Ovarian Cancer Treatment in Bangalore, India
Cervical cancer surgery (Radical Hysterectomy or Wertheim’s Operation) can be performed by conventional open method or by laparoscopy. Laparoscopic or Laproscopic cancer surgery has several advantages over conventional open surgery with same cure rate. Only surgery is curative in most of the cancers. Additional therapies (chemotherapy & radiotherapy) are mostly supportive. But, many patients and their relatives try to avoid surgery for the fear of the immense trauma for their loved ones, resulting in patient getting wrong or less effective treatment. With laparoscopy the trauma is much less and makes the treatment more acceptable. The Team MACS precisely addresses all these issues and works relentlessly for a better life.
Dr. Sandeep Nayak
MBBS, MRCSEd, DNB (Gen Surg),
MNAMS (Gen Surg), DNB (Surgical Oncology),
Fellowship in Laparoscopic and Robotic Onco-Surgery.
Dr Nayak is one of the leading senior Surgical Oncologists (cancer surgeon) of Bangalore. He is one of the pioneers of Laproscopic (laparoscopic) cancer treatment (surgery).
The Advantages Of Robotic & Laparoscopic Cancer Surgery Include
Least Pain and Discomfort
Less Blood Loss
Least Pain and Discomfort
Avoid Unnecessary Major Surgery
Quick Return to Normal Life and Work
Get All the Advantages of Robotic Surgery
Better Vision Quality for the Surgeon
Better Preservation of Pelivic Nerves maintaining the Sexual & Urinary Functions
Cosmetically better (Smallest Wound and Scars)
Least Wound Complications, Less Risk of Wound Infections After Colostomy.
What is Ovarian Cancer?
Ovarian cancer is the abnormal development of cells in the ovaries. The cells multiply and easily penetrate and attack healthy body tissues.
The ovary is the organ where ova or eggs are produced. It is a female reproductive organ. Normal women have a pair of ovaries on either side of the uterus, which produces a single egg every month during reproductive age.
ovarian tumors
Ovaries are also responsible for producing female hormones such as estrogen and progesterone. Women have two fallopian tubes, one on each side of the uterus. These tubes are long and slender. The fallopian tubes assist in carrying eggs from the ovaries to the uterus.
Ovarian cancers are divided into several types based on where within the ovary cancer starts from. They are classified into four stages commonly represented by the Roman numerals I-IV. The presence of cancer in its early stages indicates that it has spread to the ovaries.
Cancer has spread to other parts of the body by the fourth stage. High-grade serous carcinoma is the most common type of ovarian cancer, accounting for nearly 70% of all cancers of ovary.
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Types of Ovarian Tumors
- Benign tumors of the ovary: These can be cystic (fluid-filled) or solid tumors. All cysts of the ovary are tumors. These appear and disappear throughout life and usually have no implications (functional) and do not need any treatment. Benign tumors of the ovary like mucinous or serous cystadenomas or cystic teratomas, or fibromas account for 70% of ovarian tumors. These tumors need to be surgically removed if they fail to respond to conservative treatment, as some can turn cancerous if left untreated. Epithelial (arising from the surface) Ovarian cancer accounts for about 70% of all ovarian cancers. The origin of the tumor could be from the surface of the ovary, fallopian tube, or the inner lining of the abdomen (peritoneum). Microscopically these can be serous, mucinous, clear cell, and endometrioid variety. Serous cell type is the most common variety. All these are treated the same way.
- Borderline ovarian tumors: These tumors originate in the epithelial layer but are less aggressive than epithelial ovarian cancer. They are less than 10% of epithelial ovarian cancers. Often, they are serous or mucinous cell types. They often have presentations of large masses but uncommonly spread far. Usually, surgery is curative in these cases. HIPEC surgery is often used in these cases.
- Other ovarian tumors: Germ cell tumors and sex cord-stromal tumors usually occur at a young age. These tumors arise from the inner substance of the ovary. These are generally less aggressive cancers. These are detected early due to pain or other symptoms. Surgery can cure most of these cases.
