Kathmandu
Cancer Center
Kathmandu
Cancer Center
"It's probably just menopause." "The bloating will settle." These are the reassurances that delay ovarian cancer diagnosis by months — sometimes years.
Ovarian cancer is the most lethal gynaecological cancer — not because it is untreatable, but because it is so rarely caught early. Uterine cancer, by contrast, announces itself: postmenopausal bleeding is a symptom that should never be ignored. KCC provides the complete spectrum of gynaecological cancer care — including HIPEC, PARP inhibitor therapy, and bevacizumab — in Nepal.
Medically reviewed by: The Gynaecological Oncology Team, Kathmandu Cancer Center — Surgical, Medical & Radiation Oncology. Educational content — not personal medical advice. Last updated: 2025.
These two cancers behave very differently in how they announce themselves — which changes what you need to watch for.
The ovaries sit deep in the pelvis. Early ovarian cancer causes no pain, no bleeding, and no obvious sign. By the time symptoms become persistent enough to seek help, 75% of patients are already at Stage III or IV. This is not a reason for despair — it is a reason to know the subtle, everyday symptoms that are actually warning signs.
Symptoms that should trigger evaluation — especially if new, frequent (>12×/month) and persistent:
Any vaginal bleeding that occurs 12+ months after the last period is postmenopausal bleeding. Even a small amount of spotting. Even once. In approximately 10% of cases, the cause is endometrial (uterine) cancer. It is never safe to assume it is "normal" or "just hormones." Every case requires a pelvic examination, transvaginal ultrasound, and endometrial biopsy if the lining is thickened.
Other uterine cancer symptoms:
If your mother, wife, or sister has reported any vaginal bleeding after menopause — even once, even months ago — and hasn't seen a doctor: please bring her to KCC for evaluation. This symptom has a name, it is taken seriously, and it is almost always very treatable when investigated promptly.
Early and accurate diagnosis is the foundation of effective treatment. KCC's gynaecological oncology team uses the complete diagnostic pathway without requiring referral to India.
A thorough pelvic examination assesses the uterus, ovaries and surrounding structures. Transvaginal ultrasound (TVUS) provides detailed imaging of ovarian morphology (size, cyst character, solid components, septations) and uterine endometrial thickness. This is the first-line investigation for both ovarian and uterine cancer suspicion.
CA-125 is the primary blood marker for ovarian cancer — elevated in ~80% of epithelial ovarian cancers but also in benign conditions. HE4 (human epididymis protein 4) is more specific. ROMA score combines CA-125 and HE4 to assess malignancy risk. AFP, hCG, LDH are checked for germ cell tumours. CEA and CA 19-9 for mucinous tumours. All available at KCC.
CT chest, abdomen and pelvis determines the extent of peritoneal disease, lymph node involvement, liver and lung metastases, and — critically — operability. For ovarian cancer, CT helps decide whether primary surgery or neoadjuvant chemotherapy first is the right approach. CT is also used to monitor treatment response after each cycle.
Radiology at KCCFor suspected uterine cancer, endometrial biopsy using a Pipelle sampler (outpatient, no anaesthetic) or hysteroscopy with directed biopsy provides histological diagnosis. Histotype (endometrioid vs. serous vs. clear cell vs. carcinosarcoma) determines adjuvant treatment strategy. MMR/MSI testing is performed on all endometrial cancer specimens at KCC.
MRI defines myometrial invasion depth, cervical stromal involvement, and lymphovascular space invasion — factors that directly determine whether adjuvant radiation and/or chemotherapy is needed after surgery. High-resolution pelvic MRI at KCC is read by dedicated gynaecological radiologists.
Every newly diagnosed ovarian cancer patient at KCC undergoes BRCA1/BRCA2 germline testing (blood) and tumour BRCA testing (somatic). HRD (homologous recombination deficiency) testing guides PARP inhibitor eligibility. MMR/MSI testing is performed on all endometrial cancers to identify patients who respond to pembrolizumab immunotherapy.
Ovarian cancer treatment requires the most coordinated multidisciplinary approach in all of gynaecological oncology. The goal of surgery is not simply to remove the tumour — it is to achieve complete cytoreduction (R0): no visible residual disease. That surgical goal, combined with modern systemic therapies, gives patients the best foundation for long-term disease control.
For patients who are fit and whose disease is resectable upfront, PCS aims to remove all visible tumour in a single operation. This includes total hysterectomy, bilateral salpingo-oophorectomy (BSO), omentectomy, peritoneal stripping, bowel resection where needed, and lymph node sampling. The single most important prognostic factor in advanced ovarian cancer is achieving no residual disease (R0) — KCC's surgical oncologists operate with this as the primary goal.
Surgical Oncology at KCCFor patients with Stage IV disease, poor performance status, or disease deemed too extensive for safe upfront complete resection, 3 cycles of carboplatin/paclitaxel chemotherapy are given first. After reassessment with CT scan, patients who respond proceed to Interval Debulking Surgery (IDS) — which in experienced hands achieves equivalent R0 rates to primary surgery. HIPEC may be incorporated at IDS.
