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Ovarian Cancer: A Deadly Silent Killer

I was called to the emergency room in the hospital to see M as she was screaming in pain. She had intermittent mild abdominal cramps and bloating for the past one week. She did not pay much attention as she thought it was due to some spicy food she ate over the weekend.

M, 50, was rolling in pain when I saw her. Her abdomen was hard and bloated. When she was more settled, I could feel a huge mass in her lower abdomen. An urgent MRI (Magnetic Resonance Imaging) of the abdomen revealed a large left ovarian mass measuring 20 cm x 14cm x 11cm. It was a multiloculated cyst with many partitions and fluid-filled sacs. Some of the sacs had solid frond-like growth and one of these showed signs of bleeding. The abdomen was also filled with ascitic fluid and there were solid tumors on the omentum (a large flat fatty tissue covering the ovary) and the peritoneum (lining of the abdomen cavity). M was suffering from an advanced stage of ovarian cancer.

How common is Ovarian Cancer?

According to the Singapore Cancer Registry, ovarian cancer is the second most common female genital cancer and the fifth commonest cancer among women in Singapore. Its incidence is rising in recent years.

Ovaries contain 2 types of cells: epithelial cells and germ cells. Epithelial cell cancer is more common than germ cell cancer. The former occurs more often among older women while the latter affects younger women.

Why is ovarian cancer deadly?

Ovaries are located deep in the pelvic cavity and hidden away. As a result, early cancerous changes are more difficult to detect. By the time these changes occur, the tumor is usually in the later stages of development and spread.

Besides, in early stages, ovarian cancer seldom has symptoms and signs and they are usually non-specific such as bloating and indigestion. Screening tests like blood tumor markers and ultrasound examination may also not be as effective.

What are the symptoms and signs of ovarian cancer?

Please refer to the article “Ovarian Cancer” in this website

Risk Factors of ovarian cancer

Risk factors associated with ovarian cancer include:

  • Early onset of menstruation and late menopause

  • Family history of ovarian cancer

  • Late pregnancy or women who have never had children

  • History of breast cancer, womb cancer and colon cancer

  • Endometriosis

  • Menopausal hormone therapy

How is ovarian cancer diagnosed?

Ovarian cancer can be detected by using various imaging techniques-- vaginal ultrasound, CT scan and MRI. The size, solid areas, multiple partitions(septa), blood flow of the ovarian mass as well as ascitic fluid in the abdomen and tumors in adjacent organs may suggest the cancerous nature of the ovarian growth.

Blood tumor marker, CA125 may not be that accurate in diagnosing ovarian cancer even though it is raised in about 80% of patients with epithelial ovarian cancers. This is because it is also raised in non-cancerous conditions, such as endometriosis and appendicitis. The result of elevated CA-125 must therefore be interpreted with care. Surgical removal of the tumor is the ultimate proof that the tumor is cancerous and originates from the ovaries.

What is the treatment of ovarian cancer?

Ovarian cancer is usually treated by surgery and chemotherapy. M had an extensive surgery (debulking operation) done after her condition was stabilized. At the operation, the cancer was staged by checking the actual extent of the spread. Fluid in the abdomen was sent for analysis under a microscope. Her uterus, ovaries and fallopian tubes were removed together with the omentum. Tumor tissue of the peritoneum was removed.

She recovered well after the operation. Histology (microscopic examination) of the tumor confirmed Stage 3 ovarian cancer. She was referred to the oncologist and has been tolerating the first course of chemotherapy well.

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