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Understanding Ovarian Cancer 

About

Symptoms

 Screening

 Risk Factors

Diagnosis

Treatment

 Recurrence

 Useful Links


About Ovarian Cancer

Ovarian cancer is the fourth leading cause of cancer death in New Zealand women. Ovarian cancer begins in a woman's ovaries. They are part of a woman's reproductive system. There are two ovaries, one on each side of the body.

Types of ovarian cancer

  • Epithelial carcinoma. Epithelial cancer makes up 9 out of 10 of ovarian cancers. This type of cancer begins in cells on the outer surface of the ovary or the ‘epithelium’.
  • Germ cell tumor. This type of ovarian cancer develops in the egg-producing cells of the ovaries, and is very uncommon.
  • Sex-cord stromal cell tumor. This is a rare form of ovarian cancer. It develops in the ‘connective tissue’ cells that produce female hormones hold the ovaries together. 


Symptoms

Ovarian cancer is known as a cancer that can be difficult to diagnose. This is because the symptoms for ovarian cancer can often initially be mistaken for other more common and less serious health matters.  You may have read that women often don’t have any symptoms of ovarian cancer until the later stages of the disease.  Please download the symptom diary if you are worried you may have ovarian cancer.

It is important to seek medical help when the symptoms listed below suddenly appear and are new to you. If they are persistent, which means they occur most days, and have been occurring for more than 2 weeks, you should consult your doctor. You may wish to download our symptom diary, to help monitor and record your symptoms. You can then take this to your doctor.

 Most frequent symptoms:

  • Persistent pelvic and abdominal pain
  • Increased abdominal size / persistent bloating - not bloating that comes and goes
  • Difficulty eating and feeling full quickly

Sometimes you may experience these symptoms on their own or at the same time:

  • Change in bowel habits
  • Extreme tiredness
  • Urinary symptoms
  • Back pain

Having these symptoms does not mean you have ovarian cancer. However, if your doctor cannot find a more common cause for your symptoms, it’s important that your doctor then considers the possibility of ovarian cancer. If you remain concerned after seeing your doctor, you should seek a second opinion. 


Beat Ovarian Cancer

B is for Bloating (it is persistent and doesn't come and go)

E is for Eating (difficulty eating & feeling full more quickly)

A is for Abdominal (and pelvic pain you feel most days)

T is for Talking (tell your GP)


Screening

There is no screening test available for Ovarian Cancer currently.


Risk Factors

A risk factor is anything that increases a person's chance of developing cancer. The following factors may raise a woman's risk of developing ovarian cancer:

  • Risk of developing ovarian cancer increases with age. Women of all ages have a risk of ovarian cancer, but women over 45 are more likely to develop ovarian cancer (85% of all ovarian cancer cases in NZ occur in women over age 45).
  • Ovarian cancer risk increases for women who have a first-degree relative (mother, daughter, sister) who has had ovarian cancer. The risk increases when two or more first-degree relatives have had the disease. .
  • About 1 in 10 ovarian cancers are caused by an inherited faulty gene. A mutation in the BRCA1 or BRCA2 gene is associated with increased risk of ovarian cancer. For more information click here.
  • Women of North American, Northern European, or Ashkenazi Jewish heritage have an increased risk of ovarian cancer.
  • Women who have never had children, and have not taken the contraceptive pill (it is thought that having children, and/or taking the contraceptive pill gives the ovaries a ‘rest’)
  • Women who have taken estrogen-only hormone replacement therapy (HRT) after menopause have a higher risk of ovarian cancer.
  • Recent studies have shown that postmenopausal women who are obese are also more likely to die from the disease. 


Diagnosis

If your doctor suspects that you might have ovarian cancer, they will perform some tests to help them determine if your symptoms are due to ovarian cancer, or other causes. Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). No one test for ovarian cancer can tell the doctor if you have the disease. As for most types of cancer, a biopsy is the only way to make a definitive diagnosis of ovarian cancer.

As well as a physical exam, the following tests may be used to diagnose ovarian cancer:

Pelvic examination

The doctor feels the lower abdomen and pelvic region for anything unusual such as a lump or mass. A Pap/Smear test, usually done with a pelvic examination, cannot find or diagnose ovarian cancer.

Imaging (USS / CT / MRI)

An ultrasound wand is inserted in the vagina and aimed at the ovaries. This creates a picture of the ovaries, including healthy tissues, cysts, and tumors. It is much clearer than an abdominal ultrasound, done outside the body, and therefore very important to help diagnose ovarian cancer. If the specialist cannot be sure whether an abnormality is cancer or not they may ask you to have a CT scan or an MRI scan to show the ovaries more clearly. Sometimes though, it is not possible to diagnose ovarian cancer for certain without an operation.

Blood Test (CA-125)

This blood test measures a substance called CA-125. This substance is a tumor marker, and is found in higher levels in women with ovarian cancer and other conditions, including endometriosis fibroids pelvic inflammatory disease and pregnancy. It does not necessarily mean a woman has ovarian cancer. The CA125 blood level is raised in about half the women who have early stage ovarian cancer. About 9 out of 10 women (90%) with more advanced ovarian cancer have raised CA125 levels. On its own, it is not considered a ‘reliable’ way to tell if you have ovarian cancer. If you are found to have ovarian cancer that produces CA125, the CA125 blood test can be used to monitor how well your treatment is working.

