World Ovarian Cancer Day Spotlight: Symptoms, Risk Factors, and Multidisciplinary Care

By Dr. Tejas SV MBBS, MS (OBG), MCh (Gyn Oncology)

Ovarian Cancer remains one of the most challenging gynecologic malignancies to detect early, often earning its reputation as a "silent killer" due to vague or absent symptoms in the initial stages. Despite advancements in diagnostics and therapeutics, many cases are still diagnosed at an advanced stage. However, early detection and improved outcomes are possible with increased awareness of symptoms, understanding of risk factors, and timely medical evaluation.

World Ovarian Cancer Day, observed on May 8th, raises awareness, promotes early detection, and supports those affected. The 2025 theme, “No Woman Left Behind,” underscores equitable care and timely diagnosis.

This article explores the signs, risk groups, diagnostic tools, and treatment strategies for ovarian cancer, along with reflections from clinical experience that highlight the importance of a multidisciplinary approach and specialized care.

Detecting ovarian cancer in its early stages can be challenging because symptoms are often vague or absent. However, early detection significantly improves the chances of successful treatment. Here are the main approaches to early detection:

1. Know the Symptoms

Pay attention to persistent symptoms such as:

● Bloating

● Pelvic or abdominal pain

● Difficulty eating or feeling full quickly

● Frequent or urgent urination

These symptoms can be caused by other conditions, but if they persist for more than a few weeks, consult a doctor.

2. Medical History and Risk Factors

Certain factors increase risk:

● Family history of ovarian, breast, or colorectal cancer

● BRCA1 or BRCA2 gene mutations

● Age (most common after menopause)

● Endometriosis

Women with higher risk may need closer monitoring.

3. Pelvic Examination

A routine pelvic exam helps detect abnormalities in the ovaries or uterus, although small tumors may not be felt.

4. Transvaginal Ultrasound (TVUS)

This imaging test can visualize the ovaries and detect abnormalities or masses.

5. CA-125 Blood Test

This test measures the level of a protein that is sometimes elevated in women with ovarian cancer. However, it is not specific and can be elevated in other conditions.

6. Genetic Testing and Counseling

Women with a strong family history may benefit from genetic testing to identify BRCA mutations or other hereditary cancer syndromes.

7. Risk-Reducing Measures (for High-Risk Women)

In high-risk women, preventive surgery (removal of ovaries and fallopian tubes) may be considered after childbearing is complete.

Certain groups of women are more prone to developing ovarian cancer due to a combination of genetic, lifestyle, and reproductive factors. Here are the main risk factors:

1. Age

● Most common in women aged 50–70.

● Rare in women under 40.

2. Family History

● Having close relatives (mother, sister, daughter) with ovarian, breast, or colorectal cancer increases risk.

3. Genetic Mutations

● BRCA1 and BRCA2 mutations significantly increase the risk.

● Lynch syndrome (hereditary non-polyposis colorectal cancer) also raises the risk.

4. Reproductive History

● Never having been pregnant or having a late first pregnancy increases risk.

● Early menstruation or late menopause extends estrogen exposure and raises risk.

5. Endometriosis

● Women with this condition have a higher risk of certain types of ovarian cancer.

6. Hormone Replacement Therapy (HRT)

● Long-term use of estrogen-only HRT, especially after menopause, can increase the risk.

7. Obesity

● Higher body mass index (BMI) is associated with a modest increase in risk.

8. Fertility Treatment

● Some studies suggest a possible link between fertility drugs and ovarian cancer, especially if pregnancy is not achieved.

9. Smoking and Alcohol

● Smoking is linked to a higher risk of mucinous ovarian cancer.

Treatment options for ovarian cancer (Ca ovary) depend on the stage of the disease, the type of tumor, the patient’s age, overall health, and desire for fertility preservation. Here’s an overview:

1. Surgery (Mainstay of Treatment)

Early-stage (Stage I–II): May involve removal of one or both ovaries, fallopian tubes, uterus (total hysterectomy), omentum, and lymph nodes. Advanced-stage (Stage III–IV): Cytoreductive (debulking) surgery to remove as much tumor as possible. Fertility-sparing surgery may be possible in selected early-stage cases. 

2. Chemotherapy

Usually given after surgery (adjuvant) or sometimes before surgery (neoadjuvant) in advanced cases. Common drugs: Carboplatin and Paclitaxel. Given in cycles, often 3–6 months in duration.

3.Targeted Therapy

Bevacizumab (Avastin): Anti-angiogenesis drug that blocks blood supply to tumors. PARP inhibitors (e.g., Olaparib, Niraparib): Especially effective in women with BRCA mutations or homologous recombination deficiency (HRD).

4. Hormonal Therapy

Less commonly used, mainly in low-grade serous tumors. Drugs like tamoxifen or aromatase inhibitors may be used.

5. Radiation Therapy

Rarely used as a primary treatment. Sometimes used for palliation in metastatic or recurrent disease.

6. Immunotherapy (Experimental/Selective)

Still under investigation but may be offered in clinical trials, especially in recurrent or resistant cases.

7. Follow-Up and Supportive Care

Regular CA-125 blood tests, imaging, and physical exams. When needed, management of side effects, nutrition, psychological support, and palliative care.

"Among hundreds of cancer patients, I have been able to be part of the treatment of a baby of 2 years to an 85-year-old granny... The presentation to prognosis varies... 

At the end of the day, even with our best efforts, the tumor biology dictates the outcome of the patient.

It’s so heartwarming to see many of the patients with germ cell tumors and early low-grade ovarian tumor patients conceive after the fertility sparing surgery.

A thorough evaluation by a dedicated gynecologic oncologist is an essential part of the treatment for the best outcome in patients with ovarian cancer.

Early and proper referral to a gynecologic oncologist improves outcomes by decreasing the suboptimal surgery and improper treatment planning. A multidisciplinary team approach is always essential in Ovarian Cancer."

“A stitch in time saves nine”

Dr. Tejas S V is a consultant gynae-oncologist currently working in Fortis Memorial Research Institute Gurgaon. He completed his MBBS and MS (OBG) from Bangalore medical college and pursued MCh (Gyn Oncology) from Kidwai Memorial Institute of Oncology.

_DP