There are three types of ovarian cancer; the common epithelial type (90%) that arises from the cells on the outside of the ovary, the germ cell type that arises from the cells which produce eggs and the rare stromal type arising from supporting tissues within the ovary.
Incidence and mortality
More than 1200 women are diagnosed with ovarian cancer each year. The risk of being diagnosed before age 85 is 1 in 77. Each year, 888 women die of ovarian cancer.
Screening
There are no proven screening tests although ultrasound through the vagina and a blood test, Ca125 are being investigated.
Symptoms and diagnosis
There may be no symptoms or symptoms may be non-specific and include:
- persistent abdominal pain
- pelvic or back pain
- cramps, swelling, bloating
- symptoms of urinary frequency or changed bowel habits with constipation or diarrhea and/or nausea
- fullness after food, weight loss, loss of appetite
- tiredness
- painful intercourse or vaginal bleeding
Staging
Ovarian cancer often presents when it has spread. A common staging system is the FIGO (International Federation of Gynaecology and Obstetrics) system which records the extent by whether it remains in the ovary, spreads to other pelvic structures or has spread into the lining of the abdomen with or without fluid (ascites). CT scans and blood tests CA125 are used.
Causes
Age over 50, family history, changes in the genes BRCA1 or BRCA2 are associated with ovarian cancer. Higher risk occurs in Northern Europeans, Northern and Ashkenazi Jews, with early onset of periods (before 12 years) and late menopause, childlessness, infertility, first child after 30 or never taking oral contraceptives, as is the case with women who have taken oestrogen only hormone replacement therapy or fertility treatment.
Prevention
There is no proven method of prevention. Women with a strong family history who have their ovaries removed do not always prevent cancer.
Treatment
Treatment depends on the extent of the cancer. Surgery is used to determine the extent of disease and if localised is the main treatment. If the ovarian cancer has spread, an attempt is made to remove as much as possible.
Chemotherapy, commonly with regimens containing cisplatin or carboplatin and paclitaxel or docetaxel, is used after surgery to try to eliminate all disease on scan and on a blood test, CA125. Chemotherapy can be injected into the bloodstream through the vein or instilled into the abdominal cavity or both.
With widespread disease, chemotherapy may be used first. Surgery after chemotherapy can assess response. Germ cell tumours can be cured with chemotherapy with PEB (cisplatin, etoposide, bleomycin).
Prognosis
If the cancer is treated when it is still confined to the ovaries, 93% patients will be alive in five years. If the cancer has spread to surrounding tissue or organs in the pelvis this drops to 39% and if it has spread more distantly, 30%. Survival will vary between individuals and may depend on their response to treatment.
Further information
More detailed information about ovarian cancer, including a range of fact sheets and position statements, is available from the National Breast and Ovarian Cancer Centre, c/o http://www.ovariancancerprogram.org.au/
You can also call contact Cancer Council Helpline on 13 11 20 (cost of a local call) for more information.