Ovarian Cancer Treatment in Mumbai, India: Advanced Surgical & Fertility Expertise

However, there is immense hope: if the cancer is caught early, the five-year survival rate jumps dramatically to 55%–70%. This is why immediate, specialized care is paramount.

As a result, we strongly encourage all patients reading this who suspect they have any type of ovarian cancer or a complex ovarian cyst to seek care at a specialized gynecological cancer referral unit like ours in Mumbai, India, immediately and as an absolute priority.

We understand that a major challenge for many patients in India is that facing an ovarian cancer diagnosis often means not immediately having the necessary funds available for the entire specialized surgery. This is a major technical challenge that can delay critical care.

We strongly encourage all our patients to take advantage of the support programs we facilitate. You can either apply directly for our low-cost surgery benefit or consider applying for the various government financial schemes that we actively manage and run within our hospital for these crucial services. Our commitment is to ensure every patient receives expert surgical care, regardless of their financial circumstances.

Call 1800-268-4000 to discuss financial aid options confidentially with our support team in Mumbai.

Ovarian cancer is a group of diseases that originates when abnormal, malignant cells begin to grow and divide uncontrollably in the tissues of the ovaries—the small, oval-shaped organs that produce eggs and female hormones. 

While the cancer name refers to the ovary, recent evidence suggests many cases may actually begin in the fallopian tubes or the peritoneum (the lining of the abdomen), but they are all staged and treated in the same manner. This abnormal cell growth forms a tumor that can invade and destroy surrounding healthy tissue.

Unfortunately, most of the patients we see with cancer of the ovary come to us when the disease is already in an advanced stage.

Symptoms in Advanced Stage (Most Common)

This later stage is usually quite noticeable, characterized by:

• Abdominal Distension (Swelling): The abdomen is swollen, often due to the presence of Ascites (fluid buildup) in the belly, which is common with aggressive cancers.

• Weight Loss and Muscle Loss: The patient often experiences noticeable loss of weight and muscle mass.

Symptoms in Early Stage (Asymptomatic or Incidental)

In the early stages of the disease, the symptoms are far less clear, which is why diagnosis is often delayed:

• Grossly Asymptomatic: The majority of women in the earliest stage feel perfectly normal and have no symptoms at all.

• Incidental Finding: Many early cases are only diagnosed incidentally when a doctor performs a scan for an unrelated issue and discovers a complex ovarian mass. If this is early-stage, it can be grossly asymptomatic.

Why Do General (Non-Specific) Symptoms Lead to Delayed Diagnosis?

The reason ovarian cancer is often caught late is that the early symptoms are very nonspecific. Symptoms like bloating, pelvic pain, feeling full quickly (early satiety), or minor urinary changes are common in many routine ailments, such as indigestion or IBS.

Because these signs seem like “routine ailments,” patients often spend time:

• Seeking basic opinions from general practitioners (GPs).

• Treating it as a simple, routine problem.

This prolonged search for basic opinions leads to a crucial delay in getting proper radiological assistance (like an ultrasound or CT scan). This delay allows the cancer to progress.

This is the most critical takeaway: If a patient is able to present early, the five-year survival rate can be dramatically higher, close to 55% to 70%. This is why we urge every patient and their relative to always approach a specialized unit for gynecological cancer assistance immediately. If these non-specific symptoms persist.

While the development of ovarian cancer is predominantly sporadic (occurring by chance), we know that certain factors significantly increase risk:

• Family History & Genetics: A family history of the disease, particularly carrying BRCA1 or BRCA2 mutations, is one of the most important early risk factors. The presence of these inherited mutations is paramount for personalized risk management.

• Age and Hormonal Factors: Risk increases with age, especially post-menopause.

We are observing that the overall trend for ovarian cancer is steadily increasing in India.

Unfortunately, India faces a significant challenge that affects the prognosis of many women: we are one of the few countries without a dedicated national program for the early referral and correct diagnosis of gynecological cancers.

The Consequences of Delayed Diagnosis

This lack of a national screening and referral system creates two major setbacks:

• Late Presentation: A majority of patients present to us only in the advanced stage of the disease, severely limiting treatment options and survival rates.

