World Ovarian Cancer Day: Oncologist Dr. Fahad Afzal Shares Insights

Dr. Fahad Afzal: So, unfortunately, ovarian cancer in the early stages does not have any specific symptoms. And usually by the time the patient actually has symptoms like bloating or any pain in the abdomen or an early satiety that is a feeling of fullness, by the time the patient has these symptoms, the ovarian cancer has already progressed into an advanced stage. 

Because the symptoms are very vague and can be seen commonly in other conditions, ovarian cancer is frequently diagnosed at an advanced or later stage. In conditions where the ovarian cancer has spread to other sites like the bone or the lungs, the patient may also suffer from symptoms like back pain or breathlessness, depending on where the ovarian cancer has spread. So it is very important for us to make women aware that if they have any symptoms like bloating or back pain which are persistent and do not go away for weeks, then that actually could be a sign of an underlying advanced ovarian malignancy. 

Dr Fahad Afzal:  So the exact cause of ovarian cancer is not known. But there are several risk factors which have been identified to increase the risk of developing ovarian cancer. Along the top of the list are mutations in the BRCA1 or BRCA2 genes. Mutations in these genes are heritable, which means it's fast from generation to generation. And they increase the risk of not only ovarian cancer but also breast and colon cancer. The other risk factors besides genetic mutation are a history of endometriosis, a history of any hormone replacement therapy, and nulliparity, which means not having children. But again, these are not causes of ovarian cancer, but they increase the risk of ovarian cancer. So the end outcome is dependent on a combination of mutations, hormonal factors, and environmental factors. 

Dr Fahad Afzal:  Yes, ovarian cancer can be cured, but unfortunately, that doesn't happen commonly. The primary reason for that is that most of the ovarian cancer cases present to the physician in an advanced stage. As we all know, ovarian cancer rarely presents with symptoms in the early stage, and that is the reason why most of the patients are either stage 3 or stage 4 at the time of presentation. So in the early stages, surgery alone or surgery followed by chemotherapy is the standard of care. In advanced stages, treatment consists of a combination of surgery and chemotherapy in different sequences. In these cases, a cure is also possible. However, it is more challenging, and most of the patients achieve a remission for a very long period of time with the current available treatment options, such as  immunotherapy and targeted therapy

Dr Fahad Afzal: So, ovarian cancer frequently affects postmenopausal women, that is typically after the age of 45. Some types of ovarian cancer, namely germ cell tumours, tend to involve younger females, sometimes even teenagers, but most of the cases that we see in practice are comprised of postmenopausal women. 

Dr Fahad Afzal: There are several factors that determine the survival rate, not just in ovarian cancer but in any other cancer, for that matter. So any cancer, if detected and treated early, has a better survival outcome. The same holds true for ovarian cancer, so if detected in the early stage, the five-year survival rate can be more than 90% means that at the end of five years, 90% of the patients can be expected to be alive. However, since most of the patients present in advanced stages, the five-year survival rate in these patients drops down from 90% to a decimal 30 to 40%. However, it is important to note that these are just numbers based on large randomised trials, and every patient is different. Now with newer therapies like immunotherapy, targeted therapy, etc, patients are defining these numbers and are living longer with a good quality of life.

Dr Fahad Afzal: Yes, like in any other cancer, early detection helps improve the outcomes. When cancer, like ovarian cancer, is detected at an early stage, the treatment is easier for the patient to tolerate, shorter in terms of duration and is more effective. However, most of the ovarian cancer cases are not detected in the early stage. Due to many factors, one of which is that there is a lack of a screening test for ovarian cancer, which makes early detection challenging in a general population which is asymptomatic. So, yes, early detection really makes a big difference. Thank you. 

Dr Fahad Afzal: Unfortunately, there is no screening test for ovarian cancer. However, patients who are at increased risk for developing variant cancer, such as those who harbour genetic mutations like BRCA1 and BRCA2, can get a routine ultrasound of the abdomen or transvaginal ultrasound along with blood tests like CA-125. However, these tests are not foolproof and many a times they may miss cancer, especially when it's done at a very early stage. So, what is more important is that any symptoms which could be a sign of an underlying variant malignancy should be brought to the oncologist's attention so that the diagnosis is confirmed at an early stage. 

Dr Fahad Afzal:  While there are a lot of myths related to cancer in general in the society, one of the important myths related to ovarian cancer that is present even amongst general practitioners and family physicians is that a normal CA125 rules out ovarian cancer. While it is true that most cases of ovarian cancer have elevated CA125 levels in the blood, there is a significant number of patients with ovarian cancer who have normal CA125 levels. That said, there is no screening tool for ovarian cancer. Pap smear, which is done for screening for cervical cancer, does not detect ovarian cancer. So, awareness is very important and busting these kinds of myths can help save lives. 

Dr Fahad Afzal:  Postmenopausal women, in particular, are at a high risk of developing ovarian cancer. Females who harbour the inherited mutations in the BRCA1 or BRCA2 gene have a significantly increased risk of developing ovarian cancer throughout their lives, and it is not just ovarian cancer; these patients also have a high risk of developing breast and colon cancer. Other risk factors are patients who have never been pregnant, those who have been using hormone replacement therapy for years together, and women with a type of syndrome called Lynch syndrome are also at risk for developing ovarian cancer. 

Dr Fahad Afzal:  Yes, while ovarian cancer does not have a screening tool which makes early detection difficult and also it cannot always be prevented, what women can do is to maintain a healthy lifestyle, follow a balanced diet, and exercise regularly. For those who have the inherited genetic mutation, they should undergo even closer surveillance that includes periodic scans, blood tests, clinical examinations so that the risk, so that the cancer can be detected at an early stage before the onset of symptoms. It is important to approach your doctor for any pain around for longer than usual.