 Hi everyone, I am Dr. Mohamad Bashi Rukti Nandar, I am a consultant, surgical oncologist and robotic surgeon. Today there is a patient awareness program conducted by Manipal Hospital Hepal. I would like to educate you on ovarian cancer. Ovarian cancer is the leading cause of mortality that is deaths among the women amongst the gynecological cancers. The reason for this is ovarian cancers tend to present at a very late stage because it is an intraabdominal organ and the symptoms by the time they present with the disease would have progressed to a greater stage and by the time we pick up the disease, the disease would have progressed to stage 3 and 4 which is where all the problem lies. So coming to the types of ovarian cancers, there are basically two broad types of ovarian cancers. The first one is called as epithelial ovarian cancer, these are the most common types. These are seen amongst the elderly people that is 5th, 6th and 7th decade. And the other one which is seen is also called as the germ cell cancers, these are seen among the younger women. So coming to the symptoms of ovarian cancer, as I have already told, the ovarian cancer tends to present at a very late stage. Initially, we hardly pick up any symptoms, they tend to present with easy fatigability, abdominal distension, some weight loss of appetite. These are the symptoms, so there is no one specific symptoms with which a patient presents, that is why it is difficult for us to pick it up in early stage. In fact, even in the developed world that is the US and Europe, even there the ovarian cancer tends to present in the stage 3 onwards that is almost about 70% of the population presents at stage 3. By when the ovarie which is usually of pelvic organ, if the cancer is seen, it would have progressed on to the upper abdomen. The speciality of ovarian cancer is that it tends to spread intra-abdominally, that is within the peritoneal cavity and generally does not spread to the other organs, though it is seen, but it is a very rare phenomenon. So as we know that as it is localized in the abdominal cavity, it can be treated, but it needs a dedicated setup for the treatment and it needs a very extensive surgery. So let's come to the treatment aspect of ovarian cancer. For stage 1 and 2, where the disease is localized on the ovarie or within the pelvic cavity, usually we go ahead with surgery. When it goes to stage 3, if the patient condition permits, the patient is very fit, then we take her up for an extensive cytoneiductive surgery and follow this up with something called as hypothermic intraperitoneal chemotherapy. This is where our department specializes in. In Manipal Hospital, we have a specialized machine called as Hypec Machine wherein the chemotherapy is given at a heated temperature that is around 41.5 degrees and we run the chemotherapy within the abdominal cavity after doing an extensive cytoreductive surgery. This is the key word. We have to do an extensive cytoreductive surgery wherein we take out the hysterectomy, the bilateral ovaries, the pelvic lymph nodes, the pariotic nodes, the momentum, the entire peritoneal lining of the abdomen, which is called as total peritonectomy. This is a very extensive surgery. It needs a dedicated center, a dedicated setup. We need trained surgeons, quality anesthetists and a good ICU backup, which is all available at Manipal hospitals. After this, we do something called as Hypec, wherein a heated chemotherapy is circulated within the peritoneal cavity. This is generally done for about 90 minutes and by the heating of chemotherapy, what we achieve is the chemotherapy tends to penetrate a lot further into the cancer cells and destroys it locally. When we give IV chemotherapy, that is systemic chemotherapy, the concentration that reaches the abdominal cavity is about one-tenth or one-hundred of what we achieve when we give intraperitoneal, that is by hyping. So, we tend to deliver a large dose with minimal side effects. This is what is called as Hypec. And when the patient unfortunately comes to us in a state where we cannot operate upon or when the disease is too extensive, the patient doesn't warrant extensive surgery, then we can do something called as PIPAC, which is pressurized intraperitoneal aerosolized chemotherapy, wherein we spray the chemotherapy in the form of nanoparticles and under pressure it goes and destroys the cancer cells. This facility is also available at Manipal hospitals and we are one of the pioneers in developing this technique and we have an extensive series. So, I would request all of the women out there, especially women in their 30s, 40s and 50s, people with family history of ovarian or breast cancers or any other cancers to go for early screening. Screening can be done by tumor markers and ultrasound abdomen or the CT scan of the abdomen and also if there are any symptoms, any doubts, any clarifications needed, you can visit us at Manipal Hospital Hypal for further clarifications. Thank you, have a good day.