Understanding ovarian cancer: A comprehensive guide in the Indian context

Ovarian cancer, often dubbed the 'silent killer,' is a formidable adversary in the realm of women's health. This insidious disease is characterized by abnormal cell growth in the ovaries, the reproductive glands responsible for producing eggs and hormones. While it may not garner as much attention as other cancers, its impact is profound, especially in the Indian context, where factors like late diagnosis, limited awareness, and cultural nuances intersect with its prevalence and management.

What is Ovarian Cancer?
Ovarian cancer originates from the ovaries, but it can also spread to other parts of the body. It is classified into various types based on the cells from which it arises, including epithelial tumors (arising from the cells covering the outer surface of the ovary), germ cell tumors (arising from the cells that form eggs), and stromal tumors (arising from the cells that produce hormones).

Prevalence in India
In India, ovarian cancer is the third most common gynecological cancer, with a disproportionately high mortality rate. According to the Indian Council of Medical Research (ICMR), it accounts for approximately 5-6% of all cancers among women. What's concerning is that a significant number of cases are diagnosed in advanced stages, leading to poorer outcomes.

Risk Factors
Several factors contribute to the development of ovarian cancer, including genetic predisposition (such as mutations in BRCA1 and BRCA2 genes), family history of ovarian or breast cancer, age (risk increases with age), reproductive history (including early menstruation, late menopause, and never having been pregnant), obesity, and certain medical conditions like endometriosis.

Signs and Symptoms
Ovarian cancer is notorious for its vague and subtle symptoms, often leading to delayed diagnosis. Common symptoms include abdominal bloating or swelling, pelvic discomfort or pain, difficulty eating or feeling full quickly, changes in bowel habits, such as constipation, and frequent urination. However, these symptoms are often non-specific and may be attributed to other benign conditions, leading to misinterpretation or dismissal.

Diagnosis
Diagnosing ovarian cancer requires a combination of imaging tests (like ultrasound, CT scan, or MRI) and blood tests (such as CA-125, a tumor marker). However, these tests may not always provide a definitive diagnosis, necessitating further evaluation through procedures like biopsy or exploratory surgery.

Treatment
Treatment strategies for ovarian cancer depend on various factors, including the stage of the disease, the type of ovarian cancer, and the patient's overall health. Common modalities include surgery, chemotherapy, targeted therapy, and in some cases, radiation therapy. Surgery aims to remove the tumor and surrounding tissue, while chemotherapy utilizes drugs to kill cancer cells. Targeted therapy, such as PARP inhibitors, specifically targets cancer cells while minimizing damage to healthy cells.

Challenges in India
The fight against ovarian cancer in India is fraught with challenges. Limited awareness about the disease often leads to delayed diagnosis, hindering timely intervention and reducing treatment efficacy. Additionally, cultural taboos surrounding women's health issues may discourage open discussions and preventive screenings. Access to quality healthcare services, especially in rural areas, remains a significant barrier, further exacerbating disparities in diagnosis and treatment outcomes.

Empowering Women through Awareness and Education
Addressing the burden of ovarian cancer in India necessitates a multi-faceted approach that emphasizes awareness, education, and access to healthcare services. Public health campaigns should focus on educating women about the signs and symptoms of ovarian cancer, the importance of regular screenings, and available treatment options. Moreover, empowering healthcare providers with training and resources to facilitate early detection and diagnosis is crucial in improving survival rates.

Ovarian cancer poses a formidable challenge to women's health in India, characterized by its stealthy nature and dire consequences. Despite the obstacles, concerted efforts to raise awareness, enhance access to healthcare, and promote early detection can make significant strides in combating this disease. By empowering women with knowledge and ensuring equitable access to quality care, we can strive towards a future where ovarian cancer no longer looms as a silent threat but is met with vigilance, resilience, and hope.

(Dr Deepthi TR is Specialist in Early cancer Detection and Prevention, Oncure Preventive and Healthcare Centre Kannur)