Ovarian cancer

This information provided by Cancer Council Western Australia (external site).

What are ovaries?

The ovaries are part of the female reproductive system. Other internal female reproductive organs are the:

• vagina
• cervix
• uterus (womb)
• fallopian tubes.

The ovaries are 2 small, oval-shaped organs, each about 3 cm long and 1 cm thick. They are found in the lower part of the abdomen (the pelvic cavity).

There is 1 ovary on each side of the uterus. Each ovary has an outer covering made up of a layer of cells called the epithelium. Inside are germ cells, which will eventually mature into eggs (ova).

The ovaries also release the female hormones oestrogen and progesterone from cells called sex-cord stromal cells.¹

Adapted from original image by Cancer Council Victoria

What is ovarian cancer?

Ovarian cancer is the growth of abnormal cells in 1 or both ovaries. Left untreated, ovarian cancer can spread to other parts of the body.

There are 3 types of ovarian cancer. The most common type of ovarian cancer is epithelial ovarian cancer. Epithelial cells form the outer covering of the ovary and this is where the cancer starts.

Over 80 per cent of women with ovarian cancer have epithelial ovarian cancer.²

Other types of ovarian cancer include:

• Germ cell ovarian cancer – this starts in the egg producing cells within ovaries. This type of cancer accounts for about 4 per cent of ovarian cancers ² and usually affects women younger than 30.
• Sex-cord stromal cancer – this develops in the cells that produce female hormones, oestrogen and progesterone. Sex-cord stromal cancers can occur at any time and account for less than 1.5 per cent of ovarian cancers.²

How common is ovarian cancer?

Because it is difficult to detect in its early stages, there are more deaths from ovarian cancer than any other gynaecological cancer.

In WA in 2011, 133 women were diagnosed with ovarian cancer and 81 died from the disease.³

The chances of a woman developing ovarian cancer by the time she is aged 85 (lifetime risk) is 1 in 78. This means for every 78 women 1 will get ovarian cancer.

Ovarian cancer is more common in women over 50. The average age at diagnosis is 63.⁴

Signs and symptoms

Ovarian cancer can be difficult to diagnose in its early stages as symptoms can be non-specific or similar to those of other diseases.

Symptoms include:⁶

• a swollen, bloated abdomen and pressure, discomfort or pain in the abdomen
• heartburn, nausea and bloating
• changes in toilet habits – for example:
  • constipation
  • diarrhoea
  • frequent urination due to pressure
  • increased flatulence
• tiredness and loss of appetite
• unexplained weight loss or weight gain
• changes in your menstrual pattern or postmenopausal bleeding
• pain during sex.

If any of these symptoms are unusual for you, and they persist, it's important to see your doctor.

It is important to know these symptoms, but it is equally important to know ovarian cancer often develops without symptoms.

What's more, having these symptoms does not mean you have ovarian cancer, as they may be caused by other conditions.

If you do have any of these symptoms you should see your doctor as soon as possible.

Diagnosis of ovarian cancer

Most ovarian cancers are present for some time before they are diagnosed.

However, if you have any signs or symptoms of ovarian cancer you need to visit your doctor who may refer you for further tests.

Having signs and symptoms does not mean you have ovarian cancer, but it means that something needs checking.

Tests used to investigate changes that may be due to ovarian cancer include⁶:

• physical examination - where the doctor checks for masses or lumps by feeling your abdomen and doing an internal vaginal examination
• blood tests - checking for chemical proteins produced by cancer cells (also known as tumour markers)
• imaging and investigations - including abdominal and transvaginal ultrasound, CT scans, MRI scans and PET scans.

These tests and scans show abnormalities, they do not diagnose ovarian cancer. The only way to confirm a diagnosis of ovarian cancer is by taking a tissue sample (biopsy) and looking at the cells under a microscope.

This is usually done during an operation, which means that the cancer is diagnosed and treated at the same time.

This can be a worrying time, especially if you need to have several tests. If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will talk to you about treatment options.

Treatment for ovarian cancer

If you have been diagnosed with ovarian cancer, you should expect to be cared for by a multidisciplinary team (MDT). This is a group of doctors and other health professionals who are experts in a specific cancer who work together to plan the best treatment for you.

Everyone's treatment is different and depends on the type of cancer and if, and how far, the cancer has spread.

Read more about the different stage of ovarian cancer (external site).

The type of treatment for ovarian cancer depends on the type of cancer, the stage at diagnosis, your health and fitness, your doctor's recommendations and your wishes. This means it can be different for everyone.

Although nearly all treatments have side effects, most can be effectively managed. Ask your doctor to explain what side effects to expect and how best to manage these.

Treatment for ovarian cancer may be one or a combination of surgery and chemotherapy or radiotherapy.

Surgery

This is a common form of treatment for ovarian cancer. There are several different types of surgery and your gynaecological oncologist will talk to you about the most appropriate type for you.

A procedure called an exploratory laparotomy is usually recommended if the doctor suspects that you have ovarian cancer. In this operation, the gynaecological oncologist makes a long, vertical cut from your bellybutton to your pubic bone while you are under general anaesthetic.

The surgeon will take tissue and fluid samples from the abdomen (biopsy). While still in theatre, the tissue samples are sent to a specialist called a pathologist who examines them for signs of cancer.

