Diagnosis - মায়া


If you have any symptoms of ovarian cancer, it’s important to see your doctor as soon as possible.
Your doctor will first ask about your symptoms, your general health and whether there is a history of ovarian or breast cancer in your family.
Your doctor may also carry out a vaginal or internal examination to investigate your ovaries and womb. They may also take a blood sample or refer you for an ultrasound scan.
The gynaecologist may carry out another internal examination. They will ask about your symptoms and general health. They may also do further tests to confirm the diagnosis of ovarian cancer, including a blood test and ultrasound.
Blood test (CA125)
You may have a blood test to look for a chemical called CA125 in the blood. This chemical is produced by some ovarian cancer cells. A very high level of CA125 in the blood may mean you have ovarian cancer.
However, this chemical is not specific to ovarian cancer and may also be raised in many benign conditions, so a raised level of CA125 does not definitely mean you have ovarian cancer.
You gynaecologist will definitely test for CA125 if you frequently experience:
feeling full quickly
loss of appetite
pelvic or abdominal pain
needing to urinate urgently or frequently
The CA125 test is particularly important if you are 50 or over, or have these symptoms more than 12 times each month.
If you experience unexplained weight loss, fatigue or changes in your bowel habits such as diarrhoea or constipation, your medicine specialist may also test for CA125 during a regular medical checkup.
If you are 50 or over and have experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your doctor should test your CA125 level.
A significant proportion of women with early stage ovarian cancers have a normal CA125 level.
If you do have a raised CA125 level, your doctor will recommend that you have an ultrasound scan.
Ultrasound uses high frequency sound waves to produce an image of your ovaries. You may have an internal ultrasound (known as a transvaginal ultrasound), where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach. The image produced can show the size and texture of your ovaries, as well as any cysts that may be present.
Further tests
If you’ve been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and whether it has spread. This is called staging.
These other tests may include:
chest X-ray – this can see if the ovarian cancer has spread to your lungs or caused a build-up of fluid around the lungs (called a pleural effusion).
CT scan or MRI scan – these imaging techniques are used to look for signs of cancer elsewhere in your chest, abdomen and pelvis.
abdominal fluid aspiration – if there is a build-up of fluid in your abdomen and it looks swollen, it could mean your ovarian cancer has spread. To find out, a thin needle is passed into your abdomen to take a sample of fluid to be tested for cancer cells. This can be done with the support of an ultrasound device or a CT scan.
laparoscopy – this small operation may be performed if the gynaecologist wants to take a better look at the ovaries. A thin tube with a camera on the end (a laparoscope) is inserted through a small cut in your lower abdomen (stomach) in order to examine your ovaries. A small sample of tissue may be taken from your ovaries for testing (this is known as a biopsy). If your doctor recommends a laparoscopy for testing, then it is fine. You should refuse a laparoscopy if it is recommended as a treatment procedure. If your ovaries are enlarged and they have to be removed it is better to opt for a laparotomy which means the surgery is carried out by making a medium to large incision on the abdomen.
Staging helps your doctors decide on the best kind of treatment for your condition. However, it is important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.
Stages and grades of ovarian cancer
When your ovarian cancer is diagnosed, the doctors will give it a stage. This is often based on surgical findings. The stage describes the size of the cancer and how far it has spread. Ovarian cancer has four commonly used stages:
stage 1 – the cancer only affects one or both of the ovaries
stage 2 – the cancer has spread from the ovary and into the pelvis or uterus
stage 3 – the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis
stage 4 – the cancer has spread to other parts of the body such as the liver, spleen or lungs
This is a simplified guide – each stage is divided into further categories called A, B and C. If you’re not sure what stage you have, ask your doctor.
The grade of cancer refers to the appearance of cells under a microscope.
low grade – although abnormal, cells appear to be slow-growing
moderate grade – cells look more abnormal than low-grade cells
high grade – cells look very abnormal and are likely to be fast-growing
involves using anti-cancer (cytotoxic) drugs to kill cancer cells. It is often given after surgery for ovarian cancer. In some cases, it can be given before surgery as it may help shrink the tumour and make it easier to remove. This is called neoadjuvant chemotherapy.
Several different drugs can be used in chemotherapy. Often, a combination is given. The choice of drug and how and when it is given depends on the stage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing drug (carboplatin), which is used alone or in combination with another drug, paclitaxel.
Chemotherapy is usually given as a drip into the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen, called intraperitoneal chemotherapy. This is not established routine practice in the Bangladesh at the moment, but it is being assessed in clinical trials.
Most often, you will have chemotherapy as an outpatient, but sometimes you may need a short stay in hospital. It is usually given in cycles, with a period of treatment followed by a period of rest to allow the body to recover. Most women have six cycles of chemotherapy.
How will I know if the chemotherapy is working?
Over the course of your chemotherapy, you will have tests to monitor how the ovarian cancer is responding to treatment. This can be done in a number of ways.
if you had higher than normal levels of the cancer chemical CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling
if you had a tumour visible on a CT or ultrasound scan when diagnosed, you may have repeated scans to see whether it has shrunk
you may have another small operation, known as ‘second-look surgery’, which is carried out in the same way as a laparoscopy
If, after your chemotherapy treatment, all of your tests are clear of cancer, you will be in remission. This means the cancer is under control.
Side effects of chemotherapy
The main side effects of chemotherapy are caused by its influence on normal, healthy cells, such as immune cells. Side effects include:
loss of appetite
nausea and vomiting
hair loss
sore mouth
Many side effects can be prevented or controlled with medicines your doctor can prescribe.
Chemotherapy for cancer that has come back
Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This may be the same drugs again or a different combination of chemotherapy drugs. This is called second-line treatment. The choice of drugs will take into account which drugs were used in previous treatments, and the side effects and benefits of the drugs. Your doctor will discuss this with you.
uses high energy X-rays. Like chemotherapy, it works by targeting rapidly growing cancer cells. Radiotherapy is not often used to treat ovarian cancer. But occasionally, the multidisciplinary team may recommend it for ovarian cancer treatment under very specific circumstances, such as treating pain and bleeding from a localised tumour mass.
A great deal of progress has been made in ovarian cancer treatment. More women are living longer and having fewer side effects. These advances were discovered through clinical trials where new drugs and combinations of drugs are compared with standard treatment.
Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties.
It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support.
Your oncologist or gynaecologist can refer you to a counsellor. If you are feeling , talk to your doctor. A course of antidepressant drugs may help, but before that it may be wise for you to see a counsellor or psychologist.
It can help to talk to someone who has been through the same thing as you. Why not upload a post on to connect with those who have gone through the same experience?

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