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Ovarian cancer

In 2006, more than 1,200 women were diagnosed with ovarian cancer. It's the ninth most common cancer in Australian women, mostly affecting those over 60.

 

About ovarian cancer 

Ovarian cancer is created by the abnormal and uncontrolled growth of cells. The cancer can sometimes spread more widely in the abdomen (tummy) through the bloodstream or the lymph system where it may grow and form secondary tumours. More rarely it can spread to other organs. The spread of cancer is called metastasis.

The ovaries 

The ovaries are two small organs that are part of the female reproductive system where eggs mature. Each month, in women of childbearing age, one ovary releases an egg into the fallopian tube, where it may be fertilised with sperm. If it's not fertilised, the egg passes into the womb and is lost when this sheds its lining as a monthly period.

The ovaries also produce the female hormones oestrogen and progesterone. After menopause, the ovaries produce less of these hormones and no longer release an egg each month.

The position of the womb and surrounding structures

Types of ovarian cancer 

There are two main types of ovarian cancer. The most common is epithelial ovarian cancer that affects the lining of the ovaries. Nine out of 10 ovarian cancers are epithelial. There are several different types of epithelial ovarian cancer including the two most common - serous and endometrioid.

Non-epithelial ovarian cancer is much less common. These include germ cell cancers that form from the cells in the ovary that make the eggs. These usually affect younger women.

Symptoms of ovarian cancer 

Lack of symptoms or vague symptoms in the early stages of ovarian cancer is why the illness is known as the 'silent killer'. If there are symptoms, they can include stomach pain or a bloated feeling that can be confused with irritable bowel syndrome (IBS). Ovarian cysts and non-cancerous growths also cause the same symptoms as ovarian cancer.

Other symptoms include:

  • loss of appetite
  • unexplained weight gain
  • swelling of your abdomen (tummy)
  • pain during sex
  • changes in bowel or bladder habits - constipation, excess wind, diarrhoea or needing to pass urine more often
  • abnormal vaginal bleeding (although this is rare).

Causes of ovarian cancer 

Doctors don't know exactly what causes ovarian cancer, but there are some things that seem to make it more likely. It's more common in women who live in developed countries and for those who have gone through the menopause.

As with breast cancer, it's known that faulty inherited genes called BRCA1 and BRCA2 increase the risk of ovarian cancer. However, having a close relative - mother, sister or daughter - with ovarian cancer doesn't necessarily mean there's a faulty inherited gene in your family and the cancer could've happened due to causes other than hereditary reasons.

Other factors that are thought to make ovarian cancer more likely include:

  • hormone replacement therapy (HRT) - especially taking HRT for longer than five years
  • being overweight or obese
  • endometriosis
  • smoking
  • starting your periods early and having the menopause late.

Fertility treatment is no longer considered a risk factor after recent research has ruled out the link.

Ovarian cancer may be less common in women who have:

  • used the contraceptive pill
  • had children - the more children, the lower the risk
  • breastfed their children
  • had a hysterectomy.

Diagnosis of ovarian cancer 

Your GP will ask you about your symptoms and examine you. They may also ask you about your medical history, including whether anyone else in your family has had breast or ovarian cancer.

You may have a blood test for a protein called CA125 that can be high in ovarian cancer. The GP may also carry out an internal examination to check your womb and ovaries.

You may be referred to a gynaecologist for further tests such as an ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to view the inside of your pelvis.

If the results of your scans show any abnormalities, you may also have a laparoscopy. This involves inserting a thin, fibre-optic tube (laparoscope) into your stomach via a small cut just below your belly button. This allows the surgeon to look at your ovaries and surrounding organs. The procedure is carried out under a general anaesthetic (so you'll be asleep during the procedure and feel no pain). The surgeon may take a biopsy - this is a small sample of tissue that will be sent to a laboratory for testing.

If fluid has built up in your stomach, it can be drawn out through a needle and examined to see whether cancer cells are present. This is known as abdominal fluid aspiration.

Treatment of ovarian cancer 

Treatment depends on the type of ovarian cancer and how far it has spread.

Surgery

Almost all women with ovarian cancer will need surgery for the best chance of successful treatment. The extent of surgery depends on the type of cancer and how far it has spread. If it hasn't spread beyond the ovary, it may be possible to remove only the single affected ovary and fallopian tube.

If the cancer has already spread beyond the ovary, it will be necessary to remove both ovaries and your womb, together with nearby lymph nodes and any surrounding tissues that the cancer may have spread to. This is called a total hysterectomy and oophorectomy.

Other types of surgery for more advanced ovarian cancer are used to remove as much of the tumour as possible.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells and can cause side effects, including tiredness and feeling sick or vomiting. Your chemotherapy treatment will vary depending on the type of ovarian cancer you have. Chemotherapy is usually used to shrink ovarian tumours. However, if you have the rarer type of germ cell ovarian cancer, chemotherapy can sometimes cure the disease.

