Ovarian cancer develops when malignant cells form in the tissues of the ovary. The ovaries are part of the female reproductive system and produce eggs and female hormones. The most common form is epithelial ovarian cancer, which develops from tissue covering the ovary. Less common forms include ovarian germ cell tumours and other ovarian tumours.[1,2]
Ovarian epithelial cancer, fallopian tube cancer and primary peritoneal cancer develop from similar tissues and are generally treated in the same way. Ovarian cancer is often diagnosed at an advanced stage because early disease may not produce noticeable symptoms.[1,2]
Certain inherited genetic changes, particularly in the BRCA1 and BRCA2 genes, increase the risk of ovarian cancer. A family history of ovarian cancer and hereditary conditions such as Lynch syndrome are also associated with increased risk.[1]
Global Impact
Ovarian cancer is an important cause of cancer morbidity and mortality among women worldwide. The disease accounted for approximately 324,000 new cases and 207,000 deaths globally in 2022.[3]
The burden of ovarian cancer varies across populations, and incidence generally increases with age. Because the disease is frequently diagnosed after it has spread beyond the ovaries, ovarian cancer continues to have a substantial mortality burden.[1,3]
Impact in India
Ovarian cancer is one of the leading cancers affecting women in India. According to IARC GLOBOCAN 2022 estimates, approximately 47,333 new cases of ovarian cancer occurred in India, accounting for 6.6% of all new cancer cases among women.[4]
Ovarian cancer was the third most commonly diagnosed cancer among Indian women, following breast and cervical cancer. It was also among the three leading causes of cancer-related death among women in India.[4]
Signs and Symptoms
Ovarian cancer may not cause noticeable symptoms during its early stages. When symptoms develop, they can be nonspecific and may resemble symptoms caused by other common conditions.[1]
Common signs and symptoms include:
- Pain, discomfort or pressure in the abdomen or pelvis
- Abdominal swelling or persistent bloating
- Difficulty eating or feeling full quickly
- Frequent or sudden urge to urinate
- Constipation or other changes in bowel habits
- A lump or mass in the pelvic area.[1]
Persistent, worsening or unexplained symptoms should be medically evaluated because ovarian cancer is often at an advanced stage by the time symptoms become apparent.[1]
Treatment Modalities
Treatment of ovarian cancer depends on the type and stage of the cancer, extent of disease and the individual's overall health. The main treatments for epithelial ovarian cancer are surgery and chemotherapy, while targeted therapies are used in selected patients.[1,5]
i. Surgery: Surgery is a major component of ovarian cancer treatment. It aims to remove the cancer and determine the extent of disease. Depending on the stage, surgery may involve removal of one or both ovaries and fallopian tubes, the uterus and other affected tissues. In advanced disease, debulking surgery is performed to remove as much visible cancer as possible.[1,5]
ii. Chemotherapy: Chemotherapy uses medicines to destroy or control cancer cells and is commonly used after surgery. In some patients with advanced disease, chemotherapy may be given before surgery to reduce the amount of cancer that needs to be removed.[1]
iii. Targeted Therapy: Targeted therapies act on specific characteristics or pathways involved in cancer growth. They may be used in selected ovarian cancers, particularly in advanced or recurrent disease. Some targeted treatments, including PARP inhibitors, are particularly relevant for patients with certain genetic or molecular characteristics.[1]
Early Detection
Ovarian cancer can be difficult to detect early because symptoms may be absent or nonspecific. Screening methods such as pelvic examination, transvaginal ultrasound and CA-125 blood testing have not been shown to be sufficiently effective for routine screening of women at average risk.[6]
Women with a strong family history of ovarian or breast cancer or inherited genetic changes such as BRCA1 or BRCA2 mutations may have an increased risk of ovarian cancer and may benefit from genetic counselling and individualized risk assessment.[6]
References
- 1. National Cancer Institute. Ovarian epithelial, fallopian tube, and primary peritoneal cancers treatment (PDQ®)–patient version. Bethesda (MD): National Cancer Institute. Available from: https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq
- 2. National Cancer Institute. Ovarian, fallopian tube, and primary peritoneal cancer–patient version. Bethesda (MD): National Cancer Institute. Available from: https://www.cancer.gov/types/ovarian
- 3. International Agency for Research on Cancer. Global Cancer Observatory: ovarian cancer fact sheet. GLOBOCAN 2022. Lyon: International Agency for Research on Cancer; 2024. Available from: https://gco.iarc.who.int/
- 4. International Agency for Research on Cancer. Global Cancer Observatory: India fact sheet. GLOBOCAN 2022. Lyon: International Agency for Research on Cancer; 2024. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/356-india-fact-sheet.pdf
- 5. National Cancer Institute. Advances in ovarian cancer research. Bethesda (MD): National Cancer Institute. Available from: https://www.cancer.gov/types/ovarian/research
- 6. National Cancer Institute. Ovarian, fallopian tube, and primary peritoneal cancers screening (PDQ®)–patient version. Bethesda (MD): National Cancer Institute. Available from: https://www.cancer.gov/types/ovarian/patient/ovarian-screening-pdq