What’s my tummy so bloated?

G, 43, had a rude shock and felt devastated a year ago when she had been diagnosed with ovarian cancer. She was unaware that the bloated feeling in her tummy was connected to the disease.

“I’d nausea and a bloated feeling in my belly for a week. My family physician diagnosed me as having tummy upset and treated me with gastric drugs” G remembered,”but the symptoms persisted and I started to lose my appetite. She then arranged for me to have an ultrasound evaluation of the clitoris that showed a 5 cm tumor in my left leg”

As soon as I examined G, the abdomen was distended with fluid. MRI (Magnetic Resonance Imaging) scan supported the left knee cyst with solid areas in its wall. There was ascitic fluid from the thoracic cavity with a hint of tumor spreading into the peritoneum, the inner lining of the abdominal cavity. The blood level of ovarian cancer tumors marker, CA125, was raised many times above normal.

She had an extensive operation a week after the removal of the left ovarian tumor together with the uterus, the right ovary and the omentum, the fatty tissue apron covering the intestines. Microscopic evaluation of this tumors confirmed ovarian cancer with spread into the omentum and peritoneum. The cancer had been classified as stage III and chemotherapy has been shortly administered after she recuperated from the surgery.

It is a very quiet disease with no or minimal symptoms in early stage. It often goes undetected until it’s spread into the abdomen. When this occurs, these symptoms may be present. They comprise:

• Bloatedness of this stomach

• Indigestion and loss of appetite

• Weight loss

• Abdominal pain

• Change of bowel and urinary habits

A number of these symptoms are non invasive and can also function as indicators of other less severe conditions like irritable bowel syndrome.

Based on the extent, the disease is categorized into four stages.

• Stage I: cancer is confined to the ovaries.

• Stage II: cancer has spread to the surrounding pelvic organs, like the fallopian tubes or uterus.

• Phase III: cancer has spread beyond pelvis into different areas of the abdomen.

• Phase IV: cancer has disseminated to remote sites outside the abdomen such as the brain and lungs.

It’s been estimated that over 60% of ovarian cysts are in the advanced stages (stage III and IV) when the patient is first diagnosed. Until now, there is no dependable, effective screening method to detect the disease early.

Because of the late diagnosis, patients with ovarian cancer have a poor prognosis despite treatment which normally involves a combination of surgery and chemotherapy. Surgery is typically the initial step. It is done to remove the cancer as much as possible and also helps confirm the stage of the disease.

How much surgery to be performed would depend on just how far the cancer has spread. For first stage, the operation may involve removing the affected ovary and its fallopian tube.

Chemotherapy might be necessary to kill cancer cells which may remain. These strong medications are often given through the vein (intravenous). But sometimes they might work better if they are injected directly into the abdomen.

G had negative effects from the chemotherapy. She looked slightly pale and tired on her very last inspection. She had to put on a wig from the baldness. But she had been in great spirits.

“I’m a fighter” she said.

Want to find out more about Dr Peter Chew – one of the primary women’s clinic in Singapore? Contact us today! We’re based at Gleneagles Hospital.