Hope after chemo: Lymph node removal may boost ovarian cancer survival

A recent study by Aiims, Delhi suggests that removing lymph nodes after chemotherapy may significantly improve survival rates among ovarian cancer patients

For women battling advanced-stage ovarian cancer, the journey is long, painful, and filled with uncertainty. But now, there is new hope. A recent study by the All India Institute of Medical Sciences (Aiims), New Delhi, brings a powerful insight that could change the course of treatment for many.

 

According to the study titled "Proposed Nodal Cancer Index (NCI) in ovarian carcinomatosis", recently published in the Journal of the Egyptian National Cancer Institute, women who underwent systematic removal of lymph nodes from the pelvis and rear abdominal walls exhibited a five-year overall survival rate of 48.9 per cent.

 

The study that analysed 105 patients with advanced-stage ovarian cancer who had undergone chemotherapy found that this surgical approach targets residual cancer cells that may persist post-chemotherapy, potentially reducing recurrence rates.

 

 

According to the researchers, survival chances can improve significantly when lymph nodes are surgically removed after chemotherapy compared to patients who did not undergo the additional surgical step. This breakthrough not only strengthens the importance of surgery in cancer care but also offers a renewed sense of possibility to patients and their families fighting this devastating disease.

 

However, the procedure is complex and requires highly trained surgeons due to the proximity of these lymph nodes to major blood vessels, the researchers said in the paper.

Why removing lymph nodes after chemotherapy may prevent ovarian cancer relapse 

Lymph nodes, small bean-shaped components of the body’s immune system, are common sites for cancer spread. In advanced ovarian cancer, these nodes may retain residual cancer cells even after chemotherapy. The study says removing them could help prevent further spread and lower the risk of recurrence.

 

“This study adds a crucial layer to our understanding of ovarian cancer management,” the researchers said in the report. “While chemotherapy helps shrink the tumour burden, surgery must be comprehensive. Lymph node removal, especially in advanced-stage disease, can be life-saving.” 

Ovarian cancer: Symptoms, causes, and why early detection is difficult 

According to the American Cancer Society, ovarian cancer is a malignancy in the ovaries, the reproductive glands that produce eggs. Ovarian cancers were previously believed to begin only in the ovaries, but recent evidence suggests that many ovarian cancers may start in the cells in the far (distal) end of the fallopian tubes. It is often referred to as a ‘silent killer’ because symptoms tend to appear only in the advanced stages. These may include abdominal bloating, pelvic pain, difficulty eating, or frequent urination, often mistaken for less serious health issues.

 

It is among the five most common cancers affecting women in India, according to estimates from the Indian Council of Medical Research (ICMR), with late detection continuing to be a significant obstacle to effective treatment.

 

There are several types of ovarian cancer, but epithelial ovarian cancer is the most common, accounting for over 90 per cent of all cases. It primarily affects women over 40, with risk increasing significantly after menopause.

 

Major risk factors for ovarian cancer in women 

The precise causes of ovarian cancer are not fully understood. However, researchers have identified several factors that may elevate a woman’s risk of developing the disease:

• Family history 
• Genetic mutations (e.g., BRCA1 and BRCA2) 
• Hormone-related treatments 
• Endometriosis 
• Reproductive history 
• Ageing

 

Although not all risk factors can be modified, heightened awareness and routine health check-ups can contribute to early detection and improved outcomes.

Ovarian cancer screening tests and costs in India: CA-125 and TVUS explained 

Regular pelvic examinations and ultrasound scans may help detect anomalies early. However, there are no recommended screening tests for ovarian cancer for women who do not have symptoms and are not at high risk of developing ovarian cancer.

 

Despite extensive research efforts, there is currently no reliable screening test specifically for ovarian cancer. However, two procedures commonly used, alongside a standard pelvic examination, are transvaginal ultrasound (TVUS) and the CA-125 blood test.

 

Transvaginal Ultrasound (TVUS)

 

TVUS involves the use of sound waves to visualise internal reproductive organs. It helps detect the presence of a mass in the ovary but cannot confirm whether the mass is malignant.

 

Cost in India: Rs 1,500–3,500

 

CA-125 Blood Test

 

This test measures CA-125 protein levels, which may be elevated in some ovarian cancer cases. However, it is not a definitive diagnostic tool.

 

Cost in India: Rs 800–2,000 

Early warning signs of ovarian cancer most women miss

According to the Cleveland Clinic, symptoms may include:

• Pelvic or abdominal pain or bloating 
• Feeling full quickly or loss of appetite
• Abnormal vaginal bleeding or discharge 
• Bowel habit changes 
• Increased abdominal size 
• Frequent urination 

How ovarian cancer is treated in India: Surgery, chemotherapy, and lymph node removal 

Treatment usually involves surgery and chemotherapy. In early-stage disease, surgery targets tumour removal. In advanced cases, chemotherapy is administered before surgery.

 

The Aiims study supports expanding surgery to include lymph node removal, which was often avoided earlier due to complications. The research suggests it may improve survival outcomes and reduce relapse risk.

 

In India, late diagnosis, limited access to specialists, and economic barriers hamper effective care. The Aiims study could reshape treatment protocols in public healthcare.

What ovarian cancer patients should ask their doctors after chemotherapy 

Patients undergoing chemotherapy should consult their oncologists about lymph node removal. Decisions should be based on cancer stage, health condition, and overall treatment goals.  For more health updates and wellness insights, follow #HealthWithBS