Ovarian cancer

Ovarian cancer is cancer that starts in the ovaries or the fallopian tubes. There are different types of ovarian cancer. 

Ovaries are small organs that make hormones and eggs. You usually have two ovaries, one on each side of your uterus (womb).

Each month before menopause, an ovary releases an egg. It travels through your fallopian tube into your uterus. If sperm fertilises the egg, it can grow into a baby. If not, the egg leaves your body through the vagina during your period.

Causes

We’re not exactly sure what causes someone to get ovarian cancer. However, there are common factors, known as risk factors that increase the chance of someone getting it. They include:

• being older - most people with ovarian cancer are over 50
• never having had children
• having several close blood relatives who’ve had ovarian, breast, endometrial, or colorectal cancer
• inheriting a faulty gene, such as BRCA1 or BRCA2
• having Lynch syndrome, also called hereditary non-polyposis colorectal cancer or HNPCC.

Some research also suggests that ovarian cancer may be linked to:

• endometriosis
• long-term menopausal hormone therapy (MHT)
• cigarette smoking
• obesity.

Some people have a higher risk of developing ovarian cancer because they inherited a change (called a mutation) in certain genes. The most common gene mutations linked to ovarian cancer are BRCA1 or BRCA2, but others - like those causing Lynch syndrome - can also increase the risk. 

People with a high inherited risk of ovarian cancer may choose to have surgery, called Risk-reducing bilateral salpingo-oophorectomy (RRBSO), to lower their risk. RRBSO has been proven to reduce the chance of getting ovarian cancer. 

You can learn more about RRBSO in our booklet ‘Considering surgery to reduce your risk of ovarian cancer?’.

Ovarian cancer can affect anyone with ovaries including women, transgender, and gender-diverse people. 

Each year, about 1,700 Australians are diagnosed with ovarian cancer.

Symptoms

Ovarian cancer can be difficult to diagnose because its symptoms are often similar to many other common conditions, especially during menopause when ovarian cancer often occurs.

Symptoms can include:

• swelling in your abdomen (tummy)
• pain in your abdomen and back
• loss of appetite or feeling full quickly
• changes to your toilet patterns, like needing to wee often or urgently, or changes to your bowel movements (poo)
• unexplained weight loss or gain  
• indigestion or heartburn
• tiredness.

See your doctor if you have any of these symptoms and they don’t go away or are unusual for you.

Diagnosis

If you have symptoms you think might be linked to ovarian cancer:

• see your doctor, nurse, or gynaecologist (a doctor who specialises in the ovaries and reproductive system) 
• discuss any changes you’ve noticed in your body 
• tell them if you or anyone in your family has had cancer or been tested for genetic faults.

During your visit, they will likely:

• ask you about your medical history
• examine your pelvis by pushing on the outside of your abdomen and putting two fingers inside your vagina to feel the shape, size, and position of your ovaries and other pelvic organs
• do a blood test
• arrange for an MRI or CT scan of your abdomen and pelvis.

If the results suggest ovarian cancer, you’ll be referred to a gynaecologic oncologist. This is a doctor who specialises in diagnosing and treating cancers of the reproductive system.

Depending on the results of your tests, surgery called a laparotomy might be recommended. During this surgery, the doctor makes a cut in your abdomen so they can look at the organs in your abdomen and pelvis. 

If they find cancer, they’ll start treatment immediately by removing any cancer they can.

Sometimes, doctors will take a sample of fluid (abdominal paracentesis) or tissue (core biopsy), possibly from the ovary.
All of these tests tell us more ab out your cancer, so you can receive the most suitable treatment.

Treatment

The kind of treatment you receive and how well it works will depend on:

• the size of the cancer and how far it has spread (stage of cancer)
• how quickly it’s growing and how different it looks from normal cells (grade of cancer)
• where in the ovaries it started (type of cancer)
• your age, health, and medical history.

Your doctors will discuss these things with you and help choose the best possible treatment for your particular cancer, lifestyle, and wishes.

If doctors find cancer only in your ovaries, surgery may cure it. But in many cases, ovarian cancer isn’t found until it has grown or spread, so treatment often involves surgery and chemotherapy. Some people with advanced ovarian cancer may be cured, but for many, there is no long-term cure.

Surgery

Surgery may be needed to remove one or both of your ovaries (oophorectomy). 

Your uterus and cervix may also be removed (total hysterectomy), as well as your fallopian tubes, some of the nearby lymph nodes, and your omentum (the fatty tissue covering the organs in your abdomen). 

These surgeries may happen immediately after cancer is diagnosed during a laparotomy. If the cancer has spread to other parts of your body, you may need more surgery to remove the affected areas, for example, part of your bowel.

Chemotherapy

Chemotherapy (or chemo) is medicine that aims to control or kill the cancer. The medicine is usually given through an IV or drip, slowly releasing it into your body over a few hours.

Radiotherapy

Radiotherapy uses radiation to control or kill the cancer. You will lie or sit near a machine that directs radiation beams straight at your cancer. Radiotherapy is rarely used to treat ovarian cancer. 

Hormonal therapy

Hormonal therapy may be used after the initial treatment to block the hormones that help cancer to grow.

Questions to ask

• How big is my cancer and where exactly is it?
• Is my child more likely to have ovarian cancer if I do?
• What if I still want to have children?
• What will my abdomen look like after treatment?
• Will treatment stop my periods and start menopause?
• What are the side effects of the treatment you’re recommending?
• Why is the treatment you’re recommending the best option for me?
• How often will I need to have check-ups?
• Will I still be able to have sex?
• Can you write down what you’ve told me so that I can read it later?

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