What is ovarian cancer?
Ovarian cancer is when abnormal cells grow and multiply in one or both of the ovaries. The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month in women of menstruating age. This is known as ovulation.
There are several types of ovarian cancer. They include:
- epithelial ovarian cancer, which affects the surface layers of the ovary; it is by far the most common type
- germ cell ovarian cancer, which originate in the cells that make the eggs
- stromal tumours, which develop within the cells that release female hormones
It is also possible to have borderline epithelial tumours which are not as aggressive as other epithelial tumours. These are sometimes called 'low malignant potential' or LMPO tumours.
As with most types of cancer, the outlook depends largely on how far the cancer has advanced by the time it is diagnosed, and on your age at diagnosis.
What are the symptoms of ovarian cancer?
The most common symptoms that may indicate ovarian cancer are:
- abdominal bloating or feeling full
- abdominal or back pain
- appetite loss or feeling full quickly
- changes in toilet habits
- needing to urinate more often
- unexplained weight loss or weight gain
- indigestion or heartburn
- bleeding in-between periods or after menopause
- indigestion or nausea
- pain during intercourse
Many of these symptoms are be similar to those of other conditions. Having some of these symptoms doesn’t mean you have ovarian cancer.
What causes ovarian cancer?
We don't know the causes of ovarian cancer, but there are risk factors that may make developing the condition more likely. These include:
- 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 colorectal cancer and endometrial cancer
Only around 5 to 10 in every 100 cases of ovarian cancer are due to inherited factors. Having endometriosis, using hormone replacement therapy for a long time, smoking cigarettes and being obese also increase your risk of developing ovarian cancer.
When should I see my doctor?
See your doctor if you regularly have pain in the pelvis and lower stomach, persistent bloating and difficulty eating.
If you've already seen your doctor and the symptoms continue or get worse, it is important to go back and explain this, as you know your body better than anyone.
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How is ovarian cancer diagnosed?
A physical examination for ovarian cancer involves checking for any lumps or masses by feeling the abdomen and doing an internal examination. If your doctor thinks your symptoms should be investigated further, you will be referred for imaging and a blood test.
An ultrasound is usually done internally (transvaginal ultrasound) by inserting a small probe into the vagina to check for cysts, tumours or other changes that might or might not be ovarian cancer. Ultrasound results cannot be used to give a definite diagnosis of ovarian cancer.
Imaging of the chest and abdomen (tummy) may also be done to look for spread of the cancer. This usually involves ultrasound or computed tomography (CT) scans. Magnetic resonance imaging (MRI) scans or x-rays may sometimes be used.
If a transvaginal ultrasound shows a cyst or tumour on the ovary, blood tests might be done to look for increased levels of the protein CA125. This may indicate that ovarian cancer is present. However, it can also indicate other conditions such as ovulation, menstruation, endometriosis, fibroids or benign ovarian cysts. Illnesses such as liver or kidney disease can also cause an increase in CA125 levels. For these reasons, a CA125 test alone cannot be used to diagnose ovarian cancer.
If there's a build-up of fluid in the abdomen, a fluid sample can be taken by paracentesis (through a needle passed through the skin). The fluid is checked under a microscope for cancer cells.
The only way to definitely find out whether a woman has ovarian cancer is with an operation and a biopsy of the tumour or cyst.
How is ovarian cancer treated?
The first treatment for ovarian cancer is usually an operation called a 'laparotomy'. This operation is also the main way that a diagnosis of ovarian cancer is confirmed.
During a laparotomy, a long vertical cut is made in your abdomen, which allows the surgeon to find and remove as much of the tumour as possible. In many cases, the surgeon will do a biopsy of the tumour at the beginning of the operation to confirm that it is cancer. This is called a 'frozen section'. If the frozen section confirms that the tumour is cancer, the operation will continue.
For most women, the operation will involve removal of the ovaries, fallopian tubes, the uterus, the omentum (the fat pad around the organs in your abdomen), the appendix and some of the lymph glands in the area. Sometimes it may be necessary to remove some of the bowel.
After your operation, samples of the tissue removed are sent to a laboratory for further examination. The results of these biopsies will provide more information about the type and extent of your cancer and enables the gynaecological oncologist to make decisions about further treatment.
Most women stay in hospital for up to a week after surgery. You may have pain relief through an epidural, rectal suppositories or patient-controlled analgesia (PCA), which enables you to control the level of pain medicine given. It will be uncomfortable to move around at first but getting out of bed and walking a little bit can also help to relieve the pain caused by wind (gas) in the abdomen. You will need to avoid heavy lifting, driving and having sex for about 6 weeks after surgery.