• Suboptimal Care: This also leads to many patients undergoing surgery in units that lack the operational efficiency and specialization required for optimal, life-saving cancer care.

This reality makes it even more important for patients and families to be proactive and seek out specialized gynecologic oncology units immediately if cancer is suspected.

The most common type of ovarian cancer we diagnose is Epithelial Cancer, which starts on the surface of the ovary. For treatment purposes, we classify these broadly based on their behavior:

• Low Grades: These are generally slower-growing tumors that usually do not carry specific genetic mutations.

• High Grades: These are usually very aggressive and often carry key genetic mutations, impacting how we plan treatment.

The common subtypes of epithelial tumors include Serous Papillary, Mucinous, Clear Cell (considered one of the most aggressive types), and Endometrioid.

We also see tumors that arise from the egg-producing cells, called Germ Cell Tumours. These are often diagnosed in young girls and tend to be found very early. The excellent news is that germ cell tumors are typically very easy to manage and have excellent long-term survival outcomes.

The grade and specific subtype of your tumor are crucial because they dictate how we approach your treatment and what your long-term outlook (prognosis) will be.

The Impact of High-Grade Tumors

• Aggressive Behavior: A high-grade tumor is inherently extremely aggressive.

• Survival and Recurrence: These tumors are unfortunately associated with poorer survival rates and a very high chance of relapse and recurrence.

• Mutations: Most high-grade tumors carry specific genetic mutations that influence their behavior.

Personalizing Management with Advanced Testing

To give you the most targeted and effective treatment, we rely heavily on advanced lab work:

1. Histopathology and IHC:

When we examine the tissue (histopathological examination), we frequently perform special staining called Immunohistochemistry (IHC). We specifically look for markers like WT-1, p53, and CD7 to confirm the tumor’s exact identity and behavior.

2. Targeted Therapy:

Testing for the BRCA mutation and the HRD (Homologous Recombination Deficiency) mutation is now paramount in our management plan. These mutations are common in 30% to 50% of patients with aggressive, high-grade disease.

3. Maintenance Therapy:

If these mutations are found, the patient becomes eligible for maintenance therapy using medications like PARP inhibitors (e.g., Olaparib), which are specifically designed to target these genetic flaws and significantly reduce the risk of the cancer returning.

Determining the exact stage of ovarian cancer is crucial, as it directly dictates your treatment path and long-term outlook (prognosis).

Staging: The Best Way to See the Disease

While we use radiology (CT and PET scans) for initial diagnosis, the best and most accurate way to stage the cancer is through diagnostic laparoscopy.

• Why Laparoscopy? This minimally invasive procedure allows me to perform an accurate mapping of the disease and measure its resectability (how much can be safely removed). Even the best scans can miss small tumor deposits, which is why a surgical look is often necessary.

Surgery: The Modality of Choice

Currently, for patients where Primary Cytoreductive Surgery (PCS) is possible, open surgery (Midline Vertical Laparotomy) remains the gold standard.

• Minimally Invasive vs. Open: Although trials are ongoing regarding minimally invasive surgery (like the LANCE Trial), the major outcome for disease-free survival (DFS) confirms that open surgery is necessary to ensure the best clearance possible.

Key Prognostic Factor: Achieving Optimal Clearance

The entire goal of PCS is to achieve optimal cytoreduction (tumor removal). This is the single most important marker for your prognosis.

• What is optimal cytoreduction? This means ensuring the residual disease remaining after surgery is less than 0.5 cm, or ideally, achieving R0 disease (no visible cancer left behind).

The Complete Picture: To be completely honest, the disease is never finished with surgery alone. Ovarian cancer is always associated with chemotherapy, which begins either before the surgery (neoadjuvant) or after it.

We know that cancer of the ovary is always associated with either pre-surgical or post-surgical chemotherapy.

The treatment for ovarian cancer is personalized and multi-modal, meaning we almost always use a combination of surgery and powerful medications (chemotherapy and targeted therapy) to achieve the best results.

1. Surgery: The Foundation of Treatment 

Surgery is the cornerstone of curing ovarian cancer, but the timing depends on the disease’s extent:

• Primary Cytoreductive Surgery (PCS): When a patient is judged to be operable, this is the definitive treatment of choice. It has been consistently proven that performing PCS—where we aim to remove all visible cancer—is critical for survival.

