Ovarian Cancer

Ovarian cancer is a disease where malignant (cancerous) cells are found inside, near or on the outer layer of the ovaries, which is an almond shaped organ located on either side of the uterus.

There are over 30 types of ovarian cancer and are classified by the type of cell from which they originate.

Surface Epithelium tumours

These tumours develop from the cells that cover the outer surface of the ovaries and are mostly benign (non-cancerous). Cancerous epithelial cells originate from the tissues that line the ovaries and are the most common and perilous accounting for 85-90% of ovarian cancers. Almost 70% of women diagnosed with this form of ovarian cancer are done so in the advanced stages of this cancer.

Germ cell tumours

These tumours occur mostly in teenagers and women in their twenties and develop from ova (egg) producing cells and are mostly benign (non-cancerous). The most common cancerous germ tumours are maturing teratomas (tumours made up of tissues such as hair, muscle and bone), dysgerminomas, and endodermal sinus tumours also known as yolk sac tumours. 90% of these tumours can be cured while preserving a woman’s fertility.

Stromal cells are cells that release hormones and connect various parts of the ovaries

There are a rare class of tumours that develop from the hormone (oestrogen and progesterone) producing cells and connective tissue cells in the ovaries and are considered low grade. Granulosa cell tumours are stromal cell tumours and include those composed of granulosa cells, theca cells, and fibroblasts. These account for almost 2% of ovarian cancers.

Primary Peritoneal Carcinoma

These tumours closely related to epithelial ovarian cancer are less common and develops from the peritoneum (abdominal lining).

Statistics

1 in 78 women are diagnosed with ovarian cancer in their lifetime

Ovarian cancer is the 5thleading cause of cancer related deaths in women between the ages of 35 and 74.

Early detection and treatment brings the 5 year survival rate to over 90%

About 250 000 women are diagnosed with Ovarian cancer and about 140 000 women die of it making it the cancer with the lowest survival rates for women.

Signs and Symptoms

Early stage ovarian cancer follows a definite pattern and are different from the normal menstrual or digestive complications and may include:

  • Abdominal pain
  • Feeling bloated much of the time
  • Needing to urinate urgently or urinating more often than normal
  • Finding it difficult to eat or feeling full too soon.

Other symptoms include:

  • Back pain
  • Indigestion
  • Heartburn
  • Constipation
  • Fatigue
  • Changes in your menstrual cycle
  • Painful intercourse

If symptoms are new and persist for more than two weeks, it is recommended that a woman see her doctor, and a gynaecologic oncologist before surgery if cancer is suspected.

Diagnosis

Your general health history is documented as well as unusual symptoms, followed by an external examination of the abdomen.

The following internal examinations of the abdomen can be done:

  • Blood tests reveal if CA125 is present which can be an indicator of ovarian cancer but also an indication of fibroids, endometriosis, pregnancy and pelvic inflammatory disease.
  • Abdominal ultrasound scan will reveal if the ovaries are the correct size, if the texture is normal and if there are any cysts in the ovaries.
  • A CT Scan shows the ovaries clearly and a fasting test will be done to identify cysts.

Persistence of these symptoms are key to detecting the cancer early. When relief of these symptoms is not found through normal interventions such as diet, exercise or non-chronic medication then it is wise to have yourself checked out.

Once diagnosed the stage of the tumour can be determined during surgery where the doctor will be able to establish if the tumour has spread outside of the ovaries

There are 4 stages of ovarian cancer and can be identified as the following:

Stage 1

The cancer is restricted to the ovary or the fallopian tube. It can be further categorised as a cancer restricted to 1 ovary; a cancer found in both ovaries and a cancer found in 1 or both ovaries with cancer cells spilling out from the ovaries.

15% of ovarian cancer are diagnosed in stage 1 and the relative 5 year survival rate is between 85-95%

Stage 2

The cancer growth involves 1 or both ovaries and extends into the pelvic area. This can be further categorised as cancer cells found in 1 or both ovaries with cancer cells also being found in the fallopian tubes extending into the uterus; or a cancer found in 1 or both ovaries with cancer cells also extending to other pelvic organs.

19% of ovarian cancer are diagnosed in stage 2 and the relative 5 year survival rate is between 55-80% averaging at about 70%

Stage 3

The cancer growth involves 1 or both ovaries and extends beyond the pelvic area. This can be further categorised as cancer cells additionally found in the upper abdomen and lymph nodes; Visible tumours found in the upper abdomen that is less than 2cm in size and visible tumours found in the upper abdomen that are greater than 2cm in size. At this stage you may also find diseased cells on the surface of the liver and spleen.

60% of ovarian cancer are diagnosed in stage 3 and the relative 5 year survival rate is between 39-60% averaging at about 49%

Stage 4

At this stage the cancer has widely spread throughout the body. The cancer may be found in the fluids surrounding the lungs or even found inside the lungs, liver and spleen.

Most women diagnosed with stage 4 ovarian cancer have a 5 year survival rate of 17% which is also dependant on other factors such as age, general health and physical wellbeing.

Risk Factors

20-25% of ovarian cancers diagnosed are hereditary and are due to gene mutations.

Breast cancer patients have a higher risk of developing ovarian cancer.

The older you get, the larger your chance of being diagnosed with ovarian cancer.

The following also increases your risk of being diagnosed with ovarian cancer:

  • Early start to menstrual cycles (before the age of 12)
  • Infertility
  • Not given birth to children
  • First child born after the age of 30
  • Menopause experienced after the age of 50
  • The use of menopausal hormone therapy

Obesity also increases your risk of being diagnosed with ovarian cancer.

Treatment

Grading of cancer compares cancerous cells with healthy tissue. The more similar the cancerous groups of cells look to normally healthy tissue, the lower the grade of the tumour, whereas if the cancerous cells look very different from normal tissue it is known as a high-grade tumour. The grading of tumours assists the doctors in predicting how quick the cancer will spread and thus helps determine the treatment plan.

Various treatments are available, and the options used are dependant on the stage of cancer that is present:

  • A total hysterectomy also known as a salpingo-oophorectomy
  • Unilateral salpingo-oophorectomy (removal of the diseased ovary only to preserve fertility)
  • Combination chemotherapy
  • Intraperitoneal Chemotherapy
  • Neoadjuvant Chemotherapy
  • Radiation therapy
  • Clinical trials are available