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 (around 4% of cases) 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 affecting women in Australia.
In 2014, 1395 new cases of ovarian cancer were diagnosed in Australian women. The risk of being diagnosed before age 85 is 1 in 81.
In 2016, there were 938 deaths caused by ovarian cancer in Australia.
The five year survival rate for ovarian cancer is 45%.
Ovarian cancer symptoms
There are often no obvious signs of ovarian cancer, however you may have one or more of the following symptoms:
- 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
Some factors that can increase your risk of ovarian cancer include:
- ageing (risk increases for women over 50)
- family history of ovarian, breast or bowel cancer
- changes in the genes BRCA1 or BRCA2.
- being of Ashkenazi Jewish descent
- early onset of periods (before 12 years) and late menopause
- women who have not had children or had their first child after the age of 35
- 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 to check for a common tumour marker for ovarian cancer, CA125
- 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).
Radiation therapy can be used to treat the pelvis or other sites of cancer that have spread. It may be used on its own or after chemotherapy.
Your GP generally arranges for initial tests and looks after your general health as well as coordinating with your specialists. 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
- gynaecological pathologist who examines tissue removed from the abdomen or ovaries
- cancer nurses
- other health professionals such as a dietitian, physiotherapist, social worker and counsellor.
In some cases of ovarian cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
As well as slowing the spread of ovarian cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
Screening for ovarian cancer
There is currently no screening for ovarian cancer available in Australia.
Prognosis for ovarian cancer
Prognosis refers to the expected outcome of a disease. 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. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. 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.