Biopsy

A biopsy is the removal of a small amount of tissue for examination under a microscope. If the doctor suspects ovarian cancer, the patient will most likely have surgery to remove as much of the tumor as possible, and a tumor sample or biopsy, will be analyzed afterwards. 


Treatment

The treatment of ovarian cancer depends on the size and location of the tumor, whether the cancer has spread, the woman's overall health, and personal considerations, such as the woman's age and if she is planning to have children. These days it’s common for a team of doctors to work with the woman to decide on the best treatment plan for her.

Treatment usually involves surgery and chemotherapy. Radiotherapy is not commonly used for ovarian cancer treatment.

A woman with ovarian cancer should see a Gynaecological Oncologist (a doctor specializing in the treatment of cancers of the female reproductive system). Research shows that women treated by a Gynaecological Oncologist as part of their team of doctors, have more successful outcomes.

Surgery

Surgery usually involves the removal of the ovaries and fallopian tubes and a hysterectomy is also performed. The surgeon may also remove the omentum,(the thin tissue covering the stomach) and large intestine, and appendix. Any lymph glands in the surrounding area could also be removed, as well as fluid from the abdomen. Examination of these and the tumour itself, by the laboratory will help show whether the cancer has spread, and what type of ovarian cancer is present. This is called giving the cancer a ‘stage and grade’. This helps the Oncology team decide on the most effective treatment for the type of cancer the woman has.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. Often the goal is to destroy cancer cells left after the tumour has been surgically removed. It can also be used to slow down the growth of the cancer, to reduce side effects from the cancer itself, and to shrink some cancers before they are surgically removed.

Although chemotherapy can be given orally (by mouth), most drugs used to treat ovarian cancer are given intravenously (IV), - injected directly in to the bloodstream through the vein via a drip. A course of chemotherapy, is made up of ‘cycles’, most often six cycles, with each cycle given every three or four weeks. A course of chemotherapy therefore will last several months. Research is currently looking at giving chemotherapy intraperitoneally (IP), i.e. directly into the peritoneum, or pelvic area.

The side effects of chemotherapy vary, and also depend on the patient and the dose used. Side effects may include fatigue, risk of infection, nausea and vomiting, loss of appetite, loss of hair, and diarrhea. These side effects usually go away once treatment is finished.

The CA125 blood test is often used to measure how well the cancer has responded to the chemotherapy. If your cancer has not responded as well as hoped, you may need further chemotherapy. If your cancer returns in the future you may also need further chemotherapy. Your doctor will discuss with you which drugs to use and why.

Radiation therapy

Radiation treatment is not usually used to treat ovarian cancer. However it may occasionally be used to relieve symptoms by specifically aiming at and killing cancer cells in the area of the body causing symptoms.


Useful Links 

We hope you find these sites useful (if you have any other recommendations please contact us).

The first two sites are more general medical sites that deal with cancer, ovarian cancer, and cancer issues. The remaining sites are specific to Ovarian Cancer research, information, support and networks in both the UK and Australia.

Granulosa Cell Tumour Foundation (NZ)

The Granulosa Cell Tumour Foundation New Zealand was created to assist women in their fight against one of the rarest forms of ovarian cancer. They are currently raising funds for Dr Andrew Shelling to conduct research into all Ovarian Cancers.

People Living With Cancer (USA)

A comprehensive website for all cancers, with a full section on Ovarian Cancer including symptoms, diagnosis, illustrations (including staging), treatment and after treatment.

Mayo Clinic (USA)

Mayo Clinic is a not-for-profit medical practice dedicated to the diagnosis and treatment of virtually every type of complex illness.  The Mayo clinics provide clinic and hospital services in the USA. Their website is another comprehensive site, and is not limited to cancer but includes other medical issues. It addresses some important topics in the Cancer section, including but certainly not limited to Cancer Myths, cancer survival, sexuality after cancer and end of life issues.

Ovarian Cancer Research Foundation (Australia)

Established to foster research into ovarian cancer - a disease which in Australia claims the life of one woman every 10 hours and often remains undetected until in its advanced stages.

Ovarian Cancer Australia - OVCA (Australia)

Aims to represent the needs of the ovarian cancer community, thereby improving the outlook for ovarian cancer patients through improved diagnosis, care and treatment.

Cancer Research UK

A comprehensive site with diagnosis, treatment, question and answer section and more.

Ovacome (UK)

A UK-wide support network providing information and support for everyone affected by ovarian cancer. This site is designed for women with ovarian cancer, their families, friends and carers, and health professionals. It includes real-life stories about how other people have coped with the disease and information about treatment, screening and research.

Ovarian Cancer Action (UK)

Ovarian cancer action is wholly dedicated to improving survival rates and creating a future free from the fear of ovarian cancer.  It does this by funding research into the prevention, detection, treatment and cure of ovarian cancer, raising awareness of symptoms, and by giving a voice to women with ovarian cancer, combating the view that this is a 'silent cancer'.

Venus Appeal (UK)

There are four main types of gynaecological cancer and the earlier a cancer is found, the easier it is to treat. The information on this website will help you to identify the common signs and symptoms associated with these cancers and give you further information on what to do, and who to see.  You will be able to read stories written by women who have experienced these types of cancer.  

Gift of Knowledge (NZ)

A website set up by Nicola Coom, a BRCA gene carrier, to help New Zealanders affected by inherited cancer risks by providing information and support about their treatment and choices.