If the pathologist confirms that cancer is present, the surgeon will continue the operation. If there is obvious spread of cancer, the surgeon will remove as much of the cancer as is possible. This is called surgical debulking and allows chemotherapy treatment to be more effective.¹

You may have one or more of the following procedures:

• total abdominal hysterectomy – removal of the uterus and the cervix.
• bilateral salpingo-oophorectomy – removal of both ovaries and fallopian tubes.
• omentectomy – removal of the fatty protective tissue (omentum) covering the abdominal organs.
• colectomy – removal of all or part of the bowel, where the end of the bowel may be re-joined to a new opening called a stoma (colostomy or ileostomy).
• lymphadenectomy – removal of some lymph nodes, which are small, bean-shaped organs that help filter toxins, including cancer cells, from the bloodstream.

It may sound as if a lot of your body parts or organs will be removed in an operation. However, these organs are quite small compared with everything else in your abdomen and pelvis, and their removal will not leave an empty space.

Some women do not need extensive surgery. A young woman with early epithelial ovarian cancer, germ cell cancer or a borderline tumour usually will not have her uterus and ovaries removed.¹

For those with larger tumours or whose cancer has spread to the lymph nodes, the best results are often achieved by combining surgery, with radiation therapy and chemotherapy.

Read more about radiation therapy and chemotherapy.

Risk factors for ovarian cancer

The causes of ovarian cancer are not fully understood. However, there are several factors that are known to increase the risk of developing ovarian cancer – some of which are beyond your control, some of which are not.

Known risk factors for ovarian cancer include:⁵

• getting older – women over 50 are more likely to develop ovarian cancer than younger women
• inheriting a faulty gene (called a gene mutation) that increases the risk of ovarian cancer
• having a strong family history of ovarian cancer, breast cancer, or some other cancers, including bowel cancer and endometrial cancer. It is important to remember that only around 5 to 10 per cent of all ovarian cancers are due to inherited factors
• endometriosis, which is when the tissue lining of the uterus (the endometrium) is found outside the uterus
• hormonal factors such as early puberty, late menopause or the long-term use of hormone replacement therapy (HRT).

Lifestyle factors are things you can do something about. Your risk of ovarian cancer is increased if you:

• smoke 
• are overweight or obese
• don't exercise
• have a poor diet
• drink alcohol.

The importance of family history

About 1 in 10 women diagnosed with ovarian cancer may have an inherited faulty gene in their family. This faulty gene increases the risk of developing the disease.

For this reason it is important to know your family health history.

There are 2 genetic conditions known to cause an increased risk of ovarian cancer:

• hereditary breast/ovarian cancer (BRCA1 and BRCA2 gene)
• Lynch syndrome (formerly known as hereditary non-polyposis colorectal cancer or HNPCC).

You may want to ask your doctor for a referral to a family cancer clinic if you have one or more of the following risks:

• A family member who has had breast cancer:
  • before age 40
  • in both breasts
  • and ovarian cancer.
• You have 2 or more family members on the same side of the family (mother's or father's side) diagnosed with breast or ovarian cancer.
• If you are younger than 60, and you have a personal history of some types of ovarian, fallopian tube or peritoneal cancers.
• You have a personal history of breast cancer.
• You have Jewish ancestry.

Protective factors against ovarian cancer

Some things may protect you against ovarian cancer. These are called protective factors and may include:

• having a baby
• breastfeeding
• using the combined oral contraceptive pill for several years
• having your fallopian tubes tied (tubal ligation)
• the surgical removal of some female reproductive organs, such as the uterus or fallopian tubes.^1,5

Reducing your risk

You can reduce the risks of getting ovarian cancer by:

• quitting smoking 
• achieving and maintaining a healthy body weight
• getting at least 30 to 60 minutes or more of moderate intensity physical activity on most days of the week
• avoid alcohol – if you choose to drink, limit your alcohol intake
• eating well – enjoy a wide variety of nutritious foods from the 5 groups every day.
  • eat plenty of fruit and vegetables, including different types and colours, and legumes/beans
  • avoid processed meats
  • limit your intake of red meat to 3 or 4 palm sized serves (65 to 100 g) a week.
  • eat foods which are high in fibre.

Screening

There are no proven screening tests, although ultrasound through the vagina and a blood test, CA125, are being investigated.⁶

Remember

• Ovarian cancer is the growth of abnormal cells in 1 or more ovaries in a woman’s reproductive system.
• Ovarian cancer can be difficult to detect in its early stages as symptoms are unclear and similar to those of other health conditions.
• Eating well, being active, reducing alcohol intake and not smoking will help to reduce the risk of ovarian cancer.

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References

1. Cancer Council Australia. Understanding ovarian cancer: A guide for women with cancer, their families and friends. 2012 2013 May 21.
2. Australian Institute of Health and Welfare, National Breast and Ovarian Cancer Centre. Ovarian cancer in Australia: an overview, 2010, 2012.
3. Threlfall TJ, Thompson JR. Cancer incidence and mortality in Western Australia, 2011. [Internet] Perth: Department of Health; 2013 [cited 2013 September 25]; Available from Western Australian Cancer Registry (external site).
4. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview 2010 (external site). [Internet] Canberra: Australian Institute of Health and Welfare; 2010 [cited 2012 Mar 17]; Cancer series no. 60. Cat. no. CAN 56.
5. Cancer Australia. What causes ovarian cancer? (external site). [Internet] Surry Hills: Australian Government; 2012 [updated 19 Sep 2012; cited 2014 31 Jan].
6. Cancer Council Australia. Ovarian Cancer (external site). [Internet] [updated 2013 Jan 8; cited 2013 May 21].
7. Cancer Australia. Ovarian Cancer (external site). [Internet] 2012 [updated 2012 Oct 10; cited 2013 May 21].

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.