For carefully selected young women with Stage IA, Grade 1 ovarian cancer who wish to preserve fertility, unilateral salpingo-oophorectomy (removing only the affected ovary) is a validated option — provided the contralateral ovary, uterus, and peritoneum are confirmed disease-free. All fertility-sparing decisions are made after thorough MDT discussion with the patient fully informed.
HIPEC is one of the most significant advances in ovarian cancer surgery of the past decade.
After cytoreductive surgery removes all visible tumour from the abdominal cavity,
heated chemotherapy solution (cisplatin at 41–43°C) is circulated directly inside
the abdomen for 90 minutes — delivering a concentrated drug dose to the peritoneal
surface where microscopic cancer cells remain invisible to the surgeon's eye.
The heat is not incidental: it increases drug penetration into tissue by 3–4×, sensitises
cancer cells to cisplatin, and independently causes cancer cell death through hyperthermia.
The landmark van Driel trial (NEJM 2018) showed that adding HIPEC to interval debulking surgery
for Stage III ovarian cancer improved median recurrence-free survival significantly and
reduced the risk of death — with no increase in surgical complications.
KCC offers HIPEC as part of its ovarian cancer surgical programme in Nepal.
HIPEC eligibility is assessed by KCC's MDT: performance status, extent of peritoneal disease (PCI score), operability, organ function, and patient preference all inform the decision. Not every patient with peritoneal disease is a HIPEC candidate — but for eligible patients, it is the standard of care.
The global standard of care for first-line epithelial ovarian cancer. Carboplatin (AUC 5–6, IV every 3 weeks) + Paclitaxel (175 mg/m² every 3 weeks) × 6 cycles. Response rates exceed 70–80% for first-line therapy. An alternative dose-dense schedule (weekly paclitaxel + 3-weekly carboplatin) may be used in selected patients, particularly those with impaired renal function. Delivered in KCC's Day Care Chemotherapy unit — most patients go home the same day.
Chemotherapy at KCC
Most ovarian cancers relapse after first-line treatment. Relapse management depends on
the platinum-free interval (PFI):
• Platinum-sensitive relapse (PFI >6 months): Re-challenge with
carboplatin ± paclitaxel / gemcitabine / liposomal doxorubicin. Consider secondary
cytoreduction (DESKTOP III criteria). Re-maintenance with PARP inhibitor.
• Platinum-resistant relapse (PFI <6 months): Non-platinum
single agents (topotecan, gemcitabine, weekly paclitaxel) ± bevacizumab.
The past decade has transformed advanced ovarian cancer from a disease managed only with chemotherapy into one where precision-targeted drugs dramatically extend progression-free survival — and in many cases change the trajectory of the disease.
Bevacizumab is a monoclonal antibody that blocks VEGF (vascular endothelial growth factor),
cutting off the blood supply that tumours depend on to grow. In ovarian cancer, bevacizumab is
added to first-line carboplatin/paclitaxel and continued as maintenance for up to 15 months
in patients with Stage III/IV or high-risk Stage II disease.
The ICON7 and GOG-218 trials established bevacizumab as a standard component of first-line
therapy for high-risk ovarian cancer, improving progression-free survival — especially in
patients with Stage IV disease or suboptimal cytoreduction.
Bevacizumab is available at KCC as part of the first-line ovarian cancer regimen.
PARP inhibitors work by exploiting a fundamental weakness in cancer cells with BRCA mutations
or other defects in the homologous recombination repair (HRD) pathway. These cancer cells already
have one major DNA repair pathway compromised — blocking PARP (their backup repair mechanism)
causes irreparable DNA damage and cell death. Normal cells, with intact BRCA, survive.
The results in clinical trials are striking: olaparib maintenance therapy after first-line
chemotherapy reduces the risk of disease progression by over 70% in BRCA1/2-mutant patients
(SOLO-1 trial — median PFS 56 months vs 13.8 months with placebo). Niraparib benefits patients
regardless of BRCA status (PRIMA trial). This is not a marginal gain — it is a fundamental
change in the biology of disease control.
KCC offers PARP inhibitor maintenance therapy and performs all required testing (BRCA, HRD) on-site.
First-line maintenance for BRCA1/2-mutant advanced ovarian cancer after complete/partial response to platinum chemotherapy. 300 mg twice daily orally. SOLO-1: 56 months median PFS vs 13.8 months. Also used in platinum-sensitive relapse (SOLO-2).
First-line maintenance regardless of BRCA/HRD status — benefits all patients, with greatest effect in HRD-positive tumours. 200–300 mg daily orally (dose by weight/platelets). PRIMA trial established efficacy. Particularly relevant where BRCA testing result is pending or negative.
Used in platinum-sensitive relapse for BRCA-mutant or HRD-positive tumours. Also available as treatment (not just maintenance) in BRCA-mutant patients after 2+ prior lines. 600 mg twice daily orally.
Combination maintenance for HRD-positive (BRCA-mutant or HRD+) patients after first-line bevacizumab-containing chemotherapy. The PAOLA-1 trial showed significant PFS improvement — the most effective maintenance regimen for HRD+ ovarian cancer. Available at KCC.
