Causes
The cause of ovarian cancer is unknown. However, the following factors increase a woman's chance of developing ovarian cancer:
- Age: Most common in women over 50 and in women who have stopped menstruating (have been through menopause). The risk increases with age.
- Child-bearing history: Women who haven't had children, or were unable to have children, may be slightly more at risk.
- Hormonal factors: Includes early puberty or late menopause and using oestrogen-only hormone replacement therapy (HRT).
Women who have taken the contraceptive pill for a number of years seem to have a lower risk. There is also limited evidence suggesting that breastfeeding may protect against ovarian cancer.
There is no proven link between ovarian cancer and a high-fat diet, using talcum powder around the genital region, or the mumps virus.
Family history
In about 5-10% of women diagnosed with ovarian cancer there may be an inherited faulty gene in their family. This fault increases the risk of developing ovarian cancer.
There are two genetic conditions known to cause an increased risk of ovarian cancer:
- hereditary breast/ovarian cancer
- Lynch syndrome (hereditary non-polyposis colorectal cancer or HNPCC).
You may want to talk to your doctor about referral tr or go to a family cancer clinic if you have several close family members on either your mother or father’s side with cancers particularly breast, ovary, bowel or uterus.
Symptoms
Ovarian cancer is often a silent disease in the early stages, which means many women have no symptoms. If symptoms do appear, they are usually vague and may include:
- swelling, pressure, discomfort or pain in the abdomen
- heartburn, nausea or bloating
- changes in toilet habits, such as constipation, diarrhoea and frequent urination due to pressure
- tiredness and appetite loss
- unexplained weight loss or weight gain
- changes in your menstrual pattern or postmenopausal bleeding
- pain during sex.
These symptoms are common to many illnesses, and most women with these symptoms will not have ovarian cancer. Only tests can confirm the diagnosis.
Diagnosis
Tests to find cancer
Most ovarian cancer tumours are present for some time before they are discovered. Sometimes ovarian cancer is found unexpectedly during an operation such as a hysterectomy.
The Pap test does not detect ovarian cancer, but it may show if cancer cells have spread to the cervix.
Physical examination
The doctor will check for a mass or lump by feeling your abdomen and doing a vaginal examination.
If there is a build-up of fluid in the abdomen, a fluid sample may be taken by a needle passed through the skin (paracentesis). The fluid is checked under a microscope for cancer cells.
You may have a type of surgery called an exploratory laparotomy so the doctor can examine the tissue in your abdomen.
Blood tests
Chemicals that are produced by cancer cells as proteins are found in the blood. They are called tumour markers.
You will have a blood test to check the level of your tumour markers. The most common tumour marker for ovarian cancer is called CA125.
If the CA 125 is raised, you may have ovarian cancer. However, you could have raised markers and not have ovarian cancer, as levels may be higher in women who have common gynaecological conditions, such as endometriosis or fibroids. For this reason the CA 125 test alone cannot be used to screen or diagnose ovarian cancer.
For more information about CA 125 www.nbocc.org.au has produced a fact sheet – Information about CA 125 and Ovarian Cancer
Imaging and scans
Abdominal ultrasound: A handheld device called a transducer is passed over your abdomen. Echoes from soundwaves are turned into a picture by a computer.
Transvaginal ultrasound: A transducer is inserted into your vagina and echoes from soundwaves are turned into a picture by a computer. This should not be painful.
CT scan: Uses x-ray beams to take pictures of hte inside of your body. You will be asked not to eat or drink before the scan, and you may have some liquid dye that makes your organs appear white on the scans. You will lie on a table while the scanner, which is large and round like a doughnut, rotates around you.
Stages of ovarian cancer
Working out how far the cancer has spread is called staging.
Staging the cancer helps your doctors decide on treatment.
A simplified version of a common staging system is described below:
Stage I - Cancer is found in one or both ovaries.
Stage II - Cancer is found in one or both ovaries and has spread to other organs near the pelvis.
Stage III - Cancer has spread beyond the pelvis to the lining of the abdomen, the intestines or lymph nodes in the abdomen or pelvis.
Stage IV - Cancer has spread outside the abdomen, for example, to the liver, lungs or distant lymph nodes.
Prognosis
Prognosis means the expected outcome of a disease. You will need to talk about this with your doctor. It is not possible for any doctor to predict the exact course of your illness.
