Ovarian cancer

What is ovarian cancer?

Ovarian cancer can be difficult to diagnose and in the early stages women may not show any symptoms.

The symptoms most often reported include abdominal pain, bloating and swelling.

The disease can affect one or both ovaries, and risk factors include age, genetic factors and child-bearing history.

The ovaries are part of the female reproductive system. The two small almond-shaped organs sit on either side of the uterus (or womb). Each ovary contains germ cells that eventually develop into eggs. The ovaries also produce the hormones oestrogen and progesterone.

In cases of ovarian cancer, cells in one or both ovaries start to grow abnormally. There are four main types of ovarian cancer:

• Epithelial – begins in the epithelium (the outer cells covering the ovary), and accounts for about 90% of cases
• Germ cell – begins in the cells that mature into eggs, and usually affects women under 30 years old
• Sex-cord stromal cell – begins in the ovary cells that release female hormones and can affect women of any age
• Borderline tumours – less aggressive epithelial tumours, also called 'low malignant potential' or LMP tumours. Generally a good chance of recovery whether diagnosed early or late.

Both germ cell and sex-cord stromal cell ovarian cancers respond well to treatment and if either of these cancers affect only one ovary, it may be possible for younger women to have children after treatment.

Causes of ovarian cancer

While the causes of ovarian cancer are unknown, risk factors include:

• Age – ovarian cancer is most common in women over 50 and who have stopped menstruating, and the risk increases with age
• 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 may be increased
• Child-bearing history – women who have not had children, have never used oral contraceptives or have had children over the age of 30 may be slightly more at risk
• Endometriosis – this condition occurs when the tissue lining the uterus is also found outside of the uterus
• Lifestyle factors – such as smoking, being overweight or eating a high-fat diet
• Hormonal factors – including early puberty (menstruating before 12) or late-onset menopause (after 50

Symptoms of ovarian cancer

Ovarian cancer can be difficult to diagnose at early stages, because symptoms are vague and similar to those of other common illnesses. However, 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

Other symptoms may include:

• Changes in bowel habits
• Unexplained weight gain or weight loss
• Bleeding between periods or after menopause
• Back pain
• Indigestion or nausea
• Excessive fatigue
• Pain during intercourse

Treatment of ovarian cancer

Ovarian cancer is difficult to diagnose – surgery is the only way to get a definitive diagnosis. Doctors use both a blood test and a trans vaginal ultrasound (and possibly other tests) to help make a diagnosis. The blood test, to detect the protein CA 125, is not a definitive test – while CA 125 can be produced by cancer cells, there are other causes such as menstruation, endometriosis or ovarian cysts.

When a definitive diagnosis is reached during surgery, the affected ovary or ovaries are removed at the same time. Parts of the reproductive system such as the fallopian tube and the uterus may also be removed. Sometimes, it is necessary to take out the appendix and part of the bowel.

Chemotherapy is almost always given after surgery, to slow or stop the growth of any cancer cells that may have been left behind. Radiotherapy (using x-rays to kill cancer cells) is also sometimes used.

Many women with ovarian cancer are interested in trying natural or complementary therapies to help manage symptoms, reduce pain, relieve stress and encourage a sense of wellbeing. It’s important to talk to your doctor about any types of therapy that you are thinking about using. The Cancer Council of Victoria factsheet Complementary and alternative medicine: making informed decisions may be a useful resource.

Further information and sources

• Health Direct Australia
• Ovarian Cancer of Victoria
• Better Health Channel