Ovarian Cancer

Ovarian tumours are classified by the cell type from which they originate. The distinction matters because each subtype behaves differently and responds to different treatments.

• High-grade serous carcinoma (HGSC) — the most common and aggressive subtype, accounting for roughly 70% of epithelial ovarian cancers. Strongly associated with BRCA1/2 mutations. Often presents at an advanced stage.
• Endometrioid and clear cell carcinoma — frequently associated with endometriosis. Clear cell carcinoma is relatively platinum-resistant and requires careful treatment planning.
• Mucinous carcinoma — accounts for fewer than 5% of ovarian cancers. When advanced, it must be distinguished from metastatic colorectal or appendiceal cancer.
• Germ cell tumours — arise from the egg-producing cells. Common in adolescents and young women. Subtypes include dysgerminoma, yolk sac tumour, and immature teratoma. Highly responsive to chemotherapy; fertility-sparing surgery is usually possible.
• Sex cord–stromal tumours (e.g., granulosa cell tumours) — slow-growing tumours that produce hormones. May cause abnormal uterine bleeding due to excess oestrogen production.
• Borderline (low malignant potential) tumours — grow slowly, rarely metastasise, and carry an excellent prognosis. Conservative, fertility-sparing surgery is standard treatment for most patients.

Ovarian cancer has no single cause, but a combination of genetic, hormonal, and lifestyle factors influences individual risk.

• BRCA1 mutation — carries a lifetime ovarian cancer risk of 35–46%; average age of onset is 10–15 years earlier than sporadic cases.
• BRCA2 mutation — lifetime risk of 13–23%. Also raises risk of breast, pancreatic, and prostate cancer in the same family.
• Lynch syndrome (MLH1, MSH2, MSH6, PMS2) — associated with endometrial and ovarian cancers alongside colorectal cancer.
• Family history — having a first-degree relative with ovarian cancer roughly triples personal risk.
• Personal history of breast cancer — particularly triple-negative breast cancer diagnosed before age 50.
• Endometriosis — modestly increases risk of endometrioid and clear cell ovarian carcinoma.
• Age and menopausal status — peak incidence is between 55 and 65; risk rises significantly after menopause.
• Prolonged oestrogen-only HRT — associated with a small increase in risk after five or more years of use.
• Nulliparity and infertility — women who have never been pregnant or who used fertility treatments face a slightly higher risk.

Protective factors include oral contraceptive use (risk reduction of up to 50% with 10 years of use), multiple pregnancies, breastfeeding, and bilateral salpingo-oophorectomy in high-risk BRCA carriers.

Ovarian cancer is sometimes called a “silent disease,” but research shows it does produce symptoms — they are simply vague and easy to dismiss as digestive or menstrual problems. The key is persistence: symptoms that are new, occur frequently (more than 12 days per month), and represent a change from your normal pattern warrant evaluation.

• Persistent bloating or abdominal swelling that does not resolve
• Feeling full quickly when eating, or loss of appetite
• Pelvic or lower abdominal pain or pressure
• Frequent or urgent need to urinate without a urinary tract infection
• Unexplained fatigue or lack of energy
• Change in bowel habits — constipation, loose stools, or narrow stools
• Unexplained weight loss or a noticeable increase in abdominal girth
• Postmenopausal vaginal bleeding or new intermenstrual bleeding in premenopausal women
• Pain during intercourse
• Back pain or leg swelling (may indicate lymph node involvement in advanced disease)

If you have a known BRCA mutation or strong family history, report any of these symptoms to your gynaecologist without delay rather than adopting a watch-and-wait approach.

No single test reliably detects ovarian cancer in all women. Diagnosis follows a structured clinical pathway designed to risk-stratify pelvic masses before committing to surgery.

• Transvaginal ultrasound (TVS) — the most sensitive first-line imaging modality. Evaluates ovarian size, morphology, internal echogenicity, septations, and Doppler vascularity patterns. IOTA criteria (ADNEX model) help risk-classify findings.
• CA-125 blood test — a serum tumour marker elevated in approximately 80% of advanced epithelial ovarian cancers, but less reliable in early disease and elevated in benign conditions (endometriosis, fibroids, PID, and even menstruation).
• HE4 and ROMA score — a more specific marker panel that combines CA-125 and HE4 to improve discrimination between benign and malignant pelvic masses, particularly in premenopausal women.
• CT scan (chest, abdomen, pelvis) — assesses peritoneal spread, lymph node involvement, diaphragmatic disease, and liver/spleen metastases. Determines surgical resectability.
• MRI pelvis — used for selected cases, particularly when TVS is inconclusive or in younger patients where radiation exposure is a concern.
• PET-CT — reserved for recurrent disease or equivocal findings on CT to assess metabolic activity of lesions.
• Staging laparoscopy or laparotomy — definitive diagnosis requires histopathological confirmation. Frozen section analysis at the time of surgery allows real-time decision-making about the extent of resection.

