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Ovarian cancer
What is Ovarian Cancer?
Ovarian cancer refers to malignant growth arising from different parts of the ovaries. The ovaries are part of a woman’s reproductive system, where the eggs are developed. Most ovarian cancers are classified as ‘epithelial’ – arising from the surface of the ovary. Other types arise from the egg cells (germ cell tumour) or supporting cells (sex cord/stromal).
What Causes This Cancer and Who are at risk?
The risk factors of ovarian cancer include:
- Late pregnancy
- Early onset of menstruation
- Late menopause
- Never had children
- History of breast cancer
- Genetic predisposition
- Endometriosis, where tissue that normally lines the inside of the uterus grows outside instead
Age of Onset
Epithelial ovarian cancer usually affects older women although it can also happen to younger women. Germ cell cancers of the ovary occur more frequently in younger women.
Ovarian cancer is known to run in some families with BRCA gene abnormalities or Lynch syndrome. Families with BRCA gene abnormalities may have increased risk of getting ovarian, breast and uterine cancer. Families with Lynch syndrome may have increased risk of getting ovarian, uterine and colorectal cancer. In this case, women with a sister or mother with Lynch syndrome are 20 times more likely to develop ovarian cancer. Ovarian cancer also runs in certain families with a history of breast and colon cancers. There is now evidence to suggest that certain genes are involved in causing these diseases.
Early ovarian cancer rarely has symptoms or signs. Symptoms tend to develop only in the advanced stages of ovarian cancer, they include:
- Abdominal swelling and discomfort
- Bloating
- Persistent indigestion, gas or nausea
- Changes in bowel habits, such as constipation
- Loss of appetite
- Back pain
CA 125 Blood Test
CA 125 is a protein found on the surface of ovarian cancer cells and certain healthy tissue. The level of CA 125 is raised in about 80% of patients with epithelial ovarian cancers. However, it is not always indicative of ovarian cancer and not adequate for its diagnosis as the level of CA 125 can also be raised in conditions such as endometriosis and appendicitis.
Ultrasound Scan
You may have an internal ultrasound (known as a transvaginal ultrasound), where the ultrasound probe is inserted into the vagina. There is also the option of an external ultrasound, where the probe is put next to your stomach. The ultrasound image can show the size and texture of the ovaries, as well as any cysts that may be present.
Pelvic Examination
The doctor can inspect the genitals (vulva), vagina, uterus and ovaries for unusual changes.
CT Scan / MRI Scan
These imaging scans of the abdomen, chest and pelvis help to look for signs of cancer in the body.
Chest X-rays
These are useful in detecting whether other areas of the body such as the lungs are affected by the cancer.
Surgery / Biopsy
An operation or biopsy is required to prove that affected cells are cancerous.
What treatment is offered?
To determine the actual extent of the cancer, surgical exploration or ‘staging’ of the cancer is required. To do so, the doctor conducts surgery to examine the peritoneum, which is the inner lining of the abdomen. Fluid within the abdomen is sent for assessment which involves analysis under a microscope. Besides determining the stage of the cancer, the aim of surgery is to remove as much of the cancer as possible. Often this includes removing the ovaries, the uterus and its surrounding lymphatics.
Additional treatment following surgery will be determined by the stage of the disease, the grade of the disease and the type of cancer.
For very early stage or non-aggressive cancer, further treatment may not be required. For more advanced and aggressive cancer, chemotherapy may be the treatment of choice.
Prognosis of Ovarian Cancer
Treatment tends to be highly effective for ovarian cancer in the early stage, and very difficult in the late stage of the cancer. However, survival has increased in the last 10-20 years due to better chemotherapy.