Most women with ovarian cancer will require chemotherapy, usually referred to as 'chemo'. The purpose of chemo is to attack cancer cells and to slow or stop their growth while causing the least possible damage to normal cells.
Chemotherapy works best when the tumour is small and the cancer cells are actively growing. Even though most of the cancer may have been removed during surgery, there may be some cancer cells left. For this reason, chemotherapy works best if started soon after surgery.
Chemotherapy for ovarian cancer is usually given through an intravenous (IV) drip in an outpatient clinic at the hospital. Most women will receive 6 rounds or cycles of treatment with 3 or 4 weeks in-between each. This means the total treatment time usually continues over several months. Before each treatment, you will have a blood test to make sure your body's normal cells have had time to recover. You will also have blood tests and may have a CT scan to measure your response to the treatment.
If your cancer does not respond completely to the initial treatment, you may need further chemotherapy. You may also need further treatment if your ovarian cancer comes back in the future (this is called 'second line chemo'). The drugs used in further treatments will depend on the chemo drugs initially used, the time between treatments and the aims of the treatment.
Radiotherapy is occasionally used as a treatment option for ovarian cancer. Radiotherapy may be used where cancer is confined to the pelvic cavity. It may also be used in advanced ovarian cancer to reduce the size of the cancer and help to relieve symptoms.
You can have medications that target only the cancer cells without harming normal cells. This means there are fewer side effects than with chemotherapy.
This uses hormones or medicines that block the effects of your body’s own hormones. It’s used in some types of ovarian cancer such as ovarian stromal tumours.
Many women with ovarian cancer are interested in trying complementary therapies — 'natural' therapies that may be used to help manage symptoms and side effects, reduce pain, relieve stress and encourage a feeling of wellbeing. Let your doctor know if you are considering natural therapies to ensure they are compatible with the treatment you are receiving.
Follow-up after treatment
After your course of treatment has finished you will be invited for regular check-ups, usually every 2 to 3 months to begin with. At the check-up your doctor will examine you. They may do blood tests or scans to see how your cancer is responding to treatment.
Can ovarian cancer be prevented?
There is no proven way to prevent ovarian cancer. Even if you have a strong family history, removing your ovaries will not necessarily prevent cancer.
Complications of ovarian cancer
Ovarian cancer can spread to other parts of the reproductive system and the surrounding areas, including the womb (uterus), vagina and abdomen.
You may also experience emotional challenges from the shock of a cancer diagnosis and fears about the future. Or you may have physical side effects of treatment such as nausea and fatigue. There are also practical aspects of treatment to deal with including costs and travel. More specific emotional problems include anxiety and depression.
Some of the symptoms reported by women with ovarian cancer include:
- nausea and vomiting
- hair loss
- increased risk of infections
- loss of appetite
- distended (swollen) abdomen and build up of fluid
- shortness of breath
- lymphoedema (fluid build up in the limbs)
- discharge from the vagina
- thromboses (blood clots)
- fatigue (feeling tired)
- mouth ulcers
Ovarian cancer treatment and fertility
Younger women who have both ovaries removed as part of surgery will no longer have periods after surgery. This will lead to menopause and may result in menopausal symptoms. Women who have their uterus removed but still have one ovary will no longer have periods but will not get menopausal symptoms such as hot flushes. You may decide to take hormone replacement therapy (HRT) to control your symptoms. There is no reason why you cannot take HRT after your ovarian cancer treatment. Your doctor will be able to help you decide what's best for you.
If ovarian cancer has not spread or if it's found to be a borderline tumour (a type of less aggressive ovarian cancer), it may be possible to just remove only the affected ovary, leaving the other ovary and the uterus. This means that a woman may still fall pregnant after surgery.
It's important for women who have not yet completed their family to speak to a doctor about these issues before surgery.
Resources and support
Ovarian Cancer Australia can provide more information on ovarian cancer through their website, or by calling their information line on 1300 660 334.
Peer support groups give women the chance to meet and talk with people who have been through or are going through similar experiences. Often people say they feel less anxious and alone and more optimistic about the future after meeting with a support group. You can also get support by telephone or online. For more information about support groups, including tele-support visit the Ovarian Cancer Australia website.
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Depending on where you live, you might be able to go to a Look Good Feel Better workshop. These are free of charge and provide tips and advice about dealing with changes to the way you look caused by cancer treatment. Workshops are available in capital cities and other major centres.
Cancer Council Australia also offer support for you and your loved ones via their helpline on 13 11 20.
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Last reviewed: January 2020