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Ovarian Cancer

Cancer occurs when cells undergo a transformation and begin to grow and multiply without normal controls. As the cells grow and multiply, they form masses called tumors. Cancer is dangerous because it overwhelms healthy cells by taking their space and the oxygen and nutrients they need to survive and function.

Ovarian Cancer Causes

In 95% of ovarian cancer cases, no identifiable cause is present; however, family history does play a role.
  • The lifetime risk for US women of developing ovarian cancer is 1.4%.
  • If one first-degree relative -a mother, sister, or daughter -has the disease, the risk increases to 3-5%.
  • The risk can climb to 50% if 2 first-degree relatives have the disease.
  • If a woman has ovarian cancer and her daughter develops ovarian cancer, the daughter will probably develop the cancer at a relatively young age (younger than 60 years).

Ovarian cancer has been linked with 3 hereditary syndromes.
  • Breast-ovarian cancer syndrome
  • Hereditary nonpolyposis colorectal cancer syndrome
  • Site-specific ovarian cancer syndrome
Breast-ovarian cancer syndrome: A mutation in a gene called BRCA1 has been linked to increased risk of both breast and ovarian cancer.

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Ovarian Cancer Symptoms

Ovarian cancer is difficult to diagnose because symptoms often do not occur until late in the disease. Symptoms do not occur until the tumor has grown large enough to apply pressure to other organs in the abdomen, or until the cancer has spread to remote organs. The symptoms are nonspecific, meaning they could be due to many different conditions. Cancer is not usually the first thing considered in a woman having symptoms.

The only early symptom of the disease is menstrual irregularity. Symptoms that come later include the following: -
  • Pelvic pain or pressure
  • Pain with intercourse
  • Abdominal swelling and bloating
  • Urinary frequency
  • Constipation
  • Ascites - Collection of fluid in the abdomen, contributing to abdominal distension and shortness of breath
  • Loss of appetite
  • Feeling full after eating little
  • Gas and/or diarrhea
  • Nausea and vomiting
  • Abnormalities in menstruation, pubertal development, and abnormal hair growth (with tumors that secrete hormones)

Exams and Tests

Many exams and tests are used to determine if a woman has ovarian cancer.

Physical exam : - Every woman should have an annual pelvic exam in which the health care provider feels (palpates) the ovaries and obtains a Pap smear (Papanicolaou test).
  • Although the Pap smear is designed to check for cervical cancer, there have been some rare cases in which abnormal ovarian cells were identified with this test.
  • Ovaries are normally small, especially in women who have been through menopause, and are deep within the pelvis. Normal-sized ovaries are difficult to feel. Because of this, the pelvic exam is not very effective in detecting early ovarian cancer.
  • Masses large enough to be felt may represent advanced disease. More often, they are harmless growths or other noncancerous conditions.

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Ovarian Cancer Treatment

Treatment of ovarian cancer should be under the direction of an experienced gynecologic oncologist (a specialist in women's cancers).

Surgery is the usual first treatment for ovarian cancer. Whenever possible, the surgery takes place at the time of exploratory laparotomy. The operation is paused while the pathologist rapidly reviews the biopsy tissues. The pathologist's report determines the structures affected by cancer and if they should be removed. This spares the woman from undergoing another surgery.

  • Stage I : - tumors, only the involved ovary and fallopian tube may be removed for women who wish to become pregnant in the future. For women who do not wish to become pregnant, both ovaries, both fallopian tubes, and the uterus are removed. This is a hysterectomy with bilateral (2-sided) salpingo-oophorectomy. Usually this procedure removes the lymph nodes surrounding these organs and the omentum. If the tumor cell type is especially worrisome (grade 3 tumors and all stage IC tumors), chemotherapy is usually given as well.
  • Stage II: -cancer treatment involves removal of the uterus, ovaries, and fallopian tubes, resection (partial removal) of any tumor in the pelvic area, and resection of any other structures affected with cancer. Chemotherapy is strongly recommended. The best treatment at this time involves a platinum-based agent (carboplatin) and paclitaxel (Taxol). These agents are administered in 6 cycles of 3 weeks each.
  • Stage III : - treatment is identical to stage II treatment, except more aggressive chemotherapy and possibly experimental treatments are given. Some women may be candidates for direct abdominal treatment. This type of treatment is referred to as peritoneal therapy. This type of therapy is more difficult to take but may improve survival.
  • Stage IV : - treatment involves extensive debulking and multi-agent chemotherapy.
  • After chemotherapy is completed, the woman may undergo "second-look surgery." Her surgeon will examine her remaining pelvic and abdominal structures for evidence of residual cancer. Samples of fluid and tissues may be taken to check for residual cancer cells.

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