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Ovarian Cancer

Dr. HelloDox Care #
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Ovarian cancer is a type of cancer that begins in the ovaries. The female reproductive system contains two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the hormones estrogen and progesterone.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully.

Surgery and chemotherapy are generally used to treat ovarian cancer.

Symptoms
Early-stage ovarian cancer rarely causes any symptoms. Advanced-stage ovarian cancer may cause few and nonspecific symptoms that are often mistaken for more common benign conditions.

Signs and symptoms of ovarian cancer may include:

Abdominal bloating or swelling
Quickly feeling full when eating
Weight loss
Discomfort in the pelvis area
Changes in bowel habits, such as constipation
A frequent need to urinate
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.

If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers.

Causes
It's not clear what causes ovarian cancer, though doctors have identified factors that can increase the risk of the disease.

In general, cancer begins when a cell develops errors (mutations) in its DNA. The mutations tell the cell to grow and multiply quickly, creating a mass (tumor) of abnormal cells. The abnormal cells continue living when healthy cells would die. They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).

Types of ovarian cancer
The type of cell where the cancer begins determines the type of ovarian cancer you have. Ovarian cancer types include:

Epithelial tumors, which begin in the thin layer of tissue that covers the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.
Stromal tumors, which begin in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed at an earlier stage than other ovarian tumors. About 7 percent of ovarian tumors are stromal.
Germ cell tumors, which begin in the egg-producing cells. These rare ovarian cancers tend to occur in younger women.
Risk factors
Factors that can increase your risk of ovarian cancer include:

Older age. Ovarian cancer can occur at any age but is most common in women ages 50 to 60 years.
Inherited gene mutations. A small percentage of ovarian cancers are caused by gene mutations you inherit from your parents. The genes known to increase the risk of ovarian cancer are called breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2). These genes also increase the risk of breast cancer.

Other gene mutations, including those associated with Lynch syndrome, are known to increase the risk of ovarian cancer.

Family history of ovarian cancer. People with two or more close relatives with ovarian cancer have an increased risk of the disease.
Estrogen hormone replacement therapy, especially with long-term use and in large doses.
Age when menstruation started and ended. Beginning menstruation at an early age or starting menopause at a later age, or both, may increase the risk of ovarian cancer.
Prevention
There's no sure way to prevent ovarian cancer. But there may be ways to reduce your risk:

Consider taking birth control pills. Ask your doctor whether birth control pills may be right for you. Women who use oral contraceptives may have a reduced risk of ovarian cancer. But oral contraceptives do have risks, so discuss whether the benefits outweigh those risks based on your situation.
Discuss your risk factors with your doctor. If you have a family history of breast and ovarian cancers, bring this up with your doctor. Your doctor can determine what this may mean for your own risk of cancer. In some cases, your doctor may refer you to a genetic counselor who can help you decide whether genetic testing may be right for you. If you're found to have a gene mutation that increases your risk of ovarian cancer, you may consider surgery to remove your ovaries to prevent cancer.

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Reducing ovarian cancer risks in high-risk women

Dr. HelloDox Care #
HelloDox Care
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Ovarian cancer is almost always diagnosed at a later stage, after it has spread beyond the ovaries and is difficult to treat. That’s one of the reasons it continues to have the highest mortality rate of all women’s cancers.

There is no effective screening or early detection available, so the Familial Ovarian Cancer Clinic (FOCC) at Women’s College Hospital (WCH) is focused on prevention. The clinic’s goal is to stop cancer from ever developing in high-risk women, such as those with BRCA1 or BRCA2 mutations.

Clinic co-director Dr. Michelle Jacobson describes the FOCC as a comprehensive, full-service clinic offering high-risk women options that reduce their risks across their reproductive lives.

“That may start as early as contraception counselling, for young women who are worried about what kind of hormones are safe to take because they’re concerned about both their breast and ovarian cancer risk,” Dr. Jacobson says, explaining that taking hormones – such as birth control pills – can increase breast cancer risks in women with BRCA mutations, although the same hormones may protect against ovarian cancer.

“That may be followed by a discussion around fertility preservation, or genetic testing of embryos for BRCA genes,” she says. “Then we talk about risk reduction surgery.”

