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Dr Kanwal Saeed

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Hilal Her

Ovarian Cancer – Its Symptoms and Prevention

May 2024

The female reproductive system consists of two ovaries, which are responsible for producing eggs or ova to release them monthly through a process known as ovulation. The regular process of cellular reproduction in the body is tightly controlled and maintained within a specific range. Ovarian cancer is characterized by the uncontrolled proliferation of cells in the ovary, resulting in the formation of a tumor. Untreated cancer has the potential to metastasize, meaning it can move to other areas of the body. 



The precise cause of ovarian cancer remains unknown, however, certain predisposing factors have been identified that elevate the likelihood of its occurrence. The risk of this condition is positively correlated with age, particularly in women who have reached menopause or are over the age of 50. Young women who develop this cancer often have a positive familial history, with two or more close relatives such as their mother or sister having the disease. The incidence of 1 out of 10 cases is attributed to the inheritance of the BRCA1 and BRCA2 gene mutations. Women who are unable to conceive or are receiving medical interventions for infertility are likewise more likely to develop ovarian cancer. Conversely, the likelihood of developing ovarian cancer is reduced by many pregnancies, breastfeeding, and the use of oral contraceptive pills. 
Annually, a significant number of ovarian cancer cases are detected in Pakistan. According to the Global Cancer Observatory, there were more than 4,000 new cases of ovarian cancer in Pakistan in 2020 and nearly 3,000 deaths from this type of cancer. Ovarian cancer is the second most prevalent gynecologic cancer, although regrettably it is the primary cause of gynecologic cancer fatalities. Ovarian cancer was once referred to as a “silent killer” for an extended period of time. The disease’s fatality is attributed to its delayed diagnosis. An early diagnosis of any disease is crucial for a favorable prognosis and higher chances of survival, as the disease is best treatable during its earliest stage. The 5-year survival rate for ovarian cancer is around 85-90% when diagnosed in the early stages, but it drops to about 10-30% in cases when the illness is diagnosed at an advanced stage. Regrettably, ovarian cancer is found at an advanced stage in over 70% of women, indicating a bleak outlook. 
Indications and Manifestations 
The initial manifestations of ovarian cancer are typically ambiguous and often intermittent, hence complicating the early detection process. Women generally attribute these vague symptoms to common factors such as aging, weight gain, menopause, or other minor disorders. However, in certain instances, these signs and symptoms might be mistaken for other illnesses, such as certain gastrointestinal diseases. 
Given the close correlation between the stage of ovarian cancer at diagnosis and its survival probability, it is crucial to develop efficient measures for early detection. A screening test aids in the early detection of a disease or its likelihood of occurring in persons who do not show any symptoms. Currently, there is a lack of a screening technology capable of detecting ovarian cancer in asymptomatic women or those without the BRCA gene mutation. The sole means of detecting this fatal cancer at an early stage is by recognizing its symptoms and carefully evaluating them. Early detection of these symptoms affords women an opportunity to combat the disease prior to its advancement. 
Bloating
Bloating refers to the unpleasant sensation of feeling full in the abdominal area. Most women commonly experience this sensation, particularly during their monthly cycle, which is considered normal. However, if a persistent bloating feeling lasts for up to three weeks, it should be a cause for concern. This is a prevalent initial indication of ovarian cancer. An abdominal mass gradually leads to abdominal distension. Chronic bloating accompanied by abdominal distention is a significant warning sign that should always be taken seriously. 
Constipation 
Difficulty in passing stools is a symptom that can have various origins, including stress, anxiety, gastrointestinal problems, and in rare cases, serious conditions such as ovarian cancer. Hence, it is crucial for women to vigilantly monitor any alterations in their bowel patterns, and any recently emerged constipation that remains unalleviated despite attempted remedies. 
Chronic Pain 
Pain is a prevalent symptom that can be associated with any illness. Nevertheless, a persistent sensation of pressure or discomfort in the belly, pelvis, or lower back, lasting for several weeks, is a significant indicator of a potentially severe issue. Women should prioritize analyzing the nature of this pain and discerning the elements linked to it in order to distinguish it from other potential causes. 
Anorexia 
Ovarian cancer patients commonly experience dysphagia, early satiety, and an inability to consume even modest portions of food. These symptoms arise from the enlarging ovarian mass in the abdominal region, which exerts pressure on the stomach, thereby diminishing the appetite. In addition, weight loss is a prominent symptom of any type of cancer. Hence, it is imperative for any woman experiencing substantial weight loss or a sudden decrease in appetite to never disregard these signs. 
Urinary Issues 
The predominant urinary issue encountered by women is dysuria or urine urgency, which is frequently attributed to urinary tract infection (UTI), a diagnosis that is often accurate. Bladder symptoms in women can also be a sign of a gynecologic or reproductive problem, including ovarian cancer. Individuals experiencing recent onset and persistent urinary symptoms such as bladder pain or pressure, painful urination, urgent or frequent urination should promptly seek medical attention.
Preventative Measures
The existing knowledge about ovarian cancer risk factors has not translated into practical preventive strategies. However, based on what has been learned so far, here are some tips on how to lower the risk of ovarian cancer:
•    Eat a healthy diet 
•    Make sure to incorporate regular exercise into your routine
•    Strive to achieve and maintain a balanced body weight
•    Avoid smoking or using any tobacco products
•    Having children and nursing them, particularly at a young age, can be a significant life experience 
•    If it is deemed suitable, consider undergoing a tubal ligation procedure as a means of preventing pregnancy 
•    If a hysterectomy is advised for medical reasons, along with reducing the risk of ovarian cancer, it may be considered
•    Consider undergoing a prophylactic oophorectomy to have one or both ovaries removed
•    Avoid the use of hormone replacement therapy following menopause

Women may encounter one or more of these issues at some point in their lives. These symptoms may arise from several causes, thus it is not imperative that they only stem from ovarian cancer. Typically, these symptoms are transient and can be alleviated with uncomplicated therapies. However, symptoms that are persistent and do not simply resolve may indicate the presence of ovarian cancer, necessitating a visit with a medical professional. As the tumor expands, the symptoms intensify and when it is identified, the cancer typically spreads to other organs, so making treatment exceedingly challenging. 
Any woman who experiences these symptoms regularly for over three weeks should promptly consult her doctor for a comprehensive examination and diagnostic tests. Early detection is crucial for the most effective treatment of malignancies.


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Dr Kanwal Saeed

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