Ovarian cancer

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

Around 3 in 100 Australian women who have cancer have ovarian cancer. Each year, about 1300 Australian women find out they have ovarian cancer.

For some, the risk of being diagnosed with ovarian cancer is high because of an abnormality in a gene that has been inherited. This is called a gene mutation. Most women at high risk of ovarian cancer carry the BRCA1 or BRCA2 gene mutation, but some other gene mutations (such as those causing Lynch syndrome) also increase the risk of ovarian cancer. For women who are at high inherited risk of ovarian cancer, a surgical procedure called Risk-reducing bilateral salpingo-oophorectomy (RRBSO) has been proven to reduce this risk. You can read more about RRBSO in Considering surgery to reduce your risk of ovarian cancer?

If cancer has been diagnosed and is just in the ovaries it may be cured with surgery. However many ovarian cancers are not found until after they have grown and/or spread, so treatment often involves surgery and chemotherapy. In these cases, there is a chance of cure in a small number of women, but for many women with advanced ovarian cancer there is no long-term cure.

Causes

It is not usually possible to say what causes cancer in a particular woman but known risk factors are:

• you are older (most women with ovarian cancer are over 50)
• you have never had children
• you have several close blood relatives who have had ovarian, breast, endometrial or colorectal cancer
• you have inherited a faulty gene (such as BRCA1 or BRCA2)
• you have Lynch syndrome (or hereditary non-polyposis colorectal cancer – HNPCC).

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

• endometriosis
• hormone replacement therapy (HRT)
• smoking
• obesity.

Symptoms

Ovarian cancer can be difficult to detect because its signs are often similar to the signs of many other conditions that can be part of everyday life, particularly around menopause when ovarian cancer often occurs.

The most common symptoms that may suggest ovarian cancer are:

• swelling in your abdomen (stomach)
• pain in your abdomen and back
• lost appetite or feeling full quickly
• needing to wee often or urgently as well as other changes to your toilet patterns, such as changes to your bowel habits
• weight loss or gain that is hard to understand or explain
• indigestion or heartburn
• tiredness.

If you have any of these symptoms and they are unusual for you, or they persist, you should see your doctor.

Diagnosis

If you have symptoms that might be linked to ovarian cancer you should talk to a doctor, nurse or gynaecologist. You should tell them about any changes to your body that you have noticed. You should tell them if you or anybody in your family has had cancer or been tested for genetic faults.

If you have symptoms that might be linked to ovarian cancer your doctor will most likely:

• ask you questions about the history of the health of you and your family
• 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
• depending on the results of these tests, it may be recommended that you have an operation called a laparotomy. In this operation, a cut is made in your abdomen so the surgeon can look at the organs inside your abdomen and pelvis. If they find cancer they will start treatment immediately by removing any cancer they can find
• sometimes doctors will recommend that a sample of fluid (abdominal paracentesis) or tissue (core biopsy) – possibly from the ovary – is taken and tested to help decide what is the best treatment for you.

Treatment

The type of treatment you have will depend upon:

• the size of the cancer and where it is in your body (this is known as the stage of cancer)
• how quickly it is growing and how different it looks to normal cells (the grade of cancer)
• where in the ovaries it started (the 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.

Treatment options

• Surgery to remove one or both of your ovaries (known as an oophorectomy). Your uterus and cervix may also be removed (known as a total hysterectomy) as well as your fallopian tubes, some of the nearby lymph nodes (which filter and trap disease) and your omentum (the fatty tissue that covers the organs in your abdomen). These operations are sometimes done immediately after cancer is diagnosed in a laparotomy. If the cancer has spread to other parts of your body, further surgery may be considered to remove these areas.
• Chemotherapy is medicine that aims to control or kill the cancer. Usually this involves being connected to an IV or drip for a few hours so the drugs can be released slowly into your body.
• Radiotherapy aims to control or kill the cancer. If you have external radiation you will lie or sit near a machine that directs radiation beams at your cancer. Radiotherapy is rarely used  in the treatment of ovarian cancer.
• Hormonal therapy drugs to stop the hormones that help your cancer to grow from being made or reaching your cancer. This is sometimes used after initial treatment is finished.

Questions to ask

• How big is my cancer and where exactly is it?
• Is my daughter more likely to have ovarian cancer if I have it?
• What if I want to become pregnant?
• 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 are recommending?
• Why is the treatment you are recommending best for me?
• How often will I need to have checkups?
• Will I still be able to have sex?
• Can you write down what you have told me so that I can read it again later?

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