What is ovarian cancer?
There are three types of ovarian cancer: the common epithelial type (90% of cases) that arises from the cells on the outside of the ovary; the germ cell type that arises from the cells which produce eggs; and the rare stromal type arising from supporting tissues within the ovary.
Ovarian cancer is the eighth most common cancer and the sixth most common cause of cancer death affecting women.
The risk of being diagnosed before age 85 is 1 in 82.
Ovarian cancer symptoms
There may be no symptoms or symptoms may be non-specific and include:
- abdominal bloating
- difficulty eating or feeling full quickly
- frequent or urgent urination
- back, abdominal or pelvic pain
- menstrual irregularities
- pain during sexual intercourse.
Causes of ovarian cancer
The cause of ovarian cancer is not known, however risk factors include:
- ageing (risk increases for women over 50)
- family history
- changes in the genes BRCA1 or BRCA2.
- being of Northern European or Northern or Ashkenazi Jewish descent
- early onset of periods (before 12 years) and late menopause
- first child after 30
- never taking oral contraceptives
- using oestrogen only hormone replacement therapy or fertility treatment.
Diagnosis for ovarian cancer
If you are experiencing possible symptoms of ovarian cancer your doctor may suggest several tests or scans to look for cysts, tumours or other changes. These may include:
- physical examination in which the doctor will check your abdomen for any lumps and do an internal vaginal examination
- blood tests
- imaging scans
- CT scan
- PET scan
These can show if there are any abnormalities but a biopsy (taking a tissue sample) is the only way to confirm a cancer diagnosis.
Treatment for ovarian cancer
Ovarian cancer often presents when it has spread. A common staging system is the FIGO (International Federation of Gynaecology and Obstetrics) system, which records the extent by whether it remains in the ovary, has spread to other pelvic structures or has spread into the lining of the abdomen with or without fluid (ascites). CT scans and blood test to measure CA125 are used.
Types of treatment
Treatment depends on the extent of the cancer. Surgery is used to determine the extent of disease and, if localised, is the main treatment. If the cancer has spread, an attempt is made to remove as much as possible.
Chemotherapy, commonly with regimens containing cisplatin or carboplatin and paclitaxel or docetaxel, is used after surgery to try to eliminate all disease identified by scan and CA125 blood test. Chemotherapy can be injected into the bloodstream through the vein or instilled into the abdominal cavity or both.
With widespread disease, chemotherapy may be used first. Surgery after chemotherapy can assess response. Germ cell tumours can be cured with chemotherapy with PEB (cisplatin, etoposide, bleomycin).
Depending on your treatment you will be seen by several specialists, such as:
- gynaecological oncologist who specialises in treating women with cancers of the reproductive system
- medical oncologist who prescribes the course of chemotherapy
- radiation oncologist who prescribes the course of radiotherapy
- radiologist who is trained to interpret diagnostic scans
- cancer nurses
- other health professionals such as dietitian, physiotherapist, social worker and counsellor.
Prognosis for ovarian cancer
An individual's prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. If the cancer is treated when it is still confined to the ovaries, 93% patients will be alive in five years. If the cancer has spread to surrounding tissue or organs in the pelvis, this drops to 39%, and if it has spread more distantly, 30%. Survival will vary between individuals and may depend on their response to treatment.
Preventing ovarian cancer
There is no proven method of prevention. Oophorectomy (removal of ovaries) in women with a strong family history does not always prevent cancer.