‘O’vary is ‘O’ worry

Cancer screening camps and treatment of persons detected with cancer through screening are Block level projects of the Kerala Government. On December 27th 2017, a public meeting followed by a cancer awareness class and screening camp were held at Veliyanadu.

Through my brother, Raja Revathijan Nair, I had been approached by Mr. Venugopal, the joint BDO, who inquired about my availability to participate and conduct classes on cancer awareness at Veliyanadu. On Mr Venugopal’s initiative, I had been to Mallappally to inaugurate a similar public function around 6 months ago. I was accompanied to Veliyanadu by Mr. Venugopal. While travelling, I queried him about the project. He replied that the cancer awareness and early detection programme was of prime concern to the government and it would like to ensure that the programme was successfully implemented. However, it required massive commitment and willingness on the part of public servants to successfully implement the programme. Mr Venugopal further said that some minor obstacles in allocation of funds could be overcome by sincere and wise usage of facilities, but many were unwilling to shoulder the responsibility since they considered it a nuisance. At this moment, I recollected with great respect, Dr. Annapurna, Dr. Anil Kumar and all those involved with this programme, including Mr Venugopal, for their tireless efforts in implementing and administering the programme.

Mr. Venugopal also narrated to me his personal experience which spurred him towards this project. He said: “by the time we, the children, attained good positions, our mother had passed away without giving us an opportunity to take care of her”. His voice quivered and he stumbled over his words. A moment later he continued- my mother was losing weight daily, became easily tired and her stomach was distended with water. We consulted numerous doctors in various hospitals. After conducting various tests they came to the conclusion that my mother had liver cirrhosis. Five to six valuable months were taken to arrive at this conclusion. Subsequently, we consulted Dr. Philip Augustine in Ernakulam and he diagnosed and confirmed that my mother had final stage Ovarian Cancer. It was already too late by then. We had already lost a valuable period of nine to ten months. There was therefore no opportunity for any effective treatments to be administered. She passed away soon after. I had been searching since then for an opportunity to do something for the early detection and treatment of Cancer. We instituted a charitable society in the name of our mother. But it was very hard to mobilize money and government grants to administer it. Therefore I believe that this block level project is an opportunity given by the Almighty to fulfil my ambition.
I perceived the sincerity in his voice. Mr Venugopal suddenly queried me: ‘Madam … Hope we get good treatments for Ovarian Cancer now? Is it possible to cure it completely?

If ovarian cancer is discovered early, that is when it is at the localized stage, it can be treated and cured. But the unfortunate reality is that it is quite onerous to discover at that stage.
Mr Venugopal’s mother passed away 25 years ago. I felt sombre when I thought of the fact that even today the majority of patients are diagnosed at the same final stage as that of Mr Venugopal’s mother. However, today better surgical procedures and superior chemotherapy drugs are available. We are thus able to prevent the advancement of ovarian cancer and control it, similar to controlling ailments like diabetes and high blood pressure. However, a complete cure is unfortunately still in the distant horizon unless detected in the early stages, more so in relation to epithelial ovarian cancers, which is the most common form of ovarian cancer in women.

The Ca 125 blood test and ultrasound scanning are the best methods for early diagnosis of this cancer. However, both these tests have got certain limitations. Scientific studies propound that it is impractical for everyone to undergo these tests since the accuracy and cost effectiveness of these screening tests are not optimal. However, all women who have a family history of breast or ovarian cancer are recommended to undergo these tests biannually or annually.

It should also be noted that the Ca 125 level need not be elevated in all incidents of ovarian cancer. The normal value of Ca 125 is below 35u/ml. However, the normal value may differ from individual to individual. For example, in some individuals it might be below 4 u/ml, for others their normal level might be 30 u/ml or 20 u/ml. It can be elevated to very high levels in non-cancerous conditions, for example, endometriosis. If the normal value increases suddenly from what is generally an individual’s normal level, caution will have to be exercised in evaluating this sudden increase and close monitoring will be required. Despite the controversies, undergoing a Ca 125 blood test biannually or annually is still considered useful in identifying early ovarian cancer.

Having witnessed numerous piteous and hapless ovarian cancer patients, I think that it is only proper that a Ca 125 test be done by every woman at regular intervals, the regularity depending on their risk of getting ovarian cancer. An ultrasound scan should also be performed. Furthermore, it is also advocated that women undergoing hysterectomy (removal of uterus) for non-cancerous conditions subsequent to the age of forty-five, give serious consideration to removing their ovaries as well. If this is done, developing ovarian cancer need not be a source of worry in the future.

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DR Chitrathara K

HOD & Senior Consultant in Surgical & Gynaec Oncology. VPS Lakeshore Kochi
Specialized in gynecological, urological, and breast cancer surgeries.

  • Actively participated in the development of surgical oncology as a separate speciality in Kerala
  •  First lady Urologist of Kerala.
  • Started Kerala's first Gynaecological Cancer Surgery unit at Regional Cancer Centre, Thiruvananthapuram in 1993 & urological oncology in 2009.
  • Authored malayalam book “ Sthreekalile Arbudam-Ariyendathellam” published in 2014 by DC books
  • Editor of the following books - Ovarian Cancer (2008), Cervical cancer (2010) and Uterine Cancer (2015).

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