Childless women at risk of cancer
KARACHI – Majority of women with ovarian cancer do not come to doctors for early consultation, which is the major cause of deaths among the female patients.
This was stated by Dr Saira of the Liaquat National Hospital at the Gynaecological Oncology Group meeting, held at the PMA House on July 23 morning.
The meeting was attended by gynaecologists, oncologists, histo-pathologists and postgraduate medical students. She said that the ovarian cancer could be epithelial or non- epithelial in origin. The epithelial ovarian cancers were primarily seen in women above 50 years of age, mostly between 60 and 64 years, she added.
She said that women mostly at risk were those who never had children or were of low parity, having first pregnancy at an early age, early menopause and use of oral contraceptive pills.
Dr Kaneez Fatima of the Sindh Government Qatar Hospital stated that surgical staging of the ovarian cancer was essential followed by histo-pathological examination of the specimen to confirm prior to the tumour removal.
She said that on opening abdomen, biopsies of the area outlined according to the FIGO staging system, washings of the peritoneal cavity, removal of the tumour as much as possible, followed by the removal of the uterus and ovaries should be done.
She said that no women should be left with ovarian cancer and should be operated upon at early stage. Regarding screening of ovarian caner, Dr Shagufta said that no cost effective programme had been established so far.
However, a strong family history of epithelial ovarian cancer or the cancer of breast, colon and endometrium increased suspicion of the disease and such women needed a genetic counselling to estimate the risks pelvic examination, she added.
Dr Sonia discussed the surgical management of the EOC and said a thorough staging laparatomy was essential because the prognosis of the disease was affected by the stage of the cancer at the time of presentation, the histological grading and the volume of disease remaining behind.
She recommended that all patients who were medically fit for surgery should undergo laparatomy with maximum removal of the disease and chemotherapy regimes after discussing with oncologist.
She further said that follow up was essential to determine the response of the patient to the given therapy and for the recognition and management of any complications occurring and detection of the recurrent disease.
Prof Serajudaulla Syed of the Sindh Medical College said that the ovaries were amazing organ in female body because of its diversity and simple to complicated pathology. “These two small organs could cause multiple type of cancer because of its total potential for growth,” he added.
He emphasised that the family physician had a very important role in preventing deaths from ovarian cancer. “If the patient is referred at early stage to gynaecologist and the surgery is performed, the patient has good chances of survival,” he said.
The doctor said that surgeons should always send the whole specimen to pathologist with proper labelling because partial organ could confuse the issues and as a result management would be compromised.
He said that in majority of cases, the patients and relatives were responsible for delay in seeking help and treatment. Prof Peter Bailey of the Baqai Medical University said that ovarian cancer was more common in women who had early menarche and late menopause and they should be watched carefully.
All patients with ovarian cancer should be operated by a trained gynaecologist not by a trained surgeons. He stressed that all gynaecologists should take a detail history, do a thorough examination before making a final diagnosis of ovarian cancer.
Dr Shaheen Zafar of the Liaquat National Hospital said that no woman with advance ovarian cancer should be left alone during terminal care. “The patient should be seen by her family physicians, gynaecologists and anaesthetists,” the doctor said.