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Early detection can prevent ovarian cancer

Ovarian cancer constitutes the third most common cancer among women of India. About 50% of the total cases occur between 45 - 65 years of age.

Early detection can prevent ovarian cancer
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The most preferred type of treatment is surgery plus chemotherapy. Early detection of cases and provision of early treatment of cases may go a long way to reduce the prevalence of ovarian cancer cases in India.

Treatment with Hyperthermic Intraperitoneal chemotherapy (HIPEC) along with cytoreductive surgery resulted in better survival outcomes than surgery alone in patients with advanced and recurrent stage of ovarian cancer. For advanced & recurrent ovarian cancer, such radical surgery combined with HIPEC offers the last glimpse of hope for improved disease free & overall survival, said Dr Rajasundaram, Director, Institute of Oncology, Gleneagles Global Health City.

It is a highly radical surgery which involves multiorgan resection such as Total hysterectomy & salphingoophorectomy, Pelvic & paraaortic lymphadenectomy, supracolic omentectomy, complete peritonectomy, debulking of all visible tumour deposits and bowel resection if indicated. HIPEC Therapy is a highly sophisticated technique by which chemotherapeutic agents are circulated within the abdominal cavity at 42 degrees Celsius for about 90 minutes using a specialized machine.

The HIPEC therapy has a better penetration of the drug into the tumour tissue and targets microscopic tumour deposits in peritoneal cavity invisible to naked eye. In this therapy, higher doses of chemo agents can be used and various studies have shown confirming evidence of improved disease free and overall survival.

Pre-operative chemotherapy is very beneficial in down staging the tumour & it also dramatically increases the possibility of complete surgical removal later. The surgery is usually performed after 3 or 4 cycles of chemotherapy. During surgery, the abdominal cavity is thoroughly assessed for residual tumour load using a scoring system called Peritoneal Carcinomatosis Index (PCI).

The surgery involves complete removal of all tumour deposits that are visible to naked eye. It is usually combined with radical hysterectomy, pelvic & para aortic lymphadenectomy, total omentectomy & total peritonectomy.  If required, resection of other involved organs is combined along i.e, sleeve/ distal gastrectomy, bowel resection, anterior resection of rectum & splenectomy.

The completeness of cytoreduction is calculated using a scoring system called as CC score. This is followed by intra-abdominal instillation of chemotherapeutic agents as described above which is targeted at microscopic tumour cells. It requires strict multidisciplinary approach & teamwork between surgical oncologists, medical oncologists, anaesthetists and intensivists.

According to Dr Pandidurai, chief oncologist, KVT Superspeciality Hospital, women in the age group 0f 50-60 years are more vulnerable, but in India, the incident is being observed with women of the age group 41-50 years since the past few years, which is a decade earlier than the global data.

“A timely screening through ultrasound of the abdomen and the pelvic parts is a wise and simple method towards the early detection of the disease. It aides towards an early treatment which in turn improves the quality of life for the patient. 20 percent of women are diagnosed positive for the BRCA gene, if one has had a family history of Breast or Ovarian cancer. It has been proposed that variation in the ovulation pattern, not exercising any children or later childbirth, obesity could be potential factors towards cancer,” said Dr Pandidurai.

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