Good evening Dr. Dita, this is Sekar from yesterday.

Here are my interview question, please do

hesitate to ask for clarification if they are not clear.

1. What are the most common causes among ovarian cancer patients in Indonesia?
 The risk of ovarian cancer is higher than that of the general population in women with
certain family histories. Although most epithelial ovarian cancer is sporadic, as many
as 10% to 14% of women with epithelial ovarian cancer have a germ-line mutation in
BRCA1or BRCA2.The vast majority of ovarian cancers are sporadic and arise because
of accumulation of genetic damage.
 Oxidative stress and free radical formation as a result of inflammation and repair at the
ovulatory site may also contribute to accumulation of DNA damage. Regardless of the
mechanisms involved, reproductive events that decrease lifetime ovulatory cycles
(e.g., pregnancy and birth control pills) are protective against ovarian cancer
 Five years of oral contraceptive use provides a 50% risk reduction while only
decreasing total years of ovulation by less than 20%.
 The action of other reproductive hormones such as estrogens, androgens, and
gonadotropins also may contribute to the development of ovarian cancers. Although
the strongest epidemiologic risk factors generally affect risk of all disease subsets,
differences have been observed with respect to etiology and molecular alterations.
 Ovarian cancer has been associated with low parity and infertility. Early menarche and
late menopause increase the risk of ovarian cancer. Increased risk in women who
women who have never married
 Foreign bodies (talc) per vagina may increase risk; acetaminophen may decrease risk

2. How normal cells turn cancerous in the case of the ovarian cancer?
Human cancers arise because of a series of genetic and epigenetic alterations that lead to
disruption of normal mechanisms that govern cell growth, death, and senescence. Genetic
damage may be inherited or arise after birth as a result of either exposure to exogenous
carcinogens or endogenous mutagenic processes within the cell. The incidence of most
cancers increases with aging because the longer one is alive, the higher the likelihood that a
cell will acquire sufficient damage to become fully transformed. It is thought that at least three
to six alterations are required to fully transform a cell.
Most cancer cells are genetically unstable, and this leads to an accumulation of a
substantial number of secondary changes that play a role in evolution of the malignant
phenotype with respect to growth, invasion, metastasis, and response to therapy, among other
characteristics. Genetic instability also results in evolution of heterogeneous clones within a
tumor. There is some evidence that progenitor cells (stem cells) exist within a tumor that may
be relatively resistant to therapy.
Loss of tumor suppressor gene function also plays a role in the development of most
cancers. This usually involves a two-step process in which both copies of a tumor suppressor
gene are inactivated. In most cases, there is mutation of one copy of a tumor suppressor gene
and loss of the other copy because of deletion of a segment of the chromosome where the
gene resides.
All cells require oxygen and other nutrients for survival and growth, and cells must reside
within 100 µm of a capillary in order to receive oxygen. Therefore, growth of new vessels,
 termed angiogenesis, is required for sustained malignant growth beyond approximately 1 mm
in diameter.

3. What are the characteristics that make ovarian cancer silent killer?
The majority of women with epithelial ovarian cancer have vague and nonspecific pelvic,
abdominal, and menstrual symptoms. Symptoms associated with ovarian cancer were pelvic
or abdominal pain, urinary frequency or urgency, increased abdominal size or bloating, and
difficulty eating or feeling full. These symptoms were particularly suspicious when they were
present for less than 1 year and lasted longer than 12 days a month. Ovarian cancer has a 70%
mortality rate.

