Ovarian Cancer: Symptoms, Causes and Treatment

Ovarian cancer is a type of cancer that affects thousands of Australian women. Although there are signs of the condition, it is often difficult to detect until the later stages, making it extremely dangerous. Some risk factors associated with ovarian cancer include being older, having a family history, and having gene mutations. If you think you are at risk of ovarian cancer, talk to your doctor about testing and diagnosis options. Treatment can be effective in the early stages of the disease.

What is ovarian cancer?

Ovarian cancer is cancer of the ovaries. It can present as a malignant tumour in one or both ovaries.

Ovaries are a part of the female reproductive system. They are small, oval-shaped glands located on each side of the uterus. They are what make it possible for a woman to become pregnant, releasing an egg each month for fertilisation. Ovaries also produce a range of hormones, including hormones that trigger menstruation such as estrogen.  

There are multiple types of ovarian cancer. The most common is epithelial ovarian cancer, which comes from the cells on the outside of the ovary and accounts for 90 per cent of ovarian cancer cases. The other well-known types are germ cell, which arises from the cells which produce eggs, and stromal type, which arises from supporting tissues within the ovary.

Every year, around 1400 new cases of ovarian cancer are diagnosed in Australia. It is the eighth most common cancer affecting women in the country, with a five year survival rate of 45.7 per cent. 

Signs and symptoms of ovarian cancer

It is not easy to tell if you are suffering from ovarian cancer. Many of the symptoms associated with the disease can be caused by other conditions. However, if you are experiencing some or several of the below symptoms, you should consider checking in with your doctor. 

•     difficulty eating 
•     feeling full quickly
•     indigestion
•     abdominal bloating
•     frequent or urgent urination
•     constipation or diarrhoea
•     menstrual irregularities
•     pain during intercourse
•     back, abdominal or pelvic pain
•     tiredness
•     unexplained weight loss or weight gain.

Causes of ovarian cancer 

There is no clear cause of ovarian cancer, but there are some risk factors that can make you more likely to develop ovarian cancer. 

Ovarian cancer affects predominantly older women. Being over fifty years old is considered a risk factor. The risk of being diagnosed before age 85 is 1 in 85.

Having a family history of ovarian cancer can increase your risk, and if you have blood relatives who have been diagnosed before then you should be aware of the signs and screen for the disease more frequently. 

Additionally, inherited gene changes can cause ovarian cancer. The genes that increase the risk of ovarian cancer include BRCA1 and BRCA2. These genes also increase the risk of breast cancer.

Women who suffer from endometriosis, a disorder in which tissue from inside the uterus grows outside the uterus causing pain and discomfort, are also more likely to develop ovarian cancer. 

Other risk factors for ovarian cancer include being overweight or obese and taking hormone replacement therapy to control menopause signs and symptoms. Some people who have a longer menstruation period – beginning their periods early or starting menopause at a later age – are also more likely to experience ovarian cancer.

There are two things that may help to decrease your risk of ovarian cancer. Studies have shown that women who have been pregnant are less likely to suffer from the disease. Additionally, the oral contraceptive pill, when taken for many years, has been linked to a reduced risk of ovarian cancer. However, there are different concerns associated with long term use of birth control bills, which you should discuss with your doctor.

It’s important to remember that while there are risk factors associated with ovarian cancer, there is no known way to prevent it. If you have a family history or meet some of the other risk factor criteria noted above, speak to your doctor about screening for ovarian cancer. 

People who may have the genes that increase the risk of ovarian cancer can be referred to a genetic counsellor and undertake testing for the gene changes BRCA1 and BRCA2. If you’re found to have a gene change that increases your risk of ovarian cancer, you may consider surgery to remove your ovaries to prevent cancer.

Diagnosis of ovarian cancer

If you are experiencing some of the signs and symptoms of ovarian cancer, or you have a strong family history of the condition, your doctor may suggest some medical tests to look for cysts and tumours. Some of the common tests and scans used to diagnose ovarian cancer include:

1. Physical examination

This can be performed by your regular GP, or you may visit a specialist. The doctor will check your abdomen for any lumps or irregularities. They will also do an internal vaginal examination. The latter test can be a bit uncomfortable for many women, but it is necessary to get an accurate diagnosis.

2. Blood test

There is a blood test that doctors can order to check for a common tumour marker for ovarian cancer, CA125. You will need to visit a pathology clinic to have blood taken and wait a couple of days for results.

3. Ultrasound

Ultrasound is a safe and painless type of scan that uses soundwaves to create a clear image of your ovaries and uterus. Typically the sonographer performing the ultrasound will hold the probe against your abdomen, but sometimes they will need to insert in vaginally.

4. CT scan

CT (computerised tomography) uses X-rays to take images of your body. It is quick and doesn’t hurt.

5. PET scan

PET (positron emission tomography) scans highlight abnormal tissue and can be used to find cancer.

6. Colonoscopy

Many of the symptoms of ovarian cancer are similar to other issues, such as a bowel problem. A colonoscopy may be used to rule out other conditions.

Screening for ovarian cancer 

In Australia, screening programs have been developed to detect some cancers in the earliest stages and save lives. However, there is no national screening program for ovarian cancer. The Cancer Council notes that ‘there is no evidence to suggest that screening will reduce the number of deaths from ovarian cancer.’