- Epithelial cancer: The outcome depends on the stage of the disease. Stage I is usually a good outlook (cancer can usually be cured). Women with advanced cancer may respond well to treatment, but the cancer often comes back at a later time.
- Non-epithelial cancer: Can usually be treated successfully.
- Borderline tumours: Have a good prognosis regardless of when they are diagnosed.
Which health professionals will I see?
The multidisciplinary team will include the following people although all may not be directly involved in your care:
- gynaecological oncologist - specialist in treating women with ovarian cancer
- medical oncologist - prescribes and coordinates the course of chemotherapy
- radiation oncologist - prescribes and coordinates the course of radiotherapy
- nurses - help administer chemotherapy and provide care, information and support throughout treatment
- dietitian -- recommends an eating plan to follow while you are in treatment and recovery
- social worker -- helps provide emotional support and practical assistance to patients and carers
- psychologists and counsellors -- help you manageyour feelings and cope with changes to your life
- physiotherapist and/or occupational therapist -- help you resume normal activities
- palliative care doctor -- provides support and symptom relief.
Your general practitioner (GP) is also an important member of your treatment team. GPs can explain information provided by your specialists, help you with treatment decisions and assist you in obtaining practical and emotional support.
Treatment
Treatment for ovarian cancer depends on what type of cancer you have, the stage, your general health and fitness, your doctors' recommendations and your wishes.
- Epithelial ovarian cancer is commonly treated with surgery, chemotherapy and/or radiotherapy.
- Borderline tumours are usually treated with surgery.
- Non-epithelial ovarian cancer is usually treated with surgery and/or chemotherapy.
Surgery
Your doctor will discuss the most appropriate type of surgery with you.
Laparotomy
The first treatment for ovarian cancer is usually an operation to look inside the abdomen. This is called a laparotomy.
A cut is made in the lower abdomen from the bellybutton to the pubic bone.
Other types of surgery
If there is obvious spread of cancer, you will need an operation to remove as much of the cancer as possible. This is called surgical debulking.
You may also have one or more of the following procedures:
- total abdominal hysterectomy -- removal of the uterus and cervix
- bilateral salpingo-oophorectomy -- removal of both ovaries and both Fallopian tubes
- omentectomy -- removal of the fatty protective tissue (omentum) covering the abdominal organs
- colectomy -- removal of all or part of the bowel and rejoining of the two ends of the bowel or the creation of a new opening called a stoma (colostomy or ileostomy)
- lymphadenectomy -- removal of the small, bean-shaped organs that help filter toxins from the blood stream (lymph nodes).
The surgeon will also take samples of the tumour and fluid in the abdomen and send them to a lab.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs that kill or slow the growth of cancer cells.
Except for a small number of women with very early stage 1 ovarian cancer women with epithelial ovarian cancer usually receive a combination of two chemotherapy drugs: carboplatin and paclitaxel. However, not everyone has both drugs. One drug may be prescribed for frail or elderly women.
Chemotherapy is usually given through an intravenous drip. Your first treatment may be given while you are recovering from surgery, or a few days after you leave hospital.
About 6-8 treatments will be given every 3-4 weeks over about six months.
Blood tests will be taken to make sure your body's healthy cells have had time to recover. The tests will also check the amounts of your tumour markers, such as CA125.
Palliative treatment
Palliative care does not try to cure disease but aims to help you and your family improve your quality of life by addressing physical, practical, emotional and spiritual needs associated with your illness. To find out more information download the NSW Cancer Coundil Booklet Understanding Palliative Care or read more.
After treatment: follow-up
After your treatment, you will need regular checkups with your specialist to confirm the cancer hasn't come back. You may have scans or tests at your checkups, including physical examinations, blood tests, x-rays, ultrasounds and CT scans.
If you have health problems between follow-up appointment, let your doctor know immediately.
If the cancer comes back, this is called a relapse or recurrence.
It is likely cancer will come back for women with advanced epithelial ovarian cancer. Usually, the longer the time between the end of the first course of treatment and the relapse, the better the response will be to further treatment.
The most common treatment for epithelial ovarian cancer that has come back is more chemotherapy. The drugs used will depend on what drugs you were given, the length of your remission, and the aims of the treatment.