4. What are the stages of ovarian cancer?

5. What are the typical treatments for ovarian cancer?

 The primary treatment for early stage epithelial ovarian cancer is surgical—that is, a total
abdominal hysterectomy, bilateral salpingo-oophorectomy, and surgical staging
 In patients whose disease is high risk—for example, more poorly differentiated or in
whom there are malignant cells either in ascitic fluid or in peritoneal washings—additional
therapy is indicated. Treatment options include chemotherapy or whole-abdominal
radiation
  In advanced stage ovarian cancer, systemic chemotherapy is the standard treatment for
metastatic epithelial ovarian cancer. An alternative to first-line combination
chemotherapy for selected patients with metastatic ovarian cancer is the use of whole-
abdominal radiation therapy. The operation to remove the primary tumoras well as the
associated metastatic disease is referred to as debulking or cytoreductive surgery. Most
patients subsequently receive combination intravenous chemotherapy. In some patients
with completely resected disease, intraperitoneal chemotherapy may be considered. In
selected patients who are not candidates for initial cytoreductive surgery, neoadjuvant
chemotherapy may be given for a few cycles before surgery

6. How the chance of survival from ovarian cancer differ according to stages when the disease
was diagnosed?
 The outcome of patients after treatment can be evaluated in the context of prognostic
factors, which can be grouped into pathologic, biologic, and clinical factors

7.What are the key measures to prevent ovarian cancer ?

 As parity is inversely related to the risk of ovarian cancer, having at least one child is
protective of the disease, with a risk reduction of 0.3 to 0.4. The oral contraceptive reduces
the risk of epithelial ovarian cancer.
 Women who use the oral contraceptive for 5 or more years reduce their relative risk to
0.5—that is, there is a 50% reduction in the likelihood of developing ovarian cancer.
 Women who have had two children and have used the oral contraceptive for 5 or more
years have a relative risk of ovarian cancer as low as 0.3, or a 70% reduction.
 Therefore, the oral contraceptive pill is the only documented method of chemoprevention
for ovarian cancer, and it should be recommended to women for this purpose.
 When counseling patients regarding birth control options, this important benefit of the oral
contraceptive should be emphasized. This is also important for women with a strong
family history of ovarian cancer.

8. What are some of the risks the patient can get when finding out the information late?
Ovarian epithelial cancers spread primarily by exfoliation of cells into the peritoneal cavity,
by lymphatic dissemination, and by hematogenous spread. Systemic metastases are seen more
frequently in patients who have survived for some years. Significant risk factors for distant
metastases were malignant ascites, peritoneal carcinomatosis, large metastatic disease within
the abdomen, and retroperitoneal lymph node involvement at the time of initial surgery.

9. To what extent could early detection help prevent or better control ovarian cancer ?
Cancer deaths may also be prevented by detecting disease at a stage when it is more
curable. The secondary prevention of cervical cancer has been successful, and screening
programs for the other gynecologic cancers may eventually be devised.

10. How early and how frequent would you recommend the younger girls to have the cancer
checkups as part of the early detection?
 Women who appear to be at high risk for ovarian and or breast cancer should undergo
genetic counseling; if there is a probability of 10% or greater of having a BRCA
mutation, they should be offered genetic testing for BRCA1 and BRCA2.
  Women who wish to preserve their reproductive capacity or delay prophylactic surgery
can undergo periodic screening by transvaginal ultrasonography every 6 months,
although the efficacy of this approach is not clearly established.
 The majority of BRCA1-related ovarian cancers occur in women after the age of 40, and
BRCA2 ovarian cancers are more likely in postmenopausal women. The risk of ovarian
cancer under the age of 40 is very low.
 In women who have a strong family history of breast or ovarian cancer, annual
mammographic and MRI screening should be performed commencing at age 30 years or
younger if there are family members with documented very early onset breast cancer

11. In your opinion, why do you think it is important to get regular checkup?
Ovarian cancer is the other gynecological malignancy that may meet the criteria of a
disease for which population screening is justified. The disease is usually diagnosed in
advanced stages when chances for long-term survival are poor. Effective treatment is
available for early stage disease, and there is preliminary evidence that early detection may
increase long-term survival.

12. If you have one thing say to the younger generations about this cancer, what would you say?

Berek, J. S., & Hacker, N. F. (2010). Epithelial Ovarian, Fallopian Tube and Peritoneal Cancer. In :
Berek & Hacker’s Gynecologic Oncology Fifth Edition (5th ed.). Lippincot Williams & Wilkins, Wolters
Kluwer.