Ovarian cancer

Ovarian cancer

Ovarian cancer is the eighth most common cancer and the sixth most common cause of cancer death affecting women in Australia

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

Incidence and mortality

In 2011, 1330 new cases of ovarian cancer were diagnosed in Australian women. The risk of being diagnosed before age 85 is 1 in 81

In 2012, there were 933 deaths caused by ovarian cancer in Australia.

Screening

There are no proven screening tests, although ultrasound through the vagina and a blood test, CA125, are being investigated.

Symptoms and diagnosis

 There may be no symptoms or symptoms may be non-specific 
and include

abdominal bloating

difficulty eating or feeling full quickly

frequent or urgent urination

back, abdominal or pelvic pain

constipation

menstrual irregularities

fatigue

indigestion

pain during sexual intercourse 

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.

Causes

The cause of ovarian cancer is not known, however risk factors include:

ageing (risk increases for women over 50)

family history

changes in the genes BRCA1 or BRCA2.

being of Northern European or Northern or Ashkenazi Jewish descent

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

childlessness

infertility

first child after 30

never taking oral contraceptives

using oestrogen only hormone replacement therapy or fertility treatment.

Prevention

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

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, commonly with regimens containing cisplatin or carboplatin and paclitaxel or docetaxel, is used after surgery to try to eliminate all disease identified by scan and CA125 blood test. Chemotherapy can be injected into the bloodstream through the vein or instilled into the abdominal cavity or both.

With widespread disease, chemotherapy may be used first. Surgery after chemotherapy can assess response. Germ cell tumours can be cured with chemotherapy with PEB (cisplatin, etoposide, bleomycin).

Prognosis

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. If the cancer is treated when it is still confined to the ovaries, 93% patients will be alive in five years. If the cancer has spread to surrounding tissue or organs in the pelvis, this drops to 39%, and if it has spread more distantly, 30%. Survival will vary between individuals and may depend on their response to treatment.

In Australia, the overall five year survival rate for women diagnosed with ovarian cancer is approximately 43%.

For more information, contact Cancer Council 13 11 20 (cost of a local call).