According to experts, between 25 and 35 cases are diagnosed in Oman annually and the number has remained constant over the past several years. However the number of diagnosed cases is likely to increase over the next several years with awareness.
Dr Ikram A Burney, medical oncologist at the Sultan Qaboos University Hospital (SQUH) with special interest in research and the management of gynaecological cancers, said, “There are several types of ovarian cancers like high grade epithelial ovarian cancer that affects about 50-60 per cent cases. Low grade and borderline epithelial ovarian cancer affects 15-20 per cent cases; germ cell cancer of the ovary affects 15-20 per cent cases; cancers of the connective tissue of ovary affects two to three per cent of the population and secondary cancers of the ovary affects about five to ten per cent of cases.”
He added, “For a majority of instances, a definitive cause cannot be discerned. However, a proportion of epithelial ovarian cancers (10-15 per cent) occurs secondary to mutations in BRCA1&2 genes and run in the families. Besides, age and female hormone issues can also cause ovarian cancer.”
Dr Moza al Kalbani, a gynaecological oncologist at SQUH said, “Over the past five years or so, there have been some exciting developments in the management of the most common forms of ovarian cancer, the high grade epithelial ovarian cancer. The knowledge that up to 15 per cent of the patients may have mutations in the BRCA1&2 genes and many may have the genes inactivated have paved the way for prevention, screening and early detection, as well as treatment for this form of ovarian cancer.”
When to see the doctor?
Pain in the lower abdomen, not responding to usual medications for a few days, backache of uncertain origin, abnormal vaginal bleeding, indigestion or heartburn, feeling of fullness after eating small portion, nausea, vomiting, abdominal distention, breathlessness, urge to pass urine more frequently, change in bowel habits, and pain during sexual intercourse. Any or a combination of the above symptoms should prompt you to see the doctor.
How is it diagnosed?
A doctor would obtain detailed medical and family history, perform physical examination including vaginal examination, and conduct blood tests, tumour markers, ultrasound of the lower abdomen, CT scan of the chest, abdomen and pelvis, and MRI of the pelvis. Besides, colonoscopy may be performed to exclude chances of cancer arising from the colon in some cases. A final diagnosis is established by biopsy which may be obtained by aspirating fluid in the abdomen, or an ultrasound-guided biopsy either of the suspected ovary or any other suspected mass. Occasionally a mini surgery (laparoscopic surgery) may be needed to establish the diagnosis. A definitive diagnosis is always required to plan definitive treatment.
Treating ovarian cancer
Ovarian cancer is complex and requires multi-modal treatment. It should be managed in hospitals with the help of a multidisciplinary team.
Once diagnosed with one or the other forms of ovarian cancer, it is important for the patient to follow up with the medical oncologist or gynaecological oncologist for at least ten years.