Ovarian cancer, also know called cancer of the ovaries, affects many women and because it is usually detected in its late stages its prognosis is very bleak. New treatments have become more effective in recent years, with the best results seen when the disease is found early.
What is ovarian cancer?
Current research suggests this cancer begins in the fallopian tubes and moves to the ovaries, the twin organs that produce a woman’s eggs and the main source of the female hormones oestrogen and progesterone.
What are some symptoms of ovarian cancer?
Many women might have ovarian cancer and do not know it, as in some cases there are few signs and symptoms. When symptoms do occur they might be very non-specific and might resemble other non-cancerous disorders. Symptoms of ovarian cancer include the following:
• Bloating or pressure in the belly
• Pain in the abdomen or pelvis
• Feeling full too quickly during meals
• Urinating more frequently
• Weight loss
• Changes in bowel habits, such as constipation
These symptoms can be caused by many conditions that are not cancer. If they occur persistently for more than a few weeks, report them to your gynaecologist or healthcare provider.
What causes ovarian cancer?
It is not clear what causes ovarian cancer. In general, cancer begins when a genetic mutation turns normal cells into abnormal cancer cells. Cancer cells quickly multiply, forming a mass (tumour). They can invade nearby tissues and break off from an initial tumor to spread elsewhere in the body (metastasize).
What are some risk factors for ovarian cancer?
Family history
A woman’s odds of developing ovarian cancer are higher if a close relative has had cancer of the ovaries, breast or colon. Researchers believe that inherited genetic changes account for 10% of ovarian cancers. This includes the BRCA1 and BRCA2 gene mutations which are linked to breast cancer. Women with a strong family history should talk with a doctor to see whether closer medical follow-up could be helpful.
Age
The strongest risk factor for ovarian cancer is age. It is most likely to develop after a woman goes through menopause. Using postmenopausal hormone therapy may increase the risk. The link seems strongest in women who take oestrogen without progesterone for at least 5 to 10 years.
Obesity
Obese women have a higher risk of getting ovarian cancer than other women. The death rates for ovarian cancer are higher for obese women too, compared with non-obese women. The heaviest women appear to have the greatest risk. Yet another reason to control your weight.
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
If you have a family history of ovarian cancer or breast cancer, talk to your doctor about your risk of ovarian cancer. Your doctor may refer you to a genetic counselor to discuss testing for certain gene mutations that increase your risk of breast and ovarian cancers. Only a small number of women are found to have genetic mutations that can lead to ovarian cancer.
Ovarian cancer screening tests
There is no easy or reliable way to test for ovarian cancer if a woman has no symptoms. However, there are two ways to screen for ovarian cancer during a routine gynecologic exam. One is a blood test for elevated levels of a protein called CA-125. The other is an ultrasound of the ovaries. Unfortunately, neither technique has been shown to save lives when used in women of average risk. For this reason, screening is only recommended for women with strong risk factors.
Diagnosis
Imaging tests, such as ultrasound or CT scans, can help reveal an ovarian mass, but these scans cannot determine whether the abnormality is cancer. If cancer is suspected, the next step is usually surgery to remove suspicious tissues. A sample (biopsy) is then sent to the lab for further examination.
Types of ovarian cancer
The vast majority of ovarian cancers are epithelial ovarian carcinomas. These are malignant tumors that form from cells on the surface of the ovary. Some epithelial tumors are not clearly cancerous. These are known as tumours of low malignant potential (LMP). LMP tumours grow more slowly and are less dangerous than other forms of ovarian cancer.
Ovarian cancer survival rates
Ovarian cancer can be a frightening diagnosis, with five-year relative survival rates that range from 89% to 18% for epithelial ovarian cancer, depending on the stage when the cancer was found. For LMP tumors, the five-year relative survival rates range from 99% to 77%.
Ovarian cancer surgery
Surgery is used to diagnose ovarian cancer and determine its stage, but it is also the first phase of treatment. The goal is to remove as much of the cancer as possible. This may include a single ovary and nearby tissue in stage I. In more advanced stages, it may be necessary to remove both ovaries, along with the uterus and surrounding tissues.
Chemotherapy
In all stages of ovarian cancer, chemotherapy is usually given after surgery. This phase of treatment uses drugs to target and kill any remaining cancer in the body. The drugs may be given by mouth, through an IV, or directly into the belly (intraperitoneal chemotherapy). Women with LMP tumors usually don’t need chemo unless the tumours grow back after surgery.
Decreasing chances of getting ovarian cancer
There is no sure way to prevent ovarian cancer. But certain factors are associated with lower risk. Researchers have found that pregnancy is associated with ovarian cancer. Women who have biological children are less likely to get ovarian cancer than women who have never given birth. The risk appears to decrease with every pregnancy, and breastfeeding may offer added protection.
Ovarian cancer is also less common in women who have taken birth control pills (oral contraceptive Pill). Women who have used the pill for at least five years have about half the risk of women who never took the pill. Like pregnancy, birth control pills prevent ovulation. Some researchers think ovulating less often may protect against ovarian cancer.
Getting your tubes tied, formally known as tubal ligation, may offer some protection against ovarian cancer. The same goes for having a hysterectomy — removing the uterus.
Removing the ovaries
For women with genetic mutations that put them at high risk for ovarian cancer, removing the ovaries is an option. This can also be considered in women over 40 getting a hysterectomy.
Conclusion
Ovarian cancer is often called a silent killer as it often presents with few symptoms. If you have symptoms suggestive of ovarian cancer see your doctor, as early diagnosis and treatment are associated with improved survival rates. New treatments are now more effective in treating this cancer, especially when the cancer is detected in its very early stages.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
