Ovarian Cancer Treatment in Delhi

Introduction/ Ovarian Cancer Definition: Ovarian cancer refers to cancer i.e., abnormal growth in the ovaries (female reproductive organs that produce eggs in women for the process of reproduction). Ovarian cancer holds third place in the most commonly detected cancers in India and seventh place in the most common cancers in the world. What is Ovarian Cancer? As we have already discussed, cancer is the abnormal growth of cells. Not just the ovary, but this abnormality of growth can be seen in any part of the body. All of the cells have a defined life cycle which includes the growth phase, the dividing phase, and the death phase or the phase when they get replaced by other cells. However, at times, these cells can begin to grow at a very rapid rate or no longer die at times when they should be dying. This abnormal growth leads to the development of tumors. These tumors can be either malignant/ cancerous (that can spread to other parts of the body) or benign/ non-cancerous (confined to one area).

Types of Ovarian Cancer:

There are more than 30 types of ovarian cancer classifications. These types are put into different groups depending on the kind of cell where they start/ occur. There are three main types of cells that can be found in the ovaries and a tumour can be developed in any one of them.

These types are:

1. Epithelial cells- cover the surface of the ovary
2. Germ cells- These are the cells that make the eggs and hence, the name.
3. Stromal cells- These cells are responsible for making the hormones estrogen and progesterone and for holding the structure of the ovary together.

Epithelial tumours:

Epithelial tumours are the most common type of tumours seen in women with ovarian cancer. It is more commonly seen in women who have undergone menopause. Most of these tumours are non-cancerous in nature and hence, one should not start stressing over if she gets informed about having an epithelial tumour. The benign epithelial tumours include serous adenoma, Brenner’s tumours and mucinous adenoma. An epithelial tumour is known as carcinoma if it is cancerous. These are further divided into four subtypes depending on the things seen under the microscope by the doctor. These carcinoma subtypes are:

1. Serous (most common of the 4) – 53%
2. Mucinous- 6%
3. Endometrioid – 10%
4. Clear cell- (6%)

The cancer is referred to as an “undifferentiated” one if it does not look like any of the above subtypes. Such types of tumours have a high tendency to grow at a faster rate and these can also spread faster than any of the above 4 types of cancer. There can be times when the doctor is not able to tell whether an epithelial tumour is a cancer or not, under the microscope. Such a tumour is said to be a low malignant potential (LMP) tumour or borderline epithelial tumour. This kind of epithelial cancer is found to be less life-threatening than the other kinds of epithelial cancers.

Germ Cell Tumours:

Germ cell tumours can be found in women of any age. Although, these are most commonly seen in women who are in their 20s. The majority of these tumours are benign in nature. Germ cell carcinomas have a few subtypes and the tumours can sometimes be a mix of more than one germ cell subtype. Four of the main subtypes are:

• Teratoma: When viewed under a microscope, these germ cell tumours appear like the three layers of an embryo (in the developing stage) i.e., the endoderm (innermost layer), the mesoderm (middle layer) and the ectoderm (outermost layer). The benign form of this germ cell tumour is known as a mature teratoma. The cancerous/ malignant germ cell is known as an immature teratoma. This kind of tumour is rare in nature and is seen in girls younger than 18 years of age.
• Dysgerminoma: Even though it is a very rare germ cell tumour, this is the most common kind of germ cell cancer. This is mostly seen in women in their teens and twenties. This malignant subtype does not grow at a rapid rate as the other ones. In fact, there is a 75% probability of the patient getting cured by surgical removal of such tumours that are limited to the ovary.
• Endodermal Sinus tumours: Also called yolk sac tumours, these are rare and malignant kinds of tumours that are found lining the yolk sac of the embryo.
• Choriocarcinoma: These tumours start growing in the placenta itself (during the time of pregnancy). These grow and spread at a rapid rate and are sensitive to chemotherapy.

Stromal Tumours: These tumours are usually diagnosed earlier than the other kind of tumours. The most common symptom of these tumours is abnormal vaginal bleeding which happens due to the extra production of estrogen hormone from these tumours. Because of the same reason, such tumours can cause the development of breasts and menstrual periods in girls even before they hit puberty. In very rare cases, these tumours can also make male hormones like testosterone and hence, causing the menstrual periods to stop and the growth of facial and body hair. These tumours can cause serious abdominal pain if they start bleeding.

Ovarian Cancer Symptoms:

Majority of the ovarian cancers begin in the epithelium i.e., the outer lining of the ovaries. There may be a few or no symptoms at all in the early stages. However, even if the symptoms are there, they may resemble those of other conditions like PMS (Pre-Menstrual Syndrome), irritable bowel syndrome, etc. Although, in the case of ovarian cancer, such symptoms persist for a longer time and get worse with time.

Ovarian cancer early symptoms/ ovarian cancer first symptoms include the following:

• Experiencing pain or pressure in the pelvic region
• Vaginal bleeding at unexpected times
• Pain in the back or abdominal region
• Bloating
• Getting full even with little food
• Abnormal urinary patterns like urination getting more frequent
• Constipation

If one experiences any of the above symptoms for 2 weeks or more, she should consult a doctor, other than these symptoms, there can also be other symptoms:

• Loss of appetite
• Pain during intercourse
• Weight loss
• Short breaths or breathlessness
• Nausea
• Indigestion
• Fatigue

These symptoms can change if cancer gets metastasized to other parts of the body

Surgery for advanced cancer:

If the cancer is of the advanced stage, the doctor might recommend you to undergo surgery that involves the removal of as much cancer as can be removed. Chemotherapy is often preceded or succeeded before or after this surgery.

• Chemotherapy: This is a drug treatment that involves using chemicals in order to fast kill the abnormally growing cancer cells in the body. These drugs can be given to a person by either the oral route (ingestion) or an injection in the veins. Chemotherapy is often used after surgery in order to kill any remaining cancer cells. However, it can be used before surgery also. These chemotherapy drugs can also be infused into the abdomen after heating in certain cases which is known as hyperthermic intraperitoneal chemotherapy. These drugs are kept/ left there till the time they get drained and then the operation is said to be complete and successful.
• Targeted Therapy:  This is also known as the targeted drug treatment therapy and, as the name suggests, this includes focusing or targeting on a particular weakness existing/ present in the cancer cells and hence, ultimately causing these cancer cells to die. Your doctor may perform some tests to determine which targeted therapy is going to have the best effect on your ovarian cancer.
• Hormone Therapy: This involves the use of drugs that block the effects of the additional estrogen hormone which is produced by the cancer cells. Blocking estrogen hormone is an effective way to fight against cancer as some ovarian cancers use this estrogen hormone to grow. Hormone therapy can be an option for ovarian cancers that are slow-growing in nature. It can also be a treatment option if cancer reappears after the initial treatment protocol.
• Immunotherapy: This therapy uses the immune system of the body to fight against cancer. Normally, the immune system of the body which fights against the diseases is unable to detect cancer cells as these cells produce certain proteins which help them hide. Immunotherapy works by causing interference between this process of hiding hence, immunotherapy can also be a good option for treating ovarian cancer.
• Palliative or Supportive Care: This refers to specialized medical care that mainly focuses on providing relief from the pain and other serious symptoms associated with cancer and other serious illnesses. A palliative care specialist works with you, your family, and other doctors to give extra support for the ongoing care. It can be used with other aggressive treatments like surgery and chemotherapy.