Uterine (endometrial) cancer is the most common gynaecological cancer globally, and it is among the most treatable — particularly when caught early, as it often is thanks to the cardinal symptom of postmenopausal bleeding. The primary treatment is surgical, but adjuvant radiation and/or chemotherapy are added based on precise risk stratification.
Removal of the uterus, cervix, both fallopian tubes and both ovaries. This is the cornerstone of uterine cancer treatment for virtually all stages. Performed laparoscopically for most Stage I–II cases (smaller incisions, less pain, faster recovery) or by open surgery when needed. Laparoscopic / minimally invasive hysterectomy is the preferred approach at KCC for suitable patients — equivalent oncological outcomes with faster return to normal life.
Surgical Oncology at KCCPelvic and para-aortic lymph node dissection or sentinel lymph node biopsy (SLNB) is performed to determine nodal stage — a critical factor in adjuvant treatment decisions. SLNB (mapping with ICG or blue dye injection) identifies the first draining nodes with less morbidity than full lymph node dissection. KCC performs SLNB as the standard approach for appropriate endometrial cancer staging.
For Stage I intermediate/high-intermediate risk endometrial cancer, vaginal vault brachytherapy delivers targeted radiation to the vaginal cuff (where recurrence most commonly occurs) using an internally placed applicator. Takes 10–15 minutes per fraction. Very well tolerated. The PORTEC-2 trial established VBT as equivalent to external pelvic EBRT for preventing vaginal recurrence, with significantly less bowel and bladder toxicity. Available at KCC's radiation oncology department.
For Stage III disease with pelvic lymph node involvement or parametrial extension, pelvic IMRT (intensity-modulated radiation therapy) delivers precise dose to at-risk lymph node regions while minimising bowel, bladder and rectal dose. Given with concurrent weekly carboplatin/paclitaxel chemotherapy (PORTEC-3 protocol) for Stage III and high-risk histologies (serous, clear cell, carcinosarcoma).
For advanced or recurrent endometrial cancer that is MSS (microsatellite stable) and has progressed after platinum chemotherapy, the combination of pembrolizumab (PD-1 checkpoint inhibitor) + lenvatinib (tyrosine kinase inhibitor) achieves response rates and survival outcomes superior to single-agent chemotherapy — established in the KEYNOTE-775 trial (previously called Study 309). KCC evaluates all advanced endometrial cancer patients for pembrolizumab/lenvatinib eligibility.
For endometrial cancers that are MSI-H / dMMR (mismatch repair deficient — approximately 25–30% of endometrial cancers), pembrolizumab monotherapy achieves striking response rates. For first-line advanced disease, pembrolizumab has received accelerated approval and is being integrated into primary treatment protocols alongside chemotherapy. KCC performs MMR/MSI testing (IHC) on every endometrial cancer specimen to identify eligible patients.
After surgery, the pathology report (stage, grade, histotype, LVSI, MMR status, myometrial invasion, lymph node status) is used to classify each patient into a FIGO 2023 / ESGO-ESTRO-ESP risk group that determines adjuvant treatment:
Genetic testing has moved from an academic exercise to a clinically essential part of ovarian cancer management — because BRCA status directly determines treatment and shapes the risk picture for family members.
Lynch Syndrome (MLH1/MSH2/MSH6/PMS2 mutations) causes dramatically elevated risks of uterine cancer (40–60% lifetime) and ovarian cancer (10–15% lifetime), in addition to colorectal cancer. All endometrial cancer patients under 60 should have MMR/MSI testing. Positive result prompts germline Lynch testing and family counselling.
If you or a family member has received a diagnosis — or has symptoms that need investigating — here is exactly what the journey at KCC looks like. No surprises.
Call us, WhatsApp your reports, or book an appointment. Bring any previous scans, ultrasound reports, blood tests, or biopsy results. Our team will guide you through everything else.
डिम्बासय क्यान्सर प्रायः प्रारम्भमा कुनै स्पष्ट लक्षण देखाउँदैन — त्यसैले यसलाई "मौन हत्यारा" भनिन्छ। तर यी लक्षणहरूमा ध्यान दिनुहोस् — विशेष गरी यदि नयाँ छन्, बारम्बार छन् र हप्तौंसम्म जारी छन्:
⚠️ रजोनिवृत्ति (menopause) पछि कुनै पनि रगत आउनु — चाहे थोरै भए पनि — तुरुन्त डाक्टरलाई देखाउनुपर्छ। यो लक्षण पाठेघरको क्यान्सरको सबैभन्दा महत्वपूर्ण संकेत हो। लापरवाही नगर्नुहोस्।
KCC, सूर्यबिनायक, भक्तपुर: भारत जानु पर्दैन। डिम्बग्रन्थि र पाठेघरको क्यान्सरको सम्पूर्ण उपचार — HIPEC सहित — नेपालमै। फोन: 01-6634300 | WhatsApp मा रिपोर्ट पठाउनुहोस्