The clinic at WCH offers the full range of ovarian cancer risk-reduction surgeries, including removal of the fallopian tubes (salpingectomy), removal of the ovaries and fallopian tubes (salpingo-oophorectomy), and removal of the uterus, ovaries and fallopian tubes (hysterectomy and salpingo-oophorectomy).

Managing menopause

While removal of the ovaries prevents ovarian cancer, it also puts a woman into surgical menopause, which can induce vasomotor symptoms like hot flashes, and genitourinary symptoms such as vaginal dryness, and also increases risks for osteoporosis and cardiovascular disease.

“Menopause management is a discussion based on the individual patient,” Dr. Jacobson says. In the general population, the most effective treatment for menopausal symptoms is hormone therapy, but that may not be an option for some women with BRCA mutations.

“Whether they have had breast cancer, whether they are at high risk, whether they have had mastectomies – all of these things play into that discussion,” she says, adding that the clinic strives to find solutions for women who cannot use hormones. “If there are contraindications to hormone therapy, there is a whole discussion around how can we really optimize women’s lifestyles, health promotion, vasomotor symptoms and quality of life.”

Because of the implications of early surgical menopause, there are cases in which removing just the fallopian tubes and leaving the ovaries in place until a later date may be an option.

“It’s pretty well established that high-grade serous cancer does not originate in the ovary, but originates in the fallopian tube, so there’s good rationale that removing the fallopian tubes can be risk-reducing,” says clinic co-director Dr. Marcus Bernardini. However, because the fallopian tubes and the ovaries are in close contact, it’s impossible to be certain that every last fallopian tube cell has been surgically removed without also removing the ovaries. For that reason, the risk reduction from removing the fallopian tubes alone may not match that of a salpingo-oophorectomy.

“We think that certainly removing the fallopian tubes will reduce risk. Does it reduce to the same degree as if you take the entire complex of the ovary? We’re not sure. Obviously it doesn’t have the other protective effects that removing the ovary does, such as protection against breast cancer down the line. So the recommendations for treatment today are still the removal of both the ovaries and the fallopian tubes,” Dr. Bernardini says.

That recommendation may need to balanced with other factors in some patients. Dr. Bernardini gives the hypothetical example of a 36-year-old woman with a BRCA1 mutation, who has already had breast cancer and will not be able to take hormones to help manage menopausal symptoms.

“Removing her ovaries and fallopian tubes puts her into menopause at the age of 36. That is an option, but there is going to be a change to her quality of life in doing that,” he says. “So for these individuals, is there an intermediary step: removing the fallopian tubes? Maybe we’re not going to get 100 per cent protection, but we’ll get 97 per cent protection. It seems like a very reasonable strategy to undertake in the right individual.”

Identifying risks

The first hurdle in preventing ovarian cancer is identifying women at high risk. When researchers first discovered that BRCA1 and BRCA2 mutations were linked to increased risk of ovarian cancer in addition to breast cancer, it was believed that BRCA mutations were involved in about 10 per cent of ovarian cancers. However, more recent research has shown that BRCA mutation is most strongly linked to one specific subtype of ovarian cancer: high-grade serous ovarian cancer.

“When you look at just this population of ovarian cancers, BRCA rates are higher than 10 per cent, and some literature shows they may be as high as 20 per cent,” Dr. Bernardini says.

That discovery spurred an increase in genetic testing for women who have this subtype of cancer, which also increased the number of ovarian cancer patients who were identified as having BRCA mutations. In turn, this led to testing of family members of those women, and the identification of people who had BRCA mutations who had not yet developed ovarian cancer, but who were at high risk and can benefit from risk reduction.

“So you’re going to have much larger population of individuals who are now at risk,” Dr. Bernardini says.

In addition, the Prevent Ovarian Cancer Program (POCP) at Princess Margaret Hospital is making testing available to a group of women who would not otherwise be eligible for testing: the daughters of women who died of high-grade serous ovarian cancer. Before 2010, only about 20 per cent of women with this subtype of cancer were tested for BRCA mutations, so their families do not know if the cancer was related to a mutation.

“These family members don’t qualify for testing, but we know that their theoretical risk may be upwards of 10 per cent for having a mutation,” Dr. Bernardini says.

Women with BRCA are also at high risk for breast cancer, but risk reduction strategies differ between the two types of cancer. Although breast cancer is more common than ovarian cancer, it also has screening options such as mammography.