Only about 20 percent of ovarian cancers are found at an early stage, despite the chances of living longer after diagnosis improving dramatically when this is achieved. 94 percent of patients survive longer than 5 years when ovarian cancer is found early.

The CA-125 blood test is a common test used for diagnosing ovarian cancer, but it has not been used successfully as a method for screening for the disease. This is because high levels of the protein CA-125 in the blood can indicate a range of conditions, including endometriosis, ovarian cysts and pelvic inflammatory disease. Additionally, people suffering from ovarian cancer do not always have a higher level of CA-125. For this reason, the blood test is usually used in conjunction with other diagnostic tests such as ultrasound. 

If you’re concerned that you are vulnerable to ovarian cancer, you should speak with your GP. If you do have risk factors, they will be able to organise regular tests for you. All women should also be aware of their bodies and monitor any changes, especially when they are in the older age bracket.

Treatment for ovarian cancer  

Treatment for ovarian cancer will usually depend on a number of factors. These include the stage of the disease, the patient’s age, other health concerns, and whether or not the patient hopes to become pregnant in the future.

Stages of ovarian cancer

Ovarian cancer is usually detected in the later stages when cancer has spread. FIGO (International Federation of Gynaecology and Obstetrics) is the most common staging system for ovarian cancer. It records the extent by which cancer remains in the ovary, has spread to other pelvic structures or has spread into the lining of the abdomen with or without fluid (ascites).

1. Surgery

Surgery is the main type of treatment used for ovarian cancer. It can be used to initially determine the extent of the condition, and to remove cancerous cells. When the cancer has spread, as much of it will be removed as possible. 

Depending on how much the cancer has spread, surgery can remove one or both ovaries, the uterus, the fallopian tubes, and nearby lymph nodes. 

Oophorectomy is the term used for the removal of both ovaries. It can be used as a treatment option, or for the prevention of ovarian cancer. This can be considered by women with a strong family history of ovarian cancer or the gene changes BRCA1 and BRCA2. Women with these gene mutations will typically also have their fallopian tubes removed, as they also have a higher risk of fallopian tube cancer.

Oophorectomy can reduce your risk of developing ovarian cancer by 80 to 90 percent. However, there are risks involved with this surgery and it comes at a cost. For younger women who have not entered menopause, removing the ovaries greatly reduces the amount of the hormones estrogen and progesterone in the body, which can cause other issues. 

Additionally, the removal of the ovaries means that a woman can no longer naturally conceive. For women hoping to have children, oophorectomy is not a desirable option. If the uterus is also removed, a woman will not be able to become pregnant using frozen eggs or donated eggs either. 

2. Chemotherapy

Chemotherapy is a common treatment used for cancer patients. It involves using chemicals to kill fast-growing cells in the body, which includes cancer cells. Chemotherapy can be injected or taken orally. 

For ovarian cancer, chemotherapy can be used before surgery to shrink the size of the cancer and prevent the need to remove as much tissue. It can also be used after surgery to kill any cancer cells that might remain in the body. It will not usually be the only course of treatment for ovarian cancer patients.

3. Radiation therapy 

Radiation therapy uses X-rays to destroy or damage cancer cells so they cannot multiply inside the body. It is used to treat many types of cancers and can sometimes be successful in helping to treat ovarian cancer. It can also be used alongside chemotherapy. Radiation is specifically targeted at the pelvic area to kill cancer cells in the ovaries, fallopian tubes and uterus.

4. Hormone therapy 

Some ovarian cancer cells use estrogen to grow and multiple. Blocking your estrogen production can assist to slow the spread of ovarian cancer. It is a good treatment option for after other initial treatments and for slow-growing cancers. However, hormone therapy can result in other side effects.

5. Palliative care

Palliative care is focused on relieving pain and keeping you comfortable while you live with ovarian cancer. It is a specialised type of medical care that relieves the symptoms of serious illness, without trying to treat or cure the condition. Palliative care helps people with cancer live longer and more comfortable lives, so they can spend time with loved ones and avoid suffering from severe pain. 

Often, palliative care will be used in conjunction with treatment options such as surgery and chemotherapy. 

Resources and support

Living with ovarian cancer, particularly in the later stages of the disease, can be challenging for both patients and their loved ones. People with advanced ovarian cancer will often require comprehensive medical support throughout the day and night, including nursing care, post-surgery care, patient transport and personal care.

Homage offers specialised care for individuals and their families at all stages of cancer. Our experienced and compassionate Care Professionals undergo training to provide support and understanding to people during this difficult time.

If you or a loved one are living with ovarian cancer, find out more about how Homage may be able to assist you to remain comfortable at home.

For more information and resources on ovarian cancer, take a look at these helpful links.

•     https://www.healthdirect.gov.au/ovarian-cancer
•     https://www.cancer.org.au/cancer-information/types-of-cancer/ovarian-cancer

Tragically, ovarian cancer will take the lives of over one thousand women in Australia every year. If you have been diagnosed with ovarian cancer, it can be an extremely frightening time. Make sure you take a look at the help available to you and speak to your doctor about your treatment options.