India celebrates September as the Ovarian Cancer Awareness month. And it is strange that the cancer which is responsible for approx 140,000 deaths annually the world over is still unknown to many people. Teal is the colour of the ribbon of ovarian cancer, which stands for hope and we hope to spread awareness through this special article by Dr Prathima Reddy MBBS, MRCOG (London), FRCOG (London), FACOG (USA), Director – Fortis La Femme, Bangalore, Senior Obstetrician and Gynaecologist. Read on..

The causes, symptoms and treatment

CAUSES

The exact cause of ovarian cancer is unknown. But certain risk factors have been identified.

The risk is increased in women who have never been pregnant. Women who have been pregnant have a 50% reduced risk compared to those who have never fallen pregnant. An early menarche and late menopause may also increase the risk. Multiple pregnancies like twins etc and the use of oral contraceptive pills reduce the risk.

A family history of ovarian cancer especially in a Ist degree relative increases the risk of ovarian cancer. Carriers of the BRCA1 and BRCA2 gene mutations have a higher risk of developing ovarian and breast cancer. Families with LYNCH II syndrome are also at high risk of developing ovarian cancer. Women with a history of breast cancer have a higher risk of ovarian cancer.

Post-menopausal hormone therapy is associated with an increased risk in the long term.

SYMPTOMS

Early ovarian cancer may have nonspecific or very minimal symptoms. Women may present with:
● Bloating and abdominal discomfort
● Change in bowel habits
● Indigestion
● Tiredness
● Weight Loss
● Loss of appetite

In the later stages they may present with:
● Increase in abdominal size
● Nausea and vomiting
● Swelling of the leg due to a deep vein thrombosis

TREATMENT
The mainstay of treatment is surgery followed by chemotherapy in most cases.

Myths and Facts

Myth: It does not affect young women
Fact: Not true. About 20% of women with ovarian cancer are less than 50 years of age.

Myth: A hysterectomy prevents ovarian cancer
Fact: Removal of the uterus tubes and ovaries reduces the risk of ovarian cancer by 95% but there is still a 5% chance of ovarian cancer cells developing. There is also a risk of developing peritoneal cancer.

Myth: Pap smear can detect ovarian cancer.
Fact: Wrong. There is no routine screening test for ovarian cancer.

Myth: It is a silent killer
Fact: Ovarian cancer is associated with non-specific symptoms such as bloating of abdomen, pain, feeling full, passing urine frequently. The important thing is to be aware of these symptoms and consult a gynaecologist if they are persistent.

Myth: I cannot do anything to reduce the risk
Fact: Using the birth control pill reduces the risk. Factors that increase your risk are: smoking, obesity, giving birth to your first child after 30, not having any children, not breastfeeding, and using HRT.

Datas that would take you by surprise

Ovarian cancer is the third most common cancer in Indian women preceded by cervical and breast in that order.
The incidence of ovarian cancer is between 5.4 – 8/100000.

It has the worst prognosis amongst gynaecological cancers with is a 5 year survival rate of 45%.
This is primarily because most often it is diagnosed in Stage III or IV.

Does Talcum powder cause ovarian cancer ?

There are some studies that suggest that prolonged use of talcum powder for feminine hygiene may increase the risk of ovarian cancer. How this causes cancer is unknown. There may be other contributory factors apart from the talcum powder itself that may increase the risk.

However, as a precaution, it may be better to avoid using talcum powder as a part of feminine hygiene.