“There really is not that option for ovarian cancer,” Dr. Bernardini says. “There is nothing you can do to identify it early.”

That’s why the FOCC is changing the focus to risk reduction in women with high genetic risks.

“We don’t want to be treating people’s cancers. We want to be preventing cancer,” says Dr. Jacobson. “By identifying high-risk individuals and then cascading down – testing and educating their family members – we’re going to actually induce that change and move from a treatment perspective to primary prevention.”

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स्त्रीबीजकोशाचा कॅन्सर

Dr. HelloDox Care #
HelloDox Care
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निसर्गाने स्त्रीला पुनरुत्पादनाच्या प्रक्रियेतील महत्त्वपूर्ण अधिकार बहाल केला आहे. त्यामुळे स्त्री-स्वाथ्याच्या दृष्टीने प्रजनन संस्थेतील अवयवांच्या आरोग्याचा विचार अनिवार्य ठरतो. प्रजनन संस्थेतील महत्त्वाचा अवयव म्हणजे स्त्रीबीजाची निर्मिती करणारा स्त्रीबीजकोश. आजच्या सदरात आपण स्त्रीबीजकोशाच्या कॅन्सरची माहिती जाणून घेणार आहोत.

स्त्रीबीजकोशाचा कॅन्सर
स्त्रीबीजकोशाचा कॅन्सर हा स्त्रियांमधील मृत्यूदराचे प्रमाण अधिक असणाऱ्या कॅन्सर प्रकारांत पाचव्या क्रमांकाचा कॅन्सर आहे. नॅशनल कॅन्सर इन्स्टिटय़ूटने २०१८ साली जगभरात स्त्रीबीजकोश कॅन्सरचे अंदाजे २२२४० नवीन रुग्ण असतील असा अंदाज वर्तविला आहे. स्त्रीबीजकोशाच्या कॅन्सरचे ५ वर्षे व्याधीमुक्त असण्याचे प्रमाण सुमारे ४७% आहे. भारतीय स्त्रियांमध्ये स्तन व योनिमुखाच्या कॅन्सरमागोमाग स्त्रीबीजकोशाचा कॅन्सर आढळतो.

संभाव्य कारणे
* वयाच्या चाळिशीनंतर स्त्रीबीजकोशाचा कॅन्सर होण्याची शक्यता अधिक;
* वयाच्या साठीनंतर स्त्रीबीजकोशाचा कॅन्सर होण्याची शक्यता दुप्पट;
* आहारात चरबीयुक्त पदार्थाचा अधिक प्रमाणात व वारंवार वापर;
* एकदाही गर्भधारणा न होणे;
* गर्भधारणेसाठी किंवा मासिक पाळी निवृत्तीनंतर इस्ट्रोजेनचा अधिक काळ औषध म्हणून वापर करणे;
* स्त्रीबीजाण्ड – स्तन किंवा आंत्र व गुदाच्या कॅन्सरची आनुवंशिकता
* बीआरसीए 1 व 2 सारख्या विशिष्ट जनुकांमध्ये झालेले बदल
* स्थौल्य
* धूम्रपान
* खालील पदार्थाचे वारंवार व अधिक मात्रेत सेवन
हिरवी मिरची, लाल तिखट, गरम मसाल्याचे पदार्थ, मांसाहार, वाल-पावटा-वाटाणा-राजमा-छोले-चवळी-मटकी यांसारखी वातूळ कडधान्ये, बेसन, ब्रेड-बिस्किटे असे अतिशय कोरडे पदार्थ, शीतपेय – आइस्क्रीम – फ्रिजमधील थंड पदार्थ, दही, केळे, काकडी, मिठाई
* उष्णसंपर्कात -उन्हात अधिक काळ काम करणे,
* दिवसा जेवणानंतर झोपणे,
* रात्री जागरण करण्याची सवय
* व्यायामाचा अभाव
* अतिशय चिंता करण्याचा तसेच तापट स्वभाव,
* मासिक पाळीच्या नैसर्गिक चक्रात व्यत्यय आणणारी, दीर्घकाळ घेतली गेलेली हार्मोन्सची चिकित्सा,

