Ovarian cancer

What is ovarian cancer?

Ovarian cancer occurs when cells in one or both of the ovaries begin to grow abnormally and develop into cancer. There are four main types of ovarian cancer that are named after the cell types where the cancer originates:

Epithelial ovarian cancer

• Originates in the epithelium (outer cells of the ovary) and accounts for ~90% of cases.

Borderline or low malignant potential (LMPO) tumours

• Less aggressive epithelial tumours with a generally favourable prognosis for the women affected.

Germ cell ovarian cancer

• Arises in the cells that mature into eggs (ova) and accounts for ~5% of ovarian cancer cases, particularly affects women under 30 years.

Sex-chord stromal cell cancer

• Begins in the ovarian cells that release female hormones, also accounts for ~5% of cases and can affect women of any age.

Cause of ovarian cancer

There are a number of factors which may increase a woman's risk of developing ovarian cancer, such as:

• Family history
• Being of Northern European or Ashkenazi Jewish descent
• Alterations in BRCA1 or BRCA2 genes
• Being over the age of 50
• Late menopause
• Early onset of menstruation (<12 years)
• Infertility, never having children or having their first child after the age of 30 years
• Never taking oral contraceptives
• Having fertility treatment or oestrogen-only hormone replacement therapy
• Smoking
• Obesity

Symptoms of ovarian cancer

Although there are no obvious signs of ovarian cancer, you may experience some of the following symptoms:

• Abdominal bloating
• Difficulty eating/feeling full quickly
• Frequent/urgent urination
• Constipation
• Indigestion
• Back, abdominal or pelvic pain
• Menstrual irregularities
• Fatigue
• Pain during sex

Diagnosis

There is currently no screening option for ovarian cancer in Australia. However, if you are experiencing symptoms associated with ovarian cancer it is advised that you discuss your concerns with your doctor who may suggest various tests to detect cysts, tumours or other abnormalities. These may include:

Physical examination

• External abdomen examination and internal vaginal examination.

Blood tests

• Your blood will be tested for tumour markers, in particular the protein CA125 which may be elevated in women with ovarian cancer.

Ultrasound

• A transvaginal ultrasound (TVU) where an ultrasound probe to be inserted into your vagina to relay an image of the ovaries.

Other Imaging scans

• Other tests may include CT scans, external ultrasounds, abdominal x-rays or an MRI

If the tests suggest that there are abnormalities present, a biopsy (tissue sample) may be taken to confirm cancer diagnosis.

Staging

There are often few signs of ovarian cancer in its early stages, usually only presenting once the cancer has spread. The stage of ovarian cancer is determined using the International Federation of Gynaecology and Obstetrics (FIGO) system. The FIGO system records whether the cancer remains contained within the ovaries or the extent of which it has spread to other pelvic structures or into the abdominal lining.

Treatment

Your treatment team generally consists of your GP as well as a number of specialists including a gynaecological oncologist and possibly a medical oncologist or radiation oncologist, as well as other healthcare professionals. The best treatment option depends on the type and stage of the ovarian cancer as well as general health.

Surgery

• Surgery is usually the main treatment option for ovarian cancer, particularly when the cancer is still localised. The initial operation is known as a laparotomy, where a long vertical cut is made in the abdomen in order for the surgeon to locate and remove as much of the tumour as possible. At the start of the laparotomy a biopsy (known as a frozen section) is taken to confirm diagnosis. During the operation most women will have their ovaries, Fallopian tubes, uterus, omentum (fat pad around the abdominal organs), appendix and some lymph nodes removed, as well as part of the bowel in some instances. Biopsies from the removed tissues are examined to enable the gynaecological oncologist to learn more about the type and extent of the cancer and determine the best course of action for further treatment.

Chemotherapy

• Most women with ovarian cancer also undergo chemotherapy to slow or cease the growth of remaining cancer cells. Chemotherapy is most effective when the cancer is small and the cells are actively growing and is commonly used soon after surgery to remove remaining cancer cells. It may also be used as a first line of treatment in cases of widespread disease, or in situations where ovarian cancer has returned. Chemotherapy can damage non-cancerous cells and cause side effects. Advice for reducing of managing these side effects can be found here.

Radiotherapy

• Radiotherapy is less often used as a treatment for ovarian cancer but may be used in cases where the cancer is confined to the pelvic cavity, or in cases of advanced ovarian cancer to reduce the size and relieve symptoms.

Palliative care

• Palliative care may also be used in an attempt to alleviate symptoms, improve quality of life and slow the spread of ovarian cancer

Useful resources

Cancer Council Australia

http://www.cancer.org.au/about-cancer/types-of-cancer/ovarian-cancer.html

Ovarian Cancer Australia

https://ovariancancer.net.au/about-ovarian-cancer/