further late features.
  • In late cases the mass is usually irregular and fixed.

Diagnosis is essentially clinical but confirmed with biopsy.

Investigations

  • Haemoglobin, blood group, urinalysis, blood urea
  • Ultrasound
  • Intravenous urogram (IVU)
  • Ascitic tap for cytology
  • Fine needle aspiration and cytology (FNAC)
  • Laparotomy for biopsy and histology and staging

Management

Surgery is the mainstay treatment. To prepare:

  • Improve general health with high protein diet and transfusion where necessary.
  • Carry out palliative surgery in inoperable cases and staging.
  • Perform total abdominal hysterectomy and bilateral salpingo-oophorectomy in operable cases.
  • Administer chemotherapy in addition to surgery; available drugs include vincristine, vinblastine, alkeran, cyclophosphamide, and cisplatinum, as directed by the oncologist.
  • Admit for
    • Surgery and/or chemotherapy.
    • Confirmation of diagnosis.

Prevention

Annual pelvic examination and pelvic ultrasound are recommended as preventive measures for early detection and management.