Ovarian Cancer: The Silent Killer and Its Diagnostic Trail

The key is always the right diagnosis at the right time. Liver cancer carries a real risk of coagulopathy and bleeding, so any patient with chronic liver disease should have regular PT, PTT and INR testing. If there is any bleeding diathesis, it needs to be treated, including with vitamin K and blood products if needed. Chronic liver disease patients also commonly have low white cell counts and low platelets, so basic blood counts should be checked regularly alongside liver and kidney function tests.

Leukemias are broadly acute or chronic. Acute leukemias have a short history with low hemoglobin, white cell count and platelets, presenting with fever and bleeding. Chronic leukemias, chronic myeloid leukemia (CML) or chronic lymphocytic leukemia (CLL), generally occur in older age groups and are often managed with tablets alone. Acute leukemias are either AML or ALL. Genetic testing subcategorises each: CML needs confirmation of Philadelphia chromosome or BCR-ABL positivity; CLL needs a FISH panel to check p53 status and risk category; AML is categorised as good, intermediate or high risk. ALL is the most common leukemia in children and young adults and is treated with steroids followed by chemotherapy based on T-cell or B-cell type. AML M3, acute promyelocytic leukemia, is rare but very curable with ATRA or arsenic trioxide tablets; non-M3 AML needs chemotherapy.

Please write in with any questions, over WhatsApp or text, at any time. Many patients cannot travel to India, so the goal is to help diagnose and treat them on time wherever they are. Prepare a doctor's note with the relevant clinical details and share it; if the picture is clear, specific pointers on managing the case can be given from that.

Self-examination should be done by the woman herself, using the opposite hand on the opposite breast with three fingers held flat, including the axilla and neck. Clinical breast examination should be done by anyone properly trained, which can include nurse practitioners, physician assistants, internal medicine doctors, general surgeons, gynaecologists and oncologists. Training, not job title, is what matters, since missing lesions is common when the examiner has not been trained. GPs and internal medicine doctors should learn the technique and offer it to every woman who comes to the clinic.

Once the diagnosis is confirmed by biopsy, a staging scan, often a PET scan, establishes the exact stage, including whether the bladder, rectum, parametrium or lymph nodes are involved. Fitness for treatment is then assessed with kidney function testing (GFR) and audiometry, since some chemotherapy agents can affect hearing. Weekly chemotherapy is then given alongside radiation, with the potential radiation side effects explained to the patient beforehand.

Its symptoms, such as abdominal distension, early satiety, and pelvic heaviness, are usually mild and nonspecific, and are easily mistaken for digestion problems, weight gain, or normal ageing. By the time these symptoms prompt an evaluation, the disease has often already advanced.

A complex adnexal mass with both solid and cystic components, internal septations, and papillary projections on transvaginal ultrasound, combined with ascites and a markedly elevated CA-125, together form a strong red flag pattern for ovarian cancer, particularly in a postmenopausal woman.

A needle should never be inserted directly into the ovary when malignancy is suspected. Instead, a guided biopsy is taken from a more accessible site with disease involvement, such as the omentum, which avoids the risks associated with direct ovarian puncture.

When peritoneal disease is extensive enough that upfront surgery is not feasible, chemotherapy is started first, with cytoreductive surgery and HIPEC planned to follow once the disease has responded to treatment.

A thickness of 5 millimetres or more, in the presence of vaginal bleeding or in a patient on tamoxifen, warrants an endometrial biopsy. Without vaginal bleeding, a thickness of up to 8 millimetres is generally considered acceptable.