Ovarian cancer

About ovarian cancer | Reduce your risk | Diagnosis | Treatment | Coping with Cancer | Support Services | More information and resources | References

About ovarian cancer

The ovaries

The ovaries are part of the female reproductive system. Other internal organs in the female reproductive system are the vagina, cervix, uterus (womb) and fallopian tubes.

The ovaries are two 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 one 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

The female reproductive system

female-reproductive-system

Image courtesy of Cancer Council Victoria

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Ovarian cancer

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

There are three 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, which starts in the egg producing cells within ovaries. This type of cancer accounts for approximately 4 per cent of ovarian cancers2 and usually affect women younger than 30.
  • Sex-cord stromal cancer 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 it?

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 one will get ovarian cancer.

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

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Risk factors

The causes of ovarian cancer are not fully understood. However, there are a number of factors that are known to increase the risk of developing ovarian cancer - some of which are beyond your control, while others are not.

Known risk factors for ovarian cancer include:5

  • getting older: women who are 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 and endometrial cancer. It is important to remember that only around 5-10 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:

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The importance of family history

About one 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.

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

  1. Hereditary breast/ovarian cancer (BRCA1 and BRCA2 gene)
  2. 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:

Any family member who has had breast cancer

  • before age 40
  • in both breasts
  • and ovarian cancer

A personal history

  • of some types of ovarian, fallopian tube or peritoneal cancers, for women aged 60 or less or with breast cancer
  • Jewish ancestry

Two or more family members on the same side of the family (mother's or father's side)

  • diagnosed with breast or ovarian cancer

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Protective factors

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

  • having children
  • 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 tubes1,5

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
  • pressure, discomfort or pain in the abdomen
  • heartburn, nausea and bloating
  • changes in toilet habits (e.g. 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. However, if you do have any of these symptoms you should see your doctor as soon as possible.

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Reduce your risk

Through our prevention and education programs we encourage you to lead a healthier lifestyle and reduce your cancer risk 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
  • Eating well - enjoy a wide variety of nutritious foods from the five groups every day
    • Plenty of vegetables, including different types and colours, and legumes/beans
    • Fruit
    • Avoid processed meats
    • Limit your intake of red meat to 3 or 4 palm sized serves (65-100g) a week.
    • Eat foods which are high in fibre
  • Avoiding alcohol. If you choose to drink, limit your alcohol intake

Screening

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

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Diagnosis

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 include:6

  • 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.

What to ask your doctor or specialist?

A cancer diagnosis can be a very confusing time. There are many different cancers so it is important to find out information that is relevant to you.

There are several things you can do to help prepare for your appointment and to improve your understanding.

  • It can be helpful to write a list of questions to ask your doctor or specialist. You may need to ask for a longer appointment
  • Take some paper and a pen so that you can write down notes and instructions
  • Take a relative or friend with you for support - it can be helpful to have an extra person to hear what is being said and write down any notes
  • It may be helpful to record your visit - make sure you ask your doctor if it's okay. Remember, many smart phones and mp3 players can make audio recordings

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Treatment

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.

Stages of cancer

Ovarian cancer often presents when it has spread. A common staging system is the FIGO (International Federation of Gynaecology and Obstetrics) system, which records how much of the cancer is in the ovary, and how much has spread to other parts of the pelvis and into the lining of the abdomen with or without fluid (ascites). CT scans and blood test to measure CA125 are used.6

There are four main stages of epithelial ovarian cancer:7

  • Stage 1: the cancer is in one or both ovaries
  • Stage 2: the cancer is found in one or both ovaries and has spread to other organs in the pelvis such as the uterus (womb), fallopian tubes, bladder or bowel
  • Stage 3: the cancer is found in one or both ovaries and has spread outside the pelvis to the omentum (the fatty tissue around the organs in the abdomen), the intestines or to lymph nodes in the pelvis or abdomen
  • Stage 4: the cancer is found in one or both ovaries and has spread outside the abdomen for example to the liver, lungs or distant lymph nodes

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Prognosis

Prognosis means the expected outcome of a disease. In most cases, the earlier cancer is diagnosed and treated, the better the outcome.

You may wish to discuss your prognosis and treatment options with your doctor, but it's not possible for any doctor to predict the exact course of your cancer. Test results, the type of cancer you have, the rate and depth of tumour growth, how well you respond to treatment, and other factors such as age, fitness and medical history are all important in assessing your prognosis.

Types of treatment

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.

If you or someone you know has been diagnosed with cancer, you may have many questions and concerns and need more information to help you make decisions about your treatment.

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 the following:

Surgery 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 rejoined 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.

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Chemotherapy uses anti-cancer drugs to help destroy cancer cells that may have spread to other areas of your body but cannot be detected.8 Chemotherapy after surgery can reduce the chance of the cancer coming back.

Radiation therapy uses x-rays to destroy cancer cells. It can be used before or after surgery for cancer to reduce the tumour size and make surgery easier. It is also used to decrease the chance of cancer coming back.

Complementary therapies can work alongside medical treatments and some have been shown to improve quality of life or reduce pain. There is no evidence that these therapies can cure or prevent cancer.

It is important to know that some complementary therapies have not been tested for side effects, may work against your medical cancer treatment and may be expensive. Let your doctor know about all complementary therapies you are thinking of using.

For more information about complementary therapies visit Memorial Sloan-Kettering Cancer Centre's About Herbs, Botanicals and Other Products.

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More information and resources

Understanding Ovarian Cancer (pdf, available from our Publication page)

Cancer Australia

Ovarian Cancer Australia

Ovarian Cancer Research Foundation

Sydney Gynaecological Oncology Group

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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: http://www.health.wa.gov.au/wacr/statistics/stats_full.cfm.
  4. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia: an overview 2010. [Internet] Canberra: Australian Institute of Health and Welfare; 2010 [cited 2012 Mar 17]; Cancer series no. 60. Cat. no. CAN 56:[Available from: http://www.aihw.gov.au/publication-detail/?id=6442472459.
  5. Cancer Australia. What causes ovarian cancer? [Internet] Surry Hills: Australian Government; 2012 [updated 19 Sep 2012; cited 2014 31 Jan]; Available from: http://canceraustralia.gov.au/affected-cancer/cancer-types/gynaecological-cancers/ovarian-cancer/about-ovarian-cancer/what-causes-ovarian-cancer.
  6. Cancer Council Australia. Ovarian Cancer. [Internet] [updated 2013 Jan 8; cited 2013 May 21]; Available from: http://www.cancer.org.au/about-cancer/types-of-cancer/ovarian-cancer.html.
  7. Cancer Australia. Ovarian Cancer. [Internet] 2012 [updated 2012 Oct 10; cited 2013 May 21]; Available from: http://canceraustralia.gov.au/affected-cancer/cancer-types/gynaecological-cancers/ovarian-cancer.

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