स्त्रीबीजकोशाच्या कॅन्सरची प्रमुख लक्षणे
* बरेचदा प्राथमिक अवस्थेत रुग्णस लक्षणे जाणवत नाहीत. रोगाचा प्रसार अन्य ठिकाणी झाल्यावर लक्षणे जाणवू लागतात.
* मासिक पाळी अनियमितता
* मासिक पाळीच्या वेळी अधिक प्रमाणात रक्तस्राव
* दोन मासिक पाळींच्या मध्ये किंवा मासिक पाळी निवृत्तीनंतर योनिगत रक्तस्राव होणे.
* योनिमार्गातून अनियमित रक्तस्राव.
* पोट फुगणे.
* पोटात दुखणे.
* थोडेसे अन्नसेवन केले तरी पोट जड होणे.
* भूक मंदावणे.
* मलबद्धता
* मथुनसमयी अतिशय वेदना होणे.
* अशक्तपणा.
* वजन कमी होणे.

अशी लक्षणे दिसल्यास वैद्यकीय सल्ल्याने ट्रान्सव्हजायनल सोनोग्राफी, पोटाची सोनोग्राफी, सी.टी. स्कॅन, पेट स्कॅन, लॅपॅरोस्कोपी, बायॉप्सी, सीए-125 ही रक्त तपासणी करून स्त्रीबीजकोशाच्या कॅन्सरचे निदान निश्चित केले जाते.
* आधुनिक चिकित्सा
* शस्त्रकर्म – स्त्रीबीजकोशाचे व पूर्ण गर्भाशयाचे निर्हरण
* केमोथेरपी
* रेडिओथेरपी
* हार्मोनल चिकित्सा
* इम्युनोथेरपी
* आयुर्वेदीय चिकित्सा

1. शमनचिकित्सा – पित्तदोष व रक्तधातूचे प्रसादन करणारी अनंतमूळ, कमळ, कामदुधा अशी शीतगुणाची औषधे; वातदोषाच्या अनुलोमनासाठी एरंडस्नेह, हिंग्वाष्टक चूर्ण; स्त्रीबीजकोशाची रचना व क्रिया यावर विशेषत्वाने कार्यकारी शतावरी, आरोग्यवर्धिनी यांसारखी औषधे तसेच केमोथेरपी व रेडिओथेरपी काळात भूक वाढविणारी (दीपन), पचन सुधारणारी (पाचन), पित्ताचे शमन करणारी शमन चिकित्सा उपयुक्त ठरते.
2. रसायनचिकित्सा – स्त्रीबीजकोशाच्या कॅन्सरमध्ये आधुनिक चिकित्सा घेऊनही कॅन्सरचा पुनरुद्भव होणे, उदरपोकळीतील अन्य अवयवांत कॅन्सर पसरणे, उदरपोकळीत जलसंचिती होणे असे उपद्रव अनेक रुग्णांमध्ये उद्भवत असल्याने अशा अवस्थांमध्ये व्याधिप्रतिकारशक्ती वाढविणारी रसायन चिकित्सा लाभदायी ठरते.
3. पंचकर्म / शोधनचिकित्सा – रुग्णाचे बल चांगले असल्यास कॅन्सरच्या अपुनर्भवासाठी दरवर्षी बस्ति व वमन चिकित्साही वैद्यांच्या मार्गदर्शनाखाली करणे हितकर ठरते.
4. पथ्यकर आहार – विहार मार्गदर्शन – षड्रसयुक्त, पचण्यास हलका, पाचक परंतु पोषक आहार तसेच नियमित व्यायाम, योगशिक्षकांच्या मार्गदर्शनाखाली नित्य प्राणायाम व योगासनांची जोड देणे श्रेयस्कर ठरते.
5. समुपदेशन- रुग्णाचा आत्मविश्वास वाढविण्यासाठी तसेच रुग्णाचा दृष्टिकोन सकारात्मक ठेवण्यासाठी समुपदेशन उपयुक्त ठरते.

Dr. Pratima Kokate
Dr. Pratima Kokate
MS/MD - Ayurveda, Ayurveda, 2 yrs, Pune
Dr. Sandeep Borse
Dr. Sandeep Borse
MBBS, Internal Medicine Specialist Neurotologist, 5 yrs, Pune
Dr. ATUL KALE
Dr. ATUL KALE
MS/MD - Ayurveda, Ayurveda Neurotologist, 15 yrs, Pune
Dr. Nitin Shingare
Dr. Nitin Shingare
MS/MD - Ayurveda, Ayurveda Dermatologist, 9 yrs, Pune
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