INTRODUCTION:
Ovarian cancer is the third most common gynecological cancer in India, affecting approximately 50000 females yearly (GLOBOCAN 2022). It is also known as “silent killer” as most patients are diagnosed in advanced stages due to very vague symptoms in early stages, socio – economic barriers leading to delayed detection, poor access to ovarian cancer specialists, high costs of advanced therapies for later stages and absence of nationalized screening guidelines. India requires ovarian cancer specialists in every rural, semi – urban and urban health care centers to reduce the prevalent high mortality rates (approximately 30000 deaths from ovarian cancer are reported annually). With the help of latest research, ovarian cancer specialists investigate one’s family history of cancer, do personalized risk assessment to estimate lifetime risk of ovarian cancer, advise need for screening tests required at appropriate age, differentiate between benign and malignant ovarian masses, help understand various myths and facts surrounding the disease and when diagnosed with ovarian cancer, prescribe stage – appropriate management plan for the best possible outcomes. At South Gujarat Hematology Oncology Center, every patient diagnosed with ovarian cancer is given world class, evidence-based treatment under the care of Dr. Dhruv Mehta who is a senior recognized ovarian cancer specialist in Surat.
MYTHS AND FACTS:
Ovarian cancer is mystifying disease and there is lot of misinformation being peddled over social media regarding it. Let’s bust some myths surrounding it with facts based on rigorous science.
- MYTH – Ovarian cancer affects only older women
FACT – The median age at which diagnosis of ovarian cancer is made is around 63 years. The incidence of ovarian cancer increases with age. In patients younger than 20 years of age, germ cell tumors predominate; borderline tumors typically occur in patients in their 30s and 40s; and after age 50 years, Epithelial Ovarian Cancer predominates. But it is a myth that ovarian cancer affects only older women – patients with hereditary ovarian cancer syndrome present at younger age less than 50 years. Ovarian cancer specialist evaluates age – related risk factors through genetic counselling, germline testing (HBOC gene panel) and advises screening tests appropriate for age
- MYTH – PAP smear screens for ovarian cancer
FACT – PAP smear detects cervical abnormalities, but may occasionally detect malignant ovarian cells. US Preventive Services Task Force (USPSTF) recommends against screening for ovarian cancer for asymptomatic women who are not known to have a high-risk hereditary cancer syndrome (BRCA1, BRCA2, Lynch syndrome). For such person with family history and who tests positive for one of the above hereditary cancer syndromes, an ovarian cancer specialist may recommend risk-reducing bilateral salpingo-oophorectomy (rrBSO). Tests like CA125 and transvaginal ultrasound may be recommended by an ovarian cancer specialist depending on symptom presentation like bloating, pelvic pain or urinary changes. It is important to understand that these tests shouldn’t be done without advice and supervision from ovarian cancer specialist as they have high false – positive rate leading to unnecessary surgical intervention and psychological stress
- MYTH – No family history means no ovarian cancer
FACT – Hardly 10 – 15% of ovarian cancer cases are hereditary, rest are sporadic due to various risk factors like older age, early menarche or late menopause, nulliparity, endometriosis, etc. Once diagnosed with ovarian cancer, all patients are advised to get done genetic testing irrespective of family history. An ovarian cancer specialist will determine your risk for ovarian cancer by detailed risk assessment and family tree evaluation and advise risk mitigation strategies like oral contraceptives (more than 50 percent reduction with ≥10 years of use) or prophylactic surgeries.
- MYTH – There are no symptoms in early stages until it’s too late
FACT – There are some symptoms like bloating, indigestion, loss of appetite, easy fatigability, constipation or urinary problems in early stages. But they are mostly attributed to IBS or menopause by patients and their family physicians, leading to late diagnosis and it’s “silent killer” tag. Ovarian cancer specialists are trained to interpret these vague symptoms and catch cancers early with the help of radiological investigations and biomarker panels like OVA1, Overa, and the Risk of Malignancy Algorithm (ROMA)
- MYTH – Ovarian cancer is rare in India
FACT – Ovarian cancer is 9th most common cancer in India overall, but 3rd most common gynecological cancer. In India, breast cancer, lung cancer, cervical cancer and head and neck cancer hog the limelight with maximum clinical trials, awareness campaigns and screening camps dedicated to these cancers. An ovarian cancer specialist is passionate about educating patients and their families about ovarian cancer prevention, early detection, and various treatment options. He is a proponent of ovarian cancer dedicated clinical trials of newer and better therapies, early intervention strategies and preventative medicines for high-risk patients
- MYTH – Infertility treatments increase risk of ovarian cancer
FACT – There are multiple studies that show that infertility treatments are not associated with increased risk of ovarian cancer. This myth stems from the fact that all infertility treatments include ovulation-induction drugs that result in a temporary increase in serum concentrations of estrogen and progesterone, leading to increased risk of ovarian cancer. However, this association was found to be biased as nulliparity itself is a risk factor for ovarian cancer. Increasing parity decreases risk of ovarian cancer by 8% per each additional pregnancy
IMPORTANCE OF OVARIAN CANCER SPECIALIST:
A General Practitioner is a jack of all branches, but master of none. An ovarian cancer specialist breathes and lives ovarian cancer. He debunks myths one – on – one in clinics and in society via community outreach programs, cancer screening camps and awareness talks. During clinical consultation, he or she deep dives in your family and personal histories, identify subtle symptoms and signs, does risk assessment testing like ROMA scoring and guide treatment with cutting – edge facts. An ovarian cancer specialist participates in various clinical trials, improving outcomes even in advanced stages and can administer holistic support with the help of various nutritional, mental health and survivorship plans. If any patient wants fertility preservation, he or she guides her to pregnancy after ovarian cancer treatment in early stages.
An ovarian cancer specialist shines a hopeful light on the dismal road of cancer recovery by being the part of cancer journey with the patient every step of the way.
