It is the usual discomfort that most women have – puffiness of the tummy, feeling bloated and back pain.
Don’t just write them off. For these “very vague” symptoms could be a pointer that something is not right with the ovaries, MediScene learns.

Check them out, for they may be the vague but very first symptoms of ovarian cancer, was the strong message given by an eminent panel of three Oncologists recently who also sent forth a ray of hope about the novel therapies available in Sri Lanka.

The panel comprised Senior Consultant in Medical and Radiation Oncology, Dr. Jayantha Balawardane and Consultant in Medical and Radiation Oncology, Dr. Mahendra Perera, both attached to the Maharagama National Cancer Institute and former Professor and Head of Medical Oncology of the TATA Memorial Hospital, Mumbai, India, Dr. Purvish M. Parikh. Dr. Balawardane is also President of the Sri Lanka College of Oncologists while Dr. Perera is the President-elect.

Sounding a warning that lack of awareness on ovarian cancer could bring about a gloomy outcome, if detection is late, Dr. Balawardane pointed out that although among the cancers affecting women, breast cancer is No. 1, cervical cancer No. 2 and ovarian cancer No. 3, it is difficult to treat.

As the symptoms are vague and non-specific, he stressed that most patients come in only at Stage III which is quite late or advanced. There are four stages – I, II, III and IV. So, ovarian cancer poses “a real problem”.

Worldwide, of around 230,000 detected annually with ovarian cancer, about 140,000 succumb, making it the eighth most common cancer and the seventh most common cause of female cancer deaths.

In Sri Lanka, for 2012 around 760 ovarian cancer patients have been detected while it is indicated to be the 9th on the cancer list in the country. About 70% of the ovarian cancers in Sri Lanka are diagnosed in Stages III or IV.
Ovarian cancer usually peaks after women hit 50, while those most vulnerable are 60 or older, Dr. Balawardane said, with Dr. Perera underscoring the importance of undergoing basic screening at a well-woman clinic to catch the disease early.
There is also a need for population-based screening under the Cancer Control Programme, Dr. Perera added.
“A good way to identify ovarian cancer is ultrasound scanning,” said Dr. Parikh, explaining that it would involve both a scan of the pelvis as well as a trans-vaginal scan (TVS). If a TVS detects something, a biopsy of the ovary should be performed to check whether it is malignant.

The signs and symptoms of ovarian cancer are:

• Bloating, with the feeling that the lower tummy area is swelled or full.
• Pain in the pelvic or tummy area.
•  Back pain.
• Feeling full when eating.
• Vaginal bleeding or discharge that is not usual.
• Wanting to pass urine badly or very often, constipation or diarrhoea.

Referring to the risk factors, the doctors said that they include being middle-aged or older; not having children or have had trouble becoming pregnant; a family history of cancer including breast, uterine or colon cancer; and having endometriosis in which tissue from the lining of the womb grows elsewhere in the body.

When detected, immediate surgery under the care of a multidisciplinary team is the answer, followed by chemotherapy and radiation, says Dr. Perera.

While the treatment would depend on the spread of the cancer, surgery will involve the removal of the cancer tissue, chemotherapy will halt or slow malignant cell growth and radiation will kill off the cancer cells.

Dealing with ‘debulking’, Dr. Perera explained that if the cancer has spread, this new surgical technique is used to take out everything, leaving behind nothing larger than one centimetre, for the prognosis is better then.

A novel therapy currently being used is ‘biological response modifiers’, he says adding that attempts are made to stimulate the immune response system of the patient against the cancerous tumour. Under this therapy administered with chemotherapy, the cancerous tumour is choked by not allowing it to develop new blood vessels which provide it nutrition.
While the country is progressing in cancer treatment, both Dr. Balawardane and Dr. Perera make an urgent plea to the women of Sri Lanka – cut down your obesity, as being fat could trigger many a disease including cancer.

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