• Neoadjuvant Chemotherapy (NACT) followed by Interval Cytoreduction (ICS): In situations where we cannot safely achieve the necessary tumor clearance (PCS), we start with neoadjuvant chemotherapy (NACT)—typically 3 to 4 cycles. This significantly reduces the disease load. The patient is then reassessed, and if judged operable, they undergo Interval Cytoreduction (ICS), which is then followed by another 3 to 4 cycles of chemotherapy.

• Laparoscopic Assessment: We often perform a laparoscopic assessment of the abdomen before deciding if the patient can undergo PCS or if NACT is required first.

Dr. Jay Mehta specializes in minimally invasive laparoscopic and robotic surgeries, offering less pain, faster recovery, and fewer complications.

2. Advanced Surgical Techniques: The Role of HIPEC

We offer advanced techniques like HIPEC (Heated Intraperitoneal Chemotherapy), which has been shown to offer an overall survival benefit when done during interval cytoreduction.

• What is HIPEC? This is a specialized technique where, at the end of the tumor removal surgery, we use a special device and catheter to infuse heated chemotherapy directly inside the abdomen (peritoneum) for approximately 40 to 60 minutes.

• The Benefit: The heat and direct contact allow for excellent permeation of the chemotherapy agent into the peritoneum. This greatly helps in reducing the chances of peritoneal recurrence without adding significant long-term side effects.

• Our Unit: We perform HIPEC very routinely when indicated, using specialized machines and a best-in-class operating theater to ensure safety and precision.

3. The Emerging Role of Robotic Surgery

While open surgery remains the standard for initial, major tumor removal (PCS), we are looking closely at the data from trials like the LANCE Trial regarding minimally invasive surgery.

We do consider robotic surgery for interval cytoreduction in extremely well-selected patients who show a near-complete resolution of the disease following the initial neoadjuvant chemotherapy.

4. Chemotherapy and Targeted Maintenance Therapy

Chemotherapy is an unavoidable and crucial part of treatment:

• Standard Chemotherapy: The standard regimen is a combination of carboplatin plus paclitaxel, calculated carefully by our medical oncologist.

• Targeted Agents: We often add bevacizumab (a targeted drug) to the chemotherapy combination. In some cases, bevacizumab is continued for maintenance post-protocol for up to 12 months.

• PARP Inhibitors: Based on genetic testing for HRD and BRCA mutations, PARP inhibitors (like olaparib) are now a strong recommendation for maintenance therapy. These drugs target the genetic weaknesses in the cancer cells and are associated with a significant reduction in the rate of recurrence.

We are always exploring significant new developments and agents to maximize your survival benefit and reduce the rate of recurrence based on a sound clinical decision taken by our tumor board.

Preserving the ability to have children is a key concern for younger patients, and we approach this with immense care. Fertility-sparing options are only considered in very specific circumstances:

• Early-Stage Disease: The tumor must be completely confined to one ovary without any spread outside of the pelvis.

• Fertility-Sparing Surgery: If the desire for fertility is extremely strong, we may consider unilateral salpingo-oophorectomy (removing only the affected ovary and fallopian tube).

Strict Monitoring and Completion Surgery

It is absolutely critical to understand the commitment required for this choice:

• Close Surveillance: You must undergo very close monitoring and surveillance after the surgery due to the risk of recurrence.

• Completion Surgery: Once childbearing is complete and the family is formed, all these patients must undergo completion surgery (removal of the entire remaining reproductive organ) to eliminate the risk of the cancer returning in the conserved tissue.

Innovative Option: Ovarian Cortex Cryopreservation

A fantastic, safe new option emerging for patients who desire fertility preservation is the technique of ovarian cortex cryopreservation (freezing ovarian tissue).

• Pioneering Technique: This is a technique we have strongly pioneered due to our extensive experience performing it on patients with advanced endometriosis.

• Safety and Future Use: It is an extremely safe and sound procedure that allows young women to preserve their own genetic material and exercise the option of future fertility without compromising immediate cancer treatment.

