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What is ovarian cancer?

Ovarian cancer is a malignant tumour in one or both ovaries.

While there are many types of ovarian cancer the three most common types of ovarian cancer are: the common epithelial type (90% of cases) that arises from the cells on the outside of the ovary; the germ cell type (around 4% of cases) that arises from the cells which produce eggs; and the rare stromal type arising from supporting tissues within the ovary.

Ovarian cancer is the eighth most common cancer affecting women in Australia.

In 2016, 1289 new cases of ovarian cancer were diagnosed in Australian women. The risk of being diagnosed before age 85 is 1 in 85.

In 2018, there were 968 deaths caused by ovarian cancer in Australia.  

The five year survival rate for ovarian cancer is 45.7%.

Learn more about how Cancer Council funded researchers are outsmarting ovarian cancer.



Ovarian cancer symptoms

There are often no obvious signs of ovarian cancer, however you may have one or more of the following symptoms:

  • abdominal bloating

  • difficulty eating or feeling full quickly

  • frequent or urgent urination

  • back, abdominal or pelvic pain

  • constipation or diarrhoea

  • menstrual irregularities

  • tiredness

  • indigestion

  • pain during intercourse

  • unexplained weight loss or weight gain.

These symptoms can be caused by other conditions but if you are experiencing any of these symptoms, contact your local doctor.



Causes of ovarian cancer

Some factors that can increase your risk of ovarian cancer include:

  • age (risk increases for women over 50)

  • family history of ovarian, breast or bowel cancer

  • changes in the genes BRCA1 or BRCA2

  • being of Ashkenazi Jewish descent

  • early onset of periods (before 12 years) and late menopause

  • women who have not had children or had their first child after the age of 35

  • using oestrogen only hormone replacement therapy or fertility treatment..

Some factors that may reduce the risk of developing ovarian cancer include using the oral contraceptive pill for several years, having your fallopian tubes tied (or removed), having children before the age of 35 and breastfeeding.



Diagnosis of ovarian cancer

If you are experiencing possible symptoms of ovarian cancer your doctor may suggest several tests or scans to look for cysts, tumours or other changes. These may include:

Physical examination

In which the doctor will check your abdomen for any lumps and do an internal vaginal examination.

Blood tests

To check for a common tumour marker for ovarian cancer, CA125.

Pelvic ultrasound

A pelvic ultrasound uses echoes from soundwaves to crate a picture of your ovaries and uterus.

CT scan

A CT (computerised tomography) scan uses x-rays to take images of the inside of your body to check for cancer and to see if it has spread.

PET scan

A PET (positron emission tomography) scan highlights abnormal tissues in the body.

Colonoscopy

A colonoscopy, which is a bowel examination to ensure that symptoms are not caused by a bowel problem.

These tests can show if there are any abnormalities but a biopsy (taking a tissue sample) is the only way to confirm a cancer diagnosis.



Treatment for ovarian cancer

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, has spread to other pelvic structures or has spread into the lining of the abdomen with or without fluid (ascites). CT scans and blood test to measure CA125 are used.

Types of 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 cancer has spread, an attempt is made to remove as much as possible.

Chemotherapy uses anti-cancer drugs to destroy cancer cells. Most women will have chemotherapy after surgery (adjuvant chemotherapy) to destroy any remaining cancer cells.

Some women will have chemotherapy before surgery (neoadjuvant chemotherapy) with the aim to shrink tumours and make them easier to remove.

If you are not well enough for an operation, chemotherapy may be recommended as the main treatment.

Chemotherapy is usually given as a combination of two drugs or sometimes as a single drug, delivered as a liquid into a vein.

Radiation therapy can be used to treat the pelvis or other sites of cancer that have spread. It may be used on its own or after chemotherapy. 

Palliative care

In some cases of ovarian cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

 As well as slowing the spread of ovarian cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • Gynaecological oncologist- diagnoses and treats cancers of the female reproductive system
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Radiologist- interprets diagnostic scans (including CT, MRI and PET scans).
  • Gynaecological pathologist- examines tissue removed from the abdomen or ovaries.
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.


Screening for ovarian cancer

There is currently no national screening program for ovarian cancer available in Australia. 



Preventing ovarian cancer

There is no proven method of prevention. Oophorectomy (removal of ovaries) in women with a strong family history does not always prevent cancer.



Prognosis for ovarian cancer

Prognosis refers to the expected outcome of a disease. An individual's prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Survival will vary between individuals and may depend on their response to treatment.



Sources

Understanding Ovarian Cancer, Cancer Council Australia © 2020. Last medical review of source booklet: April 2020. 

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.