WHAT IS OVARIAN CANCER?
The Ovaries
The ovaries are part of the female reproductive system and contain the eggs (ova) which can make a new human life when fertilised. The ovaries are almond-shaped organs, each approximately 3cm long and 1cm thick. They are found inside the pelvic cavity, one on each side of the uterus and are very close to the end of the fallopian tubes.
Each ovary has an outer covering made up of a layer of cells called epithelium. Inside are ‘germ cells’ which will eventually mature into eggs. The eggs travel to the outside of the ovary to be released into the Fallopian tubes. If the egg is not fertilised by male sperm, it passes out of the uterus with the monthly period (menstruation).
The ovaries also contain cells which release the female hormones: oestrogen and progesterone. These cells are called ‘sex-chord stromal’ cells.
Ovarian Cancer
Ovarian cancer is a malignant tumour in which some of the cells of the ovary undergo changes and develop into cancer. It can affect one or both ovaries. There are four different types of ovarian cancer, named after the part of the ovary that is affected. Knowing exactly which type of cancer you have helps your doctor advise you on which treatment is best for you.
The different types of ovarian cancer are:
Epithelial ovarian cancer:
This type of ovarian cancer arises in the epithelium: the outer cells covering the ovary. It is the most common type of ovarian cancer. Nine out of ten ovarian cancers are epithelial.
Germ cells and sex-cord stromal cell ovarian cancer:
These two types of ovarian cancer are very uncommon. The germ cell cancers arise in the cells that mature into eggs and usually only affect women under 30 years of age.
Sex-cord stromal cell cancers arise in the cells which release the female hormones. These cancers can occur at any age.
Germ cell and sex-chord stromal cell ovarian cancers usually respond very well to treatment and are often curable. If these cancers only affect one ovary, it may still be possible for younger women to have children after treatment.
Borderline tumours:
Borderline tumours are a group of epithelial tumours, which are not as aggressive as other forms of ovarian cancer. Sometimes the words 'low malignant potential' are used to describe borderline tumours. The outlook for women with borderline tumours is generally good regardless of whether the disease is diagnosed early or late.
Cancer of the Fallopian Tubes
Rarely, cancers develop in the Fallopian tubes. This is very similar to epithelial ovarian cancer and is treated in much the same way.
How common is ovarian cancer?
In Australia, about 1 in 80 women will develop Ovarian Cancer during their lifetime - the most serious and life threatening of all gynaecological cancers.
Tragically, every year 800 Australian women will lose their battle and die from Ovarian Cancer, with one woman dying every 11 hours.
As there is no early detection test or screening for Ovarian Cancer, awareness is imperative. Ovarian cancer is the sixth most common cause of cancer death in women. It is now more common than cervical cancer and it kills many more women.
If the disease is detected and treated at an early stage there is a 90% chance of surviving past 5 years. However, of the 1400 cases of Ovarian Cancer diagnosed each year, some 75% will be advanced stage. A staggering 75% will not survive past 5 years.
Ovarian Cancer Awareness Message
- Ovarian cancer must be considered in cases of otherwise unexplained pelvic, abdominal and gastrointestinal disorders;
- Ovarian cancers are often mistakenly diagnosed as Irritable Bowel Syndrome, Indigestion and menopausal conditions;
- There is no reliable screening test for Ovarian Cancer;
- The Pap test does not detect ovarian cancer.
Early symptoms for Ovarian Cancer do exist. The symptoms are often vague and can be mistaken for other benign conditions. If you experience some of these symptoms for more than a week or two, see your doctor immediately.
- Pelvic or abdominal pain or discomfort, and/or feeling of fullness;
- Swelling in the abdomen;
- Unexplained weight gain;
- Weight loss;
- Appetite loss;
- Bloating;
- Feeling tired;
- Backache;
- Cramps;
- Vague but persistent gastrointestinal upsets e.g. Gas, Nausea, indigestion;
- Bladder or other urinary problems;
- Pain during intercourse;
- Unusual vaginal bleeding;
- Unexplained changes in bowel habits.
Ovarian cancer is more likely in women who:
- are over 45 – the risk of ovarian cancer increases with age;
- have never taken the contraceptive pill;
- have had few or no pregnancies;
- have a history of cancer in the family especially ovarian, breast or some bowel cancers.
If you are at increased risk, ensure your doctor knows of the relevant medical or family history. There is some evidence that suggests that women who have not had children may be at higher risk, although taking the contraceptive pill may significantly reduce the overall risk.
Young women in their teens, early twenties, and older women have all been known to be diagnosed with ovarian cancer. Although ovarian cancer is curable if diagnosed early. It remains the most lethal gynaecologic cancer because it is so difficult to detect.
Research into the causes of ovarian cancer is continuing in Australia and overseas.
How is it diagnosed?
If ovarian cancer is suspected or has been diagnosed there are a number of tests that can be performed to help the doctor decide whether symptoms are due to ovarian cancer or to other causes.
Physical Examination
This will include an internal pelvic examination where the doctor checks for a mass or a lump in the lower abdomen and the pelvis.
Blood Tests
Blood can be tested for a particular protein or a tumour marker called CA 125. This protein is often higher than normal in women with ovarian cancer. Some women may have other tumour markers called 'Inhibin' or 'CEA'. The type of marker depends on the type of tumour. However some tumours will not have any of these tumour markers. Testing the blood for these tumour markers is one way to help diagnose cancer. These tests are also used later on to check the progress of the illness. Other blood tests may be taken to help with your diagnosis and to check the effects of treatment.
X-ray and other imaging tests
Routine chest and abdominal x-rays may be taken as well as an ultrasound scan of the lower abdomen. Ultrasound scans are very important in the diagnosis of ovarian cancer. These are done in two ways. You may have an abdominal scan, where the ultrasound specialist passes a hand-held device called a transducer over your pelvic area. This is used to build up pictures of your organs, which can be seen on a screen. You may also have a trans-vaginal ultrasound, where the transducer is inserted into your vagina. This is because the ovaries sometimes cannot be imaged by the abdominal ultrasound.
You may also have an X-ray of your bowel to make sure that the symptoms are not due to a bowel problem. This X-ray is called a barium enema, which is not painful but can be rather uncomfortable.
Unfortunately, none of these tests can definitely diagnose ovarian cancer. The only way this can be done is with an operation, hence, ovarian cancer is usually diagnosed and treated at the same time.
