Ovarian cancer is still the deadliest women’s cancer. Unfortunately, this has not changed in 30 years. Every day in Australia, four women are diagnosed with ovarian cancer and three will die from the disease.
Ovarian cancer is a disease where some of the cells in one or both ovaries start to grown abnormally and develop into cancer.
The ovaries are two small almond shaped organs that are part of the female reproductive system. Each ovary measures about 2-4cm across and they sit on either side of the uterus.
Each ovary contains germ cells that eventually develop into eggs (ova). The ovaries also produce the hormones oestrogen and progesterone, which regulate your menstrual cycle and affect the development of female body characteristics.
Types of ovarian cancer
There are four main types of ovarian cancer, and these are named after the type of cells in the ovary where the cancer begins growing:
- Epithelial ovarian cancer begins in the epithelium, the outer cells that cover the ovary. This is the most common type of ovarian cancer, accounting for about 90% of cases.
- Borderline tumours are a group of epithelial tumours which are not as aggressive as other epithelial tumours. Borderline tumours may also be called ‘low malignant potential’ or LMPO tumours. The outlook for women with borderline tumours is generally good regardless of whether the disease is diagnosed early or late.
- Germ cell ovarian cancer begins in the cells that mature into eggs. These tumours account for about 5% of ovarian cancers and usually affect women under 30 years.
- Sex-cord stromal cell cancer begins in the ovary cells that release female hormones. These tumours account for about 5% of ovarian cancers and can affect women of any age. Both germ cell and sex-cord stromal cell ovarian cancers respond well to treatment and are often curable. If either of these cancers affect only one ovary, it may be possible for younger women to have children after treatment.
Diagnosing ovarian cancer
If your doctor suspects ovarian cancer, there are a number of tests they can perform to help decide whether your symptoms are due to ovarian cancer or other causes. Of these tests, it is strongly recommended that both the CA125 blood test and the transvaginal ultrasound are performed.
There isn’t any one test that can be used to diagnose ovarian cancer. Doctors use both a blood test and a transvaginal ultrasound (and possibly other tests) to help make a diagnosis. If these tests strongly suggest ovarian cancer, then your doctor will recommend an operation, which is the only definite way to diagnose ovarian cancer.
Initial examinations and tests will usually include:
Physical examination. Your doctor will examine you physically and this will include an internal pelvic examination where they check for a mass or a lump in the lower abdomen or pelvis.
Blood tests. Your blood will be tested for a particular protein or a tumour marker called CA125. This protein is often higher than normal in women with ovarian cancer. Some women may have other tumour markers called inhibin or CEA. The type of marker depends on the type of tumour. However, some tumours will not have any of these tumour markers. Testing your blood for these tumour markers is one way to help diagnose cancer. In women who are diagnosed with ovarian cancer, these tests are also used later on to check the progress of the illness.
Ultrasound. A transvaginal ultrasound (TVU) involves an ultrasound probe being inserted into your vagina to relay image of the ovaries to a radiologist. It is important that this type of ultrasound is used as it gives a much clearer picture of the ovaries than an abdominal or external ultrasound.
Other imaging tests. Sometimes your doctor may organise other imaging tests. These may include chest or abdominal x-rays, an ultrasound or your lower abdomen, a CT scan, or possibly an MRI.
Signs and Symptoms
Every woman needs to know the symptoms of ovarian cancer. Make sure you do.
It can be difficult to diagnose ovarian cancer because the symptoms are ones that many women will have from time to time, and they are often symptoms of less serious and more common health problems.
But we do know that ovarian cancer is NOT a silent disease. Women who are diagnosed with ovarian cancer report four types of symptoms most frequently:
Abdominal or pelvic pain.
Increased abdominal size or persistent abdominal bloating.
Needing to urinate often or urgently.
Feeling full after eating a small amount.
If you have any of these symptoms, they are new for you and you have experienced them multiple times during a 4-week period, go to your GP.
Other symptoms to be aware of may include:
- Changes in your bowel habits.
- Unexplained weight gain or weight loss.
- Bleeding in-between periods or after menopause.
- Back pain.
- Indigestion or nausea.
- Excessive fatigue.
- Pain during intercourse.
Be aware — but don’t make yourself sick with worry
It is important to remember that most women with these symptoms will not have ovarian cancer. Your doctor should first rule out more common causes of these symptoms, but if there is no clear reason for your symptoms, your doctor needs to consider the possibility of ovarian cancer.
Age: ovarian cancer is most common in women over 50 and in women who have stopped menstruating (have been through menopause), and the risk increases with age. However, ovarian cancer can affect women of all ages.
Genetics and family history: If a woman has two or more relatives from the same side of her family affected by ovarian, or ovarian and breast cancer her risk of developing ovarian cancer may be increased. This tends to be a result of an inherited faulty gene (BRCA1 or BRCA2 mutation) that increase a woman’s risk of developing ovarian and breast cancer. Genetics and family history are responsible for at least 15% of ovarian cancers. Women who are descended from Ashkenazi Jewish populations are more likely to carry this faulty gene. All women diagnosed with ovarian cancer are recommended to attend a familial cancer centre to consider genetic testing.
Child-bearing history: women who have not had children, are unable to have children, have never used oral contraceptives or have had children over the age of 30, may be slightly more at risk. This is due to ovaries not having a “rest” from the break and repair of the surface of the ovary when women ovulate each month.
Endometriosis: this condition is when the tissue lining the uterus (endometrium) is also found outside of the uterus.
Lifestyle factors: such as smoking tobacco, being overweight or eating a high fat diet.
Hormonal factors: including early puberty (menstruating before 12) or late menopause (onset after 50).