SARA ALZAABI (ABU DHABI)
Ovarian cancer often remains asymptomatic in its early stages, making it difficult for women to recognise the disease until it has progressed significantly, according to Dr. Stephanie Ricci, MD, a Staff Physician in the Surgical Subspecialties Institute at Cleveland Clinic Abu Dhabi.
In an interview with Aletihad, Dr. Ricci discussed the complexities surrounding the symptoms and early diagnosis of ovarian and cervical cancers.
"Unfortunately, ovarian cancer does not have symptoms at an early stage, and most women present at later stages," she stated.
Alarmingly, over 70 percent of women diagnosed with ovarian cancer are at stages three or four when symptoms become more noticeable, she said.
Dr. Ricci stressed the challenge of early detection, noting, "there is currently no effective screening test for early-stage ovarian cancer."
This lack of reliable screening contributes to the late diagnoses, as "multiple large studies… have not identified a screening method that effectively reduces mortality from ovarian cancer."
As the disease advances, women may experience symptoms such as abdominal pain, bloating, nausea, and an increase in waist size, she explained.
However, these symptoms are "very nonspecific" and can often be mistaken for conditions like irritable bowel syndrome or endometriosis.
Dr. Ricci described cervical cancer as "a very different type of cancer", primarily caused by the HPV virus, which is responsible for over 90 percent of cases.
The primary screening method for cervical cancer involves a Pap smear, which tests for cell abnormalities and the presence of HPV.
The abnormal bleeding remains the most critical early symptom. When discussing the risk factors associated with ovarian cancer, Dr. Ricci highlighted the significant impact of hereditary gene mutations, particularly BRCA1 and BRCA2, which can elevate the risk of ovarian cancer from about 1 percent in the general population to 40-60 percent for those with these mutations.
She noted additional contributing factors such as family history, pregnancy history, and unhealthy lifestyle choices like smoking and obesity.
For cervical cancer, the most significant risk factor is the lack of proper screening, as it typically develops slowly over many years, especially in women in their thirties and sixties.
Regular screenings, including Pap smears and HPV tests, are essential for early detection, as "not going for those tests regularly puts you at the greatest risk for cervical cancer," she said.
Addressing the challenges of early diagnosis for ovarian cancer, Dr. Ricci encouraged women, by stating, "Gathering family history information and consulting a genetic counselor is vital. If they test positive for a genetic mutation, they can take steps to prevent the disease."
For cervical cancer, Dr. Ricci highlighted the importance of increasing awareness through HPV vaccination, which is ideally given to young women aged 9 to 13.
"Although it is a preventative vaccine, some data suggest it may also have therapeutic benefits," she stated.
Discussing the progression of ovarian versus cervical cancers, Dr. Ricci noted that ovarian cancer is a rapidly and aggressively growing disease, whereas cervical cancer progresses more slowly.
Regarding the latest technological advances and treatment options at Cleveland Clinic Abu Dhabi, she mentioned the integration of immunotherapy with standard treatments for cervical cancer.
"New studies show that combining immunotherapy with frontline treatments, such as radiation or chemotherapy, yields better results," she said.
For ovarian cancer, genetic testing is crucial, especially for patients with BRCA mutations, as it informs maintenance drug options after surgery and chemotherapy, enhancing cure rates and delaying relapse.
Treatment typically involves a combination of surgery and chemotherapy, and in cases where immediate surgery is not possible, the clinic employs a strategy of administering half of the chemotherapy before surgery and the second half afterward.
Notably, the use of heated intraperitoneal chemotherapy (HIPEC) during surgery has shown promising results in improving survival rates, she noted.
Cleveland Clinic Abu Dhabi also focused on fertility preservation for young women diagnosed with these cancers, collaborating with Health Plus to provide timely options for freezing embryos or oocytes.
"For women with ovarian or cervical cancer, follow-up appointments occur every three months after treatment, complemented by support groups, a physical therapy programme, and a Reiki programme for energy healing," Dr. Ricci said.
She spotlighted the clinic's commitment to preventative medicine and lifestyle modifications, offering psychological services and palliative care to support the overall wellbeing of patients.