Once primary treatment is complete, our focus shifts to rigorous surveillance to quickly detect any sign of the cancer returning (recurrence).

What are the risk factors for Ovarian Cancer Recurrence?

The risk of recurrence is highest when the disease shows aggressive biological markers. Key risk factors include:

• Genetic Mutations: The presence of genetic mutations (like BRCA and HRD) and other hereditary mutations.

• Tumor Subtype: Having a high-grade ovarian malignancy (such as high-grade serous cancer).

These factors are associated with a very aggressive outcome and indicate a significantly higher risk of recurrence.

What Follow-Up Strategies Are Recommended After Treatment?

We follow a structured, long-term surveillance plan to ensure the best possible long-term outcome. You will follow up with our primary oncology team frequently:

• First 2 Years (High-Risk Period): Follow-up check-ups are scheduled once every 3 months.

• Next 2 Years: Follow-up check-ups are scheduled once every 6 months.

• Long-Term Outcome: After the first four years, most patients transition to a long-term follow-up schedule of once a year.

This consistent follow-up schedule is critical to our strategy for long-term health management.

The journey of an ovarian cancer survivor continues long after the surgery and chemotherapy are complete. We understand that recovery is not just about oncology; it’s deeply tied to emotional and personal well-being.

Challenges in Survivorship

From an honest and experienced perspective, as doctors closely associated with these patients, we know the challenges are significant:

• Sexual and Reproductive Health: For the vast majority of women in India, the cancer diagnosis and treatment—which often includes surgery and chemotherapy—heavily affects their sexual and reproductive health. This aspect requires sensitivity and open discussion.

• Psychological Health: Patients are almost always undergoing follow-up, maintenance therapy, or strict surveillance. Managing the anxiety of recurrence and the long-term emotional impact of cancer treatment is constant.

Our Dedicated Support Programs

We are committed to supporting the person, not just the disease. We run an extremely dedicated support group program to address these needs:

• Voicing Concerns: This program ensures that patients who have gone through ovarian cancer can openly communicate and voice their health concerns in a safe environment.

• Support and Healing: This activity has greatly benefited our past patients, helping them find strength and community. It is extremely heartening for our team to see the smiling faces of these women, which truly represents their power to heal and stay positive, even those who faced advanced stages of the disease.

Supportive care extends beyond the clinic walls to ensure our patients can manage the recovery process effectively and with dignity.

Comprehensive Supportive Care

1. Home-Based Care:

A significant number of our patients require home-based care. Providing this service is something we strongly look forward to doing. We view ourselves as an integral part and a true companion in this entire journey, ensuring patients have support where they need it most.

2. Financial Assistance:

Alongside the crucial emotional support we provide, many patients require a good amount of financial assistance because the long journey of cancer treatment often exhausts financial resources.

3. Commitment to Affordability:

As a referral unit for gynecological cancers in India, our team is extremely strongly committed to providing financial assistance in the form of low-cost surgeries for the majority of patients suffering from ovarian cancer.

We believe addressing these financial and logistical hurdles is just as vital as the surgery itself to ensure comprehensive patient recovery and long-term quality of life.

When faced with a complex ovarian mass or an ovarian cancer diagnosis, your survival depends on immediate and specialized care.

Do not delay seeking the highest level of expertise. Dr. Jay Mehta, a leading gynecological cancer specialist in Mumbai, India, specializes in advanced cytoreductive surgery, HIPEC, fertility-preserving techniques, and genetically based therapy.  Secure the best possible outcome for your future.

• Early diagnosis of ovarian cancer is critical; it boosts the five-year survival rate dramatically from under 20% to 55%–70%. You must seek a specialist immediately.

• The primary, life-saving approach is Primary Cytoreductive Surgery (PCS) (tumor removal) followed by specialized chemotherapy.

• Our specialized unit utilizes cutting-edge treatments like HIPEC (heated chemotherapy) and personalized PARP inhibitor maintenance therapy (for those with BRCA/HRD mutations) to reduce recurrence.

• For younger women, ovarian cortex cryopreservation (freezing ovarian tissue) is available to preserve future fertility options.

• We provide essential financial assistance programs and strong psycho-social support through dedicated groups to help you through every step of this journey.