Ovarian cancer is staged surgically using the FIGO 2014 classification. Accurate staging at the time of initial surgery directly determines adjuvant treatment and prognosis.

• Stage I — Confined to the ovaries or fallopian tubes
  • IA: One ovary or tube; capsule intact; no malignant cells in ascites or washings.
  • IB: Both ovaries or tubes; otherwise as IA.
  • IC: Surgical spill (IC1), capsule rupture before surgery or surface tumour (IC2), or malignant cells in ascites/peritoneal washings (IC3).
• Stage II — Pelvic extension
  • IIA: Extension or implants on the uterus, tubes, or other pelvic structures.
  • IIB: Extension to other pelvic intraperitoneal tissues.
• Stage III — Peritoneal metastasis beyond the pelvis and/or retroperitoneal lymph node involvement
  • IIIA1: Retroperitoneal lymph nodes only (≤10 mm or >10 mm).
  • IIIA2: Microscopic peritoneal metastasis beyond the pelvis ± positive lymph nodes.
  • IIIB: Macroscopic peritoneal metastasis ≤2 cm beyond the pelvis ± positive lymph nodes.
  • IIIC: Macroscopic peritoneal metastasis >2 cm beyond the pelvis ± positive lymph nodes (including liver/spleen capsule).
• Stage IV — Distant metastasis
  • IVA: Pleural effusion with positive cytology.
  • IVB: Parenchymal liver or spleen metastasis, extra-abdominal lymph nodes, or bowel transmural involvement.

The majority of ovarian cancers (approximately 60%) are diagnosed at Stage III. Five-year survival ranges from >90% at Stage IA to approximately 20–30% at Stage IV — underscoring the importance of early detection.

Treatment planning is discussed by a multidisciplinary oncology team and tailored to the stage, histological subtype, BRCA/HRD status, and the patient’s fitness and fertility goals.

• Primary cytoreductive surgery (debulking) — the surgical cornerstone of ovarian cancer treatment. The goal is complete macroscopic cytoreduction (R0 resection — no visible residual disease). Procedures may include total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendicectomy, peritonectomy, and bowel resection where required. Complete cytoreduction is the single strongest predictor of improved survival in advanced-stage disease.
• Interval debulking surgery (IDS) — when primary upfront surgery is unlikely to achieve R0 resection, 3–4 cycles of neoadjuvant chemotherapy (NACT) are given first. IDS is then performed, followed by 3 further cycles of adjuvant chemotherapy. This approach is used in patients with extensive disease burden or significant medical comorbidities.
• HIPEC (Hyperthermic Intraperitoneal Chemotherapy) — at the time of cytoreductive surgery, heated cisplatin (42°C, 60–90 minutes) is circulated within the abdominal cavity to destroy microscopic peritoneal disease. OVHIPEC-1 trial data support its use in platinum-sensitive Stage III ovarian cancer undergoing IDS. Dr. Nishtha performs HIPEC procedures at KD Hospital, Ahmedabad.
• Adjuvant chemotherapy — carboplatin + paclitaxel for 6 cycles is the standard regimen for Stage IC and above. Intravenous delivery is most common; in selected patients with good performance status, dose-dense weekly paclitaxel may be considered.
• Bevacizumab (anti-VEGF therapy) — added to chemotherapy and continued as maintenance for high-risk Stage III/IV patients. Particularly beneficial in those with ascites at diagnosis or suboptimal cytoreduction.
• PARP inhibitor maintenance (Olaparib, Niraparib, Rucaparib) — for patients with BRCA1/2-mutated or HRD-positive (homologous recombination deficient) tumours in first-line remission, PARP inhibitor maintenance extends progression-free survival by 2–4 years in clinical trial data. BRCA testing at diagnosis is now standard of care.
• Fertility-sparing surgery — for carefully selected Stage IA Grade 1 or borderline tumours in women who have not completed their family, unilateral salpingo-oophorectomy with comprehensive surgical staging may be offered. Dr. Nishtha discusses individualised options with patients who want to preserve fertility.

Dr. Nishtha Tripathi Patel offers comprehensive ovarian cancer care across three Ahmedabad hospitals — Sterling Hospitals (Sindhubhavan Road), KD Hospital (Bopal), and Welcare Speciality Hospital. Complex cytoreductive surgery and HIPEC are performed at KD Hospital, which is equipped for extended operating times and high-dependency post-operative care. Robotic-assisted minimally invasive surgery for early-stage disease is available at Sterling Hospitals.

For patients travelling from Surat, Vadodara, Rajkot, Bhavnagar, or other parts of Gujarat, Dr. Nishtha offers structured remote second opinions. Share your pathology reports, CT scans, and CA-125 / HE4 values in advance to enable a focused first consultation and avoid unnecessary repeat investigations. This is particularly valuable for patients who have already received a diagnosis elsewhere and need an independent surgical opinion before committing to a treatment pathway.