What you need to know about ovarian cancer
In this article Hormone Health Associate Professor Mary Ann Lumsden explains ovarian cancer, its symptoms, treatment, and the importance of knowing when to seek advice from your doctor.
Where are the ovaries?
The ovaries are located on either side of the uterus in the pelvis. They are where the eggs develop and from which ovulation into the fallopian tubes occurs.
What is ovarian cancer?
Ovarian cancer principally occurs after the menopause. There are several different types, which affect how the cancer behaves and the treatment offered.
Younger women can get Borderline Ovarian Tumours (BOTs) which form a separate entity a majority of which behave in a benign fashion and do not cause the patient too much harm.
Presentation of ovarian cancer
Signs and symptoms of ovarian cancer may include:
- Fatigue
- Changes in bowel habits, such as constipation
- Abdominal bloating or swelling
- Quickly feeling full when eating
- Weight loss
- Discomfort in the pelvic area
- Back pain
- A frequent need to urinate
When to see a doctor
It can be seen from the above list that all these symptoms may occur with other benign (non-cancerous) problems such as irritable bowel disease and other digestive problems or bladder irritability including infection. Also, the changes e.g. in weight, may be very slow. Ovarian cancer often progresses significantly before the diagnosis is made. Roughly, 20 per cent of ovarian cancers are detected before it spreads beyond the ovaries.
Advice for all women
Make an appointment with your doctor if you have any signs or symptoms that worry you, particularly if you have noticed a change in what you normally experience. You know your body better than anyone else does.
Screening for ovarian cancer
Unfortunately, there is no good way of screening for ovarian cancer at this point, as there are for breast or cervical cancer. Ultrasound scans and special blood tests will help identify some, but most ovarian cancers are identified when they are advanced.
Did you know….
40% of women wrongly believe that cervical screening detects ovarian cancer.
Source: Target Ovarian Cancer
The most prominent risk factor for this disease is a family history that includes breast or ovarian cancer.
Treatment
If the disease is identified early enough, surgical treatment will be the first option and as much of the disease as possible will be removed. Complete removal of all visible tumour is the aim of surgery for ovarian cancers where it is possible. The outlook for disease caused early when all tumour is removed before it has spread is good.
In some tumours (e.g. Borderline Ovarian tumours), a fertility sparing approach may be used in young patients which will allow a woman to have her own children. However, further surgery (removal of all the reproductive organs including the womb and ovaries) is likely to be discussed with the patient once they have completed their families.
Ovarian cancer in younger women
Particular types of tumours occur in young women and about one third will be malignant (cancer). The prognosis is very good although treatment (surgery and chemotherapy) can lead to the failure of the ovaries.
Removal of the ovaries leads to what is known as premature or early ovarian insufficiency in women. It is called early when the woman is under the age of 45 years and premature (POI) when under 40 years, which can be associated with increased risks of disease and death unrelated to the cancer.
The chemotherapy that usually follows surgery can also lead to POI. Administration of chemotherapy (drugs) to destroy the cancer will often take place after the surgery. The aim is to destroy the disease that cannot easily be seen at the time of operation. There are various different types depending on the exact nature of the cancer. Chemotherapy is often associated with side effects, and these will be explained to the patient and her family by the doctor before starting the drugs. Unfortunately, resistance to the drugs often occurs and so the ovarian cancer will return.
Many people affected by advanced ovarian cancer respond to chemotherapy, but the effects are not typically long-lasting. In more than 80% of women with advanced ovarian cancer the disease returns, and more than 50% of these patients die from the disease in less than five years post-diagnosis.
Many women with ovarian cancer are diagnosed in the late stages of the disease, therefore a discussion about treatment options for symptoms of menopause will need to address the risks and the benefits, which will include quality of life and should be individualised.
New treatments
Immunotherapy is a type of treatment that takes advantage of a person’s own immune system to help kill cancer cells. There are currently three immunotherapy options for ovarian cancer and thus there is always hope that things are improving.
The impact of HRT on ovarian cancer.
Some types of cancer contain oestrogen receptors and thus oestrogen-containing HRT poses a theoretical risk of increasing the chance of developing ovarian cancer. However, as the chance of getting ovarian cancer around the time of menopause is low it is difficult to be sure.
If you want HRT after ovarian cancer, then you need to see a specialist with a particular interest in this area.
Meet Professor Mary Ann Lumsden
Professor Mary Ann Lumsden has a particular interest in mid-life women’s health including chronic disease prevention (e.g. cardiovascular disease and osteoporosis) as well as women with medical problems who need advice on management of menopausal symptoms. She has advised on the care of women after cancer, both young and older.