Dr Moumita Bag, Consultant Gynaecology – Oncology Surgeon, HCG Cancer Centre, Nagpur

Women may face several health challenges, including cancer, chronic diseases, and reproductive issues. One essential organ in the female reproductive system is the ovary. It plays a vital role in producing hormones like estrogen and progesterone, as well as releasing eggs during ovulation. These functions are essential for menstruation, fertility, and overall reproductive health, emphasizing the significance of the ovary in women's bodies. Ovarian cancer, often known as the 'silent killer,' arises as a tumor in the ovaries, posing a fearsome threat. Symptoms are usually vague or absent in early stages, leading to late
diagnosis and worse prognoses and treatment outcomes.

Although the exact cause of ovarian cancer is still unknown, various factors contribute to its emergence.  Lifestyle choices such as obesity, smoking, and high-fat diets, alongside reproductive factors like nulliparity, early menstruation, and late menopause, elevate risk. Furthermore, vulnerability is increased by genetic abnormalities, particularly those in the BRCA1 and BRCA2 genes.

The Role of Genetics:
Genetics has a significant and complex role in ovarian cancer, affecting the onset, course, and prognosis of the illness as well as acquired and inherited genetic abnormalities. Comprehending these genetic components is essential for early identification, risk evaluation, and individualized treatment plans for individuals with ovarian cancer.

Hereditary Factors
In some cases, ovarian cancers stem from hereditary factors, often linked to mutations in genes like BRCA1 and BRCA2. These mutations significantly heighten the risk of ovarian cancer. Other genes associated with hereditary breast and ovarian cancer syndrome (HBOC) also contribute to familial susceptibility. Genetic testing and counseling are vital for individuals with family histories of ovarian cancer, aiding in risk assessment and informed decision-making regarding screening and preventative measures.

Ovarian cancer exhibits numerous acquired genetic changes in addition to hereditary factors. High-grade serous ovarian carcinoma (HGSOC), the most aggressive subtype, displays widespread genomic instability with frequent mutations in tumor suppressor genes (e.g., TP53) and oncogenes (e.g., KRAS, BRAF). Molecular profiling aids in understanding tumor behavior and guiding treatment.

Symptoms of Ovarian Cancer:
Symptoms of ovarian cancer can be subtle, making them easy to miss or mistake for other
issues.

* Typical signs comprise bloating in the abdomen,
*  Pain in the pelvic or abdominal area,
*  Challenges with eating or feeling full rapidly,
*  Alterations in bowel patterns like constipation or diarrhea,
* Frequent urination,
* Tiredness, and weight loss without a clear cause.
*  As the disease progresses, additional symptoms may manifest including fluid retention in the abdomen (ascites), breathing difficulties, and swelling in the legs.

Treatments for Ovarian Cancer:
* Surgery: Primary treatment involves surgical removal of the tumor and affected tissues, including unilateral or bilateral salpingo-oophorectomy, hysterectomy,
omentectomy, and debulking surgery.
* Chemotherapy: Administered post-surgery to destroy remaining cancer cells and prevent recurrence; may be intravenous or intraperitoneal.
* Targeted Therapy: Targets molecular abnormalities with drugs like PARP inhibitors, particularly effective for BRCA mutations or HRD.
* Immunotherapy: Stimulates the immune system to recognize and attack cancer cells, showing promise in certain cases.
* Hormone Therapy: Used for hormone receptor-positive ovarian cancer to block estrogen effects and slow tumor growth.
* Clinical Trials: Provide access to novel treatments under investigation to improve outcomes and advance knowledge.

Multiple factors, including genetics, reproductive history, and lifestyle decisions, are linked to ovarian cancer. Genetic testing can identify those who are at risk of the condition, and lifestyle changes including controlling weight and giving up smoking can reduce the likelihood of contracting it. A better prognosis for women impacted by this illness can be provided by knowing the genetic relationships, which can help with preventative actions
and individualized therapies.