After surgery, most women with ovarian cancer will be offered chemotherapy to destroy any remaining cancer cells that were not removed by surgery or if there is a risk the cancer may return. Women with very early stage ovarian cancer don't usually need chemotherapy.

If ovarian cancer comes back (relapses), you may be treated with the same chemotherapy medicine or an alternative, depending on the timing of the relapse and whether the cancer has developed resistance to previous chemotherapy medicines.

Radiotherapy

Radiotherapy uses radiation to destroy cancer cells. However, it's not often used to treat ovarian cancer.

Prevention of ovarian cancer 

You may be able to reduce your risk of developing ovarian cancer through certain lifestyle changes such as stopping smoking and eating a healthy, balanced diet.

Getting enough vitamin D may reduce your risk of developing a number of cancers, including ovarian cancer - although more research needs to be done to confirm this. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. For your body to make enough of its own vitamin D, it's important that your hands, face and arms (or an equivalent area of skin) are exposed to some sunlight on most days. However this must be balanced against the risk of sunburn and skin cancer. Deliberate sun exposure during the hours of 11am to 3pm during summer is not recommended. 

You only need a few minutes of exposure before 10am or after 3pm; as this is outside the peak UV radiation period it's safe to leave your hat and sunscreen off for the few minutes you need.

 During winter, if you live in the southern parts of Australia where UV radiation levels are less intense, you may need around two to three hours of sunlight over a week to get the vitamin D you need. But if you live in the northern parts of Australia, you can do the same as you would in summer to maintain adequate vitamin D levels.

If it's not possible for you to get much sun exposure, taking at least 10 micrograms (400 IU) of vitamin D a day can help make sure you get enough.

Ask your pharmacist for the consumer medicine information leaflet for your supplements if they're available. If you're pregnant or breastfeeding, talk to your pharmacist or GP for advice first. If you're taking diuretics for high blood pressure or have a history of kidney stones or kidney failure, talk to your GP before taking vitamin D supplements.

Help and support 

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home - this is called palliative care.

Further information 

Ovarian Cancer Australia

www.ovariancancer.net.au

National Breast and Ovarian Cancer Centre (NBOCC) (now part of Cancer Australia)

canceraustralia.nbocc.org.au

Sources 

The Australian Cancer Network and National Breast Cancer Centre. Clinical practice
guidelines for the management of women with epithelial ovarian cancer. [online] Camperdown, NSW: National Breast and Ovarian Cancer Centre. 2004 [Last updated 27 Jun 2011, accessed 9 Jul 2011] Available from: http://canceraustralia.nbocc.org.au/

The Australian Cancer Network and National Breast Cancer Centre. Assessment of symptoms that may be ovarian cancer: a guide for GPs. [online] Camperdown, NSW: National Breast and Ovarian Cancer Centre. 2005 [Last updated 2009, accessed 9 Jul 2011] Available from: http://canceraustralia.nbocc.org.au/

Australian Institute of Health and Welfare (AIHW). Ovarian cancer in Australia: an overview, 2010. Cat. no. CAN 48. [online] Canberra, ACT: AIHW. 2010 [Accessed 9 Jul 2011] Available from: http://www.aihw.gov.au/publication-detail/?id=6442468331

Cancer Australia. Signs and symptoms of ovarian cancer. [online] Canberra, ACT: Cancer Australia. c2011 [Last updated Jan 2011, accessed 9 Jul 2011] Available from: http://canceraustralia.nbocc.org.au/

Cancer Council Victoria. Ovarian cancer. [online] Carlton, VIC: Cancer Council Victoria. c2011 [Last updated 30 Jun 2010, accessed 9 Jul 2011] Available from: http://www.cancervic.org.au/about-cancer/cancer_types/ovarian_cancer

Green AE. Ovarian cancer. [online] New York: WebMD LLC. [Last updated 17 Jun 2011, accessed 9 Jul 2011] Available from: http://emedicine.medscape.com/article/255771-overview

Ovarian Cancer Australia. Treatment. [online] Melbourne, VIC: Ovarian Cancer Australia. [Last reviewed Jan 2011, accessed 9 Jul 2011] Available from: http://s3.amazonaws.com/overian-production/assets/239/Treatment%20for%20Ovarian%20Cancer_original.pdf (PDF 83kb)

Ovarian Cancer Australia. Support. [online] Melbourne, VIC: Ovarian Cancer Australia. 0[Last reviewed Jan 2011, accessed 9 Jul 2011] Available from: http://s3.amazonaws.com/overian-production/assets/237/Support%20Factsheet_original.pdf (PDF 71kb)

Simon C Everitt H Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press. 2005.

Webb PM. Fertility drugs do not increase risk of ovarian cancer. BMJ. 2009; 338: a3075. [online] Available from: http://www.bmj.com/content/338/bmj.a3075.full

Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and adult bone health in Australia and New Zealand: a position statement. MJA. 2005; 182: 281-285.

Last published: 30 July 2011

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This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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