Symptoms and Diagnosis of Ovarian Cancer
Ovarian tumors are notoriously asymptomatic. Nowadays, the ovarian tumor is detected on routine ultrasound examination and further investigated. In some other cases, they may cause early symptoms. The most common symptoms of ovarian cancer include:
- abdominal pain and/or stiffness
- loss of appetite
- constipation or indigestion
- urge to urinate frequently
- sudden weight loss
These symptoms are very common and do not always represent ovarian cancer. If these symptoms appear almost daily for more than 2 or 3 weeks, they should be investigated.
An ultrasound scan usually suspects the diagnosis. CT scan may be used to see a distant spread. Needle biopsy (FNAC) should never be performed on suspected early ovarian tumors as this can burst cancer and convert early cancer into 4th stage cancer. Needle biopsy is performed only in advanced cancers before giving chemotherapy.
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Staging & Treatment
Most ovarian cancers can only be staged accurately during surgery, which serves both as treatment and a staging procedure (conventional surgery is called staging laparotomy). This is also called cytoreductive surgery (CRS). In this case, Team MACS may perform diagnostic staging laparoscopy as the first step of the surgical process. This gives a better idea about the stage of the disease and the possibility of surgery.
The most commonly followed staging system for these tumors is proposed by FIGO (International Federation of Gynecology and Obstetrics).
Ovarian tumor surgery can be performed by conventional open method or by laparoscopy or robotic surgery. Laparoscopic or robotic cancer surgery has several advantages over traditional open surgery with the same cure rate for most cancers. In most early cancers, only surgery is curative. Chemotherapy is primarily additional therapy.
The trauma associated with laparoscopy or robotic is significantly lower than open surgery, making the treatment more tolerable. Team MACS explicitly addresses these problems, which work tirelessly for a healthy life.
Benign tumors of the ovary are best treated laparoscopically (Total Laparoscopic Hysterectomy or Laparoscopic Salpyngo-oophorectomy or Laparoscopic cystectomy).
Treatment of Ovarian Cancer Based on Stage
Stage IA
Cancer is limited to one ovary, and the tumor is confined to the inside of the ovary. There is no cancer on the ovary’s outer surface. There are no ascites (abdominal free fluid) containing malignant cells. The ovary capsule is complete. Germ cell and sex cord-stromal tumours are common at this stage.
Treatment: In the case of epethilial cancers it is imperative to perform a cytoreductive surgery (CRS) which includes the removal of the uterus, both ovaries and tubes, and lymph nodes. Some of these can be performed laparoscopically or robotically.
As Germ cell and sex cord-stromal tumours occur at a young age, fertility preservation is essential. The standard procedure for stage IA today is laparoscopicone sidedsalpingo-oophorectomy. The cure is possible in most cases. Chemotherapy is needed in most cases.
Stage IB & II
These stages indicate that the cancer is limited to the pelvic organs, pelvis (lower part of the abdomen). The lowest of the stage (IB) indicates the involvement of both ovaries. Stage II shows the involvement of other pelvic organs. There are no peritoneal or lymph nodal deposits (inner lining of the abdomen).
Treatment: These stages are best treated with surgical removal of the uterus with both the ovaries and tubes. The omentum (the large fatty structure that essentially hangs off your colon’s middle and drapes over the intestines inside the abdomen) is also removed.
These stages also benefit from eliminating lymph nodes along the aorta as the disease may be spread in up to 30% of patients into these. This can be performed by conventional open method or by laparoscopy. Chemotherapy is needed in these cases.
Stage III
In this stage, cancer has spread beyond the pelvis (lower part of the abdomen) into the upper part of the abdomen, and/or cancer has spread to lymph nodes. Many of these patients have large fluid collections (ascites) in the abdomen.
Treatment: When stage III is diagnosed before surgery, most oncologists advise chemotherapy first, followed by surgery to make surgery easier by reducing the bulk of the disease. This can be performed by conventional open method or by laparoscopy. However, surgery may be performed in some cases as the first step.
The surgical procedure is cytoreductive surgery (CRS), however, many of the patients may be benefitted by adding Hyperthermia Intra-PeritonealChemotherapy (HIPEC) to this. In some patients where we want better response or who are not responding to chemotherapy well, we could use PIPAC to increase the response.
