Ovarian Cancer

I’ve been told that I have ovarian cancer. What is it exactly?  

Ovarian cancer is the second most common group of gynaecological cancers. 

Cancer of the ovary is when the normal cells in the ovary change and grow to form a malignant tumour or cancer. As the ovaries are deep in the pelvis, the tumour, as it gets bigger, may affect nearby organs such as the bladder or the bowel. 

Some factors that may cause an increase in the risk of developing ovarian cancer include: 

  • Never been pregnant or had children 
  • Previous diagnosis of breast cancer 
  • Age: more common as age progresses and after the menopause 
  • Family history of breast, ovarian or bowel cancer 
  • Hormone replacement therapy (HRT)/fertility treatment 
  • Late menopause 

 

The main types of ovarian cancer are: 

 

Epithelial tumours 

Epthelial tumours (carcinomas) account for 90% of ovarian cancers, usually found in women aged over 40. Epithelial ovarian cancer has few early symptoms and one of the risk factors is having a family history of the disease.

 

Non-epithelial tumours

These include stroma cell and germ cell tumours of the ovary. They are more common in girls and young women. 

What are the symptoms of ovarian cancer? 

Early-stage ovarian cancer rarely causes any symptoms and can therefore go undetected until it is in the advanced stages when it has become less treatable and widespread. 

 

Signs and symptoms of ovarian cancer may include: 

  • Bloated feeling 
  • Persistent swollen abdomen 
  • Pain or dragging feeling in your lower abdomen or side 
  • Mild indigestion or nausea 
  • Poor appetite and feeling full quickly 
  • Changes in your bowel or bladder habits, for example, needing to pass water urgently or constipation 
  • Abnormal vaginal discharge or bleeding (rare) 
  • Pain in the pelvic or abdominal area (the area below your stomach and in between your hip bones) 
  • Discharge from your vagina that is not normal for you 
  • Bleeding from your vagina that is not normal for you, particularly if you are past menopause 

How is ovarian cancer diagnosed?  

How gynaecological cancer is diagnosed depends on what type of cancer is suspected. Pelvic exams, imaging tests, biopsies, colposcopy exam and possible diagnostic surgery are all methods of diagnosing gynaecological cancer. 

Once cancer is confirmed, the stage of the cancer is determined and a treatment plan is developed. Staging refers to how far the cancer has spread to nearby tissue or organs. Among all of the various types of gynaecological cancer, early detection is crucial. However, detection can be very difficult, especially in the early stages. 

 

Tests such as the following may be carried out: 

  • Transvaginal ultrasound: an ultrasound used to build up a picture of the tissues in your womb. During a transvaginal ultrasound a small metal ‘probe’, covered with a gel, is inserted into the vagina. This then creates the scan. This test is not painful but may be a little uncomfortable. 
  • Hysteroscopy: a hysteroscope is a thin, flexible tube with a light at the end which is passed through the vagina and into the womb. This allows the doctor to look inside the womb and take tissue samples or a biopsy. 
  • Biopsy: a small amounts of tissue samples are taken from the womb during a hysteroscopy. Biopsies are sent to a laboratory and looked at under a microscope to detect if cancer cells are present. 
  • D&C - dilatation and curettage: during a D&C the cervix and entrance to the womb are gently opened. Samples of tissue from the inner lining of the womb are taken with an instrument shaped like a spoon called a curette. The samples are then sent to the laboratory to be examined. 

What is the treatment for ovarian cancer? 

 

Treatment options include: 

The main treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. 

The aim of surgery is to remove the tumour. The method of surgery used will depend on the type and size of the cancer and whether it has spread. 

 

Laparotomy 

This operation opens up the abdomen so that the organs inside can be examined and tissue samples taken. If the cancer is only in one ovary, it may be possible to remove the affected ovary and leave the other ovary and womb in place. 

 

Radical hysterectomy and bilateral salpingo-oophorectomy 

In this operation, the cervix, womb, two ovaries and fallopian tubes are removed. A layer of fatty tissue that surrounds the organs in the abdomen (called the omentum) may also be removed.