Ovarian cancer is the second most common cancer in women after breast cancer. As the name goes, ovarian cancer begins within the ovarian lining but some ovarian cancers also begin in the distal end of the fallopian tubes. Before we understand more about ovarian cancer treatment in India, let us understand a little about ovarian cancer itself.
Ovarian cancer can be of three types based on its origin:
- Epithelial cell tumors – These form the most common type of ovarian cancers and arise from the cells lining the ovaries
- Germ cell tumours- These tumours arise from the germ cell or the egg(ova)
- Tumours arising from the stromal cells- These tumours arise from the cells responsible for producing hormones like oestrogen and progesterone.
Like most other cancers, ovarian cancers are said to be benign if they do not spread beyond the confines of the ovary, and malignant if they spread to other parts of the body.
As mentioned earlier, epithelial cell tumours are the most common type of ovarian cancer and can be classified as – benign, borderline malignant and malignant.
Stages of Ovarian Cancer
When a woman is diagnosed with ovarian cancer, the next crucial step is to determine it type and stage. This is usually done based on the type of cells detected in the diagnosis tests and the spread of the cancer. This information helps the oncologist understand and provide the best possible ovarian cancer treatment in India.
Ovarian cancer staging can be done using either of the two available systems – FIGO(International Federation of Gynaecology and Obstetrics) and the AJCC(American Joint Committee on Cancer) TNM classification. Both these systems are almost the same and use the same factors for determining the stage of ovarian cancer.
Stage-Wise Treatment Options
There are four stages of ovarian cancer and the treatment options vary:-
Stage 1 Ovarian Cancer Treatment:
The cancer is confined to the ovaries. Stage 1A means that the cancer is affecting only one ovary whereas, stage 1B means that the cancer has spread to both the ovaries. Also, stage 1C means that the cancer has affected both ovaries and either the outer capsule has broken during or before surgery and there are cancer cells outside the ovary, or cancer cells are found in the abdominal fluid.
Since stage 1 ovarian cancers do not spread out or far from the ovary, surgery is the main treatment. Some women, however, may also need chemotherapy after surgery if they have stage 1C ovarian cancer.
Stage 2 Ovarian Cancer Treatment:
In this stage, the cancer has affected either one or both the ovaries and has spread to other organs/tissues within the pelvis.
- -Stage 2A means that the cancer has spread from the ovaries to the fallopian tubes, uterus or both
- -Stage 2B means that the cancer has spread to other nearby organs such as the bladder, rectum or the colon
Doctors usually consider stage 2 ovarian cancers as advanced cases and the two mainstream ovarian cancer treatment in India for this stage include surgery and chemotherapy.
Whether the chemotherapy is done before, after the surgery or both is determined by the spread of the cancer and whether all of it can be removed by surgery or not.
When the cancer is removed surgically, chemotherapy may be advised as an adjuvant therapy. However, in some cases, chemotherapy may be advised before the surgery and afterwards as well.
Stage 3 Ovarian Cancer Treatment:
Stage 3 ovarian cancer when it affects one or both ovaries, lining of the abdomen and nearby lymph nodes.
- -Stage 3A ovarian cancer is it has spread to other organs in the pelvic region and the lymph nodes within the abdominal cavity
- -In stage 3B ovarian cancer, the cancer has spread to nearby organs in the pelvic region
- -In stage 3C, cancer cells can be found outside the liver and spleen or spread to other lymph nodes as well
Since stage 3 cancers spread outside of the ovaries, treatment includes surgery to remove the primary tumour. In most cases, the affected ovary/ovaries, and fallopian tubes are removed, along with the affected lymph nodes. Surgery is followed by chemotherapy that helps kill cancer cells that may have spread to other areas.
Targeted cancer drug therapy is also employed for ovarian cancer treatment in India to cure stage 3 cancers. This is done along with chemotherapy. Treatment decisions may vary and it is important to be in line international protocols for best outcomes.
Stage 4 Ovarian Cancer Treatment:
This stage of ovarian cancer is the most advanced and means that the cancer has spread to distant organs of the body. In stage 4A cancer, the cancer cells are detected in the pleural fluid around the lungs whereas, in stage 4B the cancer cells are found in organs like the brain.
This is the most advanced stage of ovarian cancer and the aim of treatment is to remove as much of the tumour as possible, improve the patient’s symptoms and overall health. Surgery and chemotherapy still remain the mainstay for stage 4 ovarian cancer treatment in India.
Chemotherapy may be done before and after the surgery, called as interval debulking surgery. It may be done post-surgery and this is called as debulking surgery. In some cases, wherein the patient cannot undergo surgery, chemotherapy is given to help improve the symptoms, shrink the tumour, stop the spread of cancer cells and improve the overall health of the patient. Other treatments include targeted chemotherapy drugs and radiotherapy.
Advanced treatment procedures such as cytoreductive surgery and HIPEC for ovarian cancer are being developed and widely used as they combine treatments like chemotherapy and regular surgery to overcome some challenges of fast-spreading peritoneal cancers.
As more cases of Ovarian cancer are getting diagnosed top Ovarian cancer experts in Gynaecological Oncology recommend genetic testing, next generation sequencing & second opinions. These tests provide chemo sensitivity to particular drugs and collaborative working of Indian experts along with international second opinion from top global cancer institutes is improving cancer survivorship.