This year, 2025, the World Ovarian Cancer Day theme is “No Woman Left Behind”, which continues a multiyear campaign theme by the World Ovarian Cancer Coalition. With the goal of educating women about their own ovarian health reminding them about warning symptoms, seeking medical attention when needed, inviting leaders to promote participation in ovarian cancer research, to enable the reach of effective screening and treatment for ovarian cancer to prevent any further complications.

Ovarian cancer originates in the tissue of the ovaries. It is also known as “the overlooked disease” or “the silent killer”. Ovarian cancer can originate from different cell types.  Most ovarian cancers originate in the ovarian epithelium. They usually present as solid masses that have spread beyond the ovary.

EPIDEMIOLOGY: - Epithelial cancer is rare in women under 40 years old. Peak incidence occurs in the 70-74 years age group (57/100,000 population). Older age group is associated with a poorer prognosis.

WARNING SIGNS:-

·         75-85% of ovarian cancer cases exhibit peritoneal spread at diagnosis.

·         Abdominal discomfort

·         Abdominal pain and distension

·         Gastrointestinal symptoms (nausea, dyspepsia, constipation).

·         Abdominal bloating or swelling, quickly feeling full when eating.

·         Weight loss.

·         Discomfort in the pelvic area.

·         Fatigue.

·         Back pain.

·         Changes in bowel habits, such as constipation.

·         A frequent need to urinate.

RISK FACTORS

·         Reproductive Factors:-

Those women who have given birth exhibit a 30-60% lower risk compared to nulliparous women (those who have never given birth). The birth of the first child reduces risk by 45%; each additional pregnancy reduces risk by 15%. Breastfeeding is associated with reduced risk. Tubal ligation correlates with lower risk of ovarian cancer. Use of ovulation induction agents increases risk by 2-3 times if used for more than 12 cycles.

·         Other Factors:-

A history of breast cancer elevates the risk. Early menarche and late menopause are considered risk factors. Hormone replacement therapy (HRT) is associated with a slight increase in risk. Regular use of OCP reduces the risk by 30-60%. High meat and animal fat consumption increases risk. Low fat diet may lower risk in postmenopausal women. Obesity is linked to an increased risk of ovarian cancer.

·         Genetic Factors:

General lifetime risk of developing ovarian cancer is 1.6%. Risk increases to 4% for women with one first-degree relative affected. Risk further increases to 7% if two first-degree relatives are affected. 5-10% of all epithelial ovarian cancers result from hereditary predisposition. The frequency of BRCA1 mutation is approximately 1 in 800. 62% of patients with epithelial ovarian cancer have a mutation of the p53 gene.

PREVENTIVE MEASURES:-

·         OCP (chemoprevention) carries the highest protective effect against ovarian cancer.

·         Taking OCP for at least 5 years can reduce relative risk by 50%.

·         Tubal ligation and hysterectomy also lower risk.

·         Prophylactic oophorectomy (removal of ovaries) is often performed alongside hysterectomy for benign conditions. Prophylactic oophorectomy in women with BRCA1 and BRCA2 mutations after age 30-35 can decrease risk by 80%. Women with BRCA mutations should have trans-vaginal ultrasound (TVS) and CA125 levels monitored every 6-12 months starting at age 25-35. Genetic testing for BRCA1 and BRCA2 is recommended.

SCREENING:

·         BRCA1 or BRCA2 mutations, one close relative (like a mother or sister) with ovarian cancer associated with a BRCA1 or BRCA2 mutation

·         Lynch syndrome (hereditary nonpolyposis colorectal cancer), which can also cause a hereditary form of colon cancer

·         Trans-vaginal ultrasound: This imaging technique (a type of pelvic ultrasound) involves guiding a wand-shaped imaging tool into the vagina. It can show clear detail of the female reproductive organs, including possible signs of cancer.

·         CA-125 blood test: This blood test checks blood for a protein (cancer antigen 125) that most ovarian cancer cells make.

DIAGNOSIS:

·         Early-stage cancer is typically diagnosed through abdominal and pelvic examination.

·         In premenopausal women, functional cysts usually do not exceed 8 cm and typically resolve without treatment in 2-3 months.

·         Adnexal masses in pre-menarchal and post-menopausal women have a higher likelihood of being malignant.

STAGES:

·         In stage 1 the cancer is limited to the ovaries.

·         In stage 2 the growth involves one or both ovaries, with pelvic extension.

·         Stage 3 cancers have spread to the lymph nodes and other organs or structures inside the abdominal cavity.

·         In stage 4, the cancer has metastasized to distant sites

TREATMENT:-

·         Surgery: An operation in which doctors cut out the cancer.

·         Chemotherapy: Use of special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.

·         Targeted therapy: Use of drugs to block the growth and spread of cancer cells. The drugs can be pills you take or medicines given in your veins. You will get tests to see if targeted therapy is right for your cancer type before this treatment is used.

·         Ayurvedic medicines that include Ashwagandha, Shatavari prove helpful in revitalizing physical health of women.