سرطان بحري

Ovarian cancer is a group of cancers arising from the ovary, the fallopian tube or the lining of the abdomen, which behave alike and are treated together. The commonest type, high-grade serous carcinoma, is now thought to begin mostly in the fallopian tube. Rarer types, such as germ cell and stromal tumours, affect younger women and have a different outlook.

Symptoms are vague and there is no effective screening test, so most women are diagnosed after the cancer has spread within the abdomen. Treatment combines surgery by a gynaecological oncologist with platinum-based chemotherapy, often followed by maintenance tablets. The disease frequently returns and is then managed as a long-term condition.

Symptoms

• Persistent bloating or an increase in abdominal size
• Feeling full quickly or loss of appetite
• Pelvic or abdominal pain on most days
• Needing to pass urine more often or urgently
• A change in bowel habit, often labelled as irritable bowel for the first time after 50
• Unexplained tiredness, weight loss or back pain
• Bleeding after the menopause, or breathlessness from fluid around the lung

Causes and risk factors

Risk increases with age and with the number of ovulations over a lifetime, so it is higher in women who have had no pregnancies and lower in those who have had children, breastfed or used the combined pill for several years. Inherited BRCA1 and BRCA2 changes account for roughly 15 percent of high-grade serous cancers, and Lynch syndrome raises risk too; every woman diagnosed should be offered genetic testing. Endometriosis is linked to the clear cell and endometrioid types. Hormone replacement therapy slightly increases risk. Removal of the tubes and ovaries markedly reduces risk in gene carriers.

How it is diagnosed

• Pelvic examination and transvaginal ultrasound: The first-line assessment of an ovarian mass, describing features that suggest a benign cyst or a cancer.
• CA-125 blood test: Raised in most advanced cases but also in endometriosis, fibroids and other benign conditions, so it supports rather than makes the diagnosis. Other markers are checked in younger women.
• CT of chest, abdomen and pelvis: Shows the extent of disease and helps decide between immediate surgery and chemotherapy first.
• Image-guided biopsy or laparoscopy: Confirms the diagnosis when chemotherapy is planned before surgery. An ovarian mass that may be early cancer is not needled, to avoid spilling cells.
• Genetic and tumour testing: BRCA and homologous recombination deficiency testing guide the use of PARP inhibitor maintenance treatment.

Treatment options

• Cytoreductive (debulking) surgery: Removal of the womb, tubes, ovaries, omentum and all visible tumour. Leaving no visible disease is the aim, and it may involve bowel surgery.
• Chemotherapy: Carboplatin with paclitaxel, usually 6 cycles at 3-week intervals, after surgery or split before and after it.
• Maintenance therapy: PARP inhibitor tablets or bevacizumab infusions for 1 to 3 years in those likely to benefit.
• Fertility-sparing surgery: Removal of one ovary and tube with full staging, for young women with early-stage or germ cell tumours.
• Treatment of recurrence: Further chemotherapy, selected repeat surgery and newer targeted agents.
• Risk-reducing surgery: Removal of tubes and ovaries for BRCA carriers once childbearing is complete.

When it is urgent

Go to a local emergency department for severe abdominal pain with vomiting and inability to pass stool or wind, which may mean bowel obstruction, for sudden severe pelvic pain suggesting a twisted or ruptured mass, for marked breathlessness, or for a painful swollen calf. During chemotherapy, a temperature of 38 degrees or higher is an emergency.

Travelling to Türkiye for treatment

Travel can be reasonable for an expert opinion on imaging and pathology, or for debulking surgery by a specialised team if you can stay about 3 weeks and your home oncologist is ready to start chemotherapy soon after, since gaps between surgery and chemotherapy should be short. Six cycles of chemotherapy, years of maintenance tablets with blood monitoring and the management of recurrences belong close to home. Remote review of your scans is a sensible first step before committing to a journey.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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