What is ovarian cancer?

Ovarian cancer starts when cells in one or both ovaries, the fallopian tubes or the peritoneum become abnormal, grow out of control and form a lump called a tumour. There are many types of ovarian cancer.

The three most common types are

• Epithelial ovarian cancers – the majority of women with ovarian cancer have cancer that starts in the surface of the ovary (epithelium), mostly occurs over the age of 60.
• Germ cell ovarian cancer – about 4% of women have these rare types of cancer, which start in the egg-producing cells. It mostly occurs under the age of 40.
• Sex-cord stromal cancers – rare cancer that starts in the cells in the ovaries that produce the female hormones oestrogen and progesterone. These cancers most commonly occur between the ages of 40 and 60.

How common is ovarian cancer?

Each year, about 285 Queensland women are diagnosed with ovarian cancer. It is more commonly diagnosed over the age of 50 but can occur at any age.

Risk factors

The causes of most cases of ovarian cancers are unknown, but factors that can increase the risk include:

• age – ovarian cancer is most common in women over 50 and in women who have stopped menstruating (have been through menopause), and the risk increases with age.
• genetic factors – up to 20% of serous ovarian cancers (the most common sub-type) are linked to an inherited faulty gene, and a smaller proportion of the other types of ovarian cancer are also related to genetic faults.
• family history – having one or more close blood relatives diagnosed with ovarian, breast, bowel or uterine cancers, or having Ashkenazi Jewish ancestry.
• endometriosis – this condition is caused by tissue from the lining of the uterus growing outside the uterus
• reproductive history – women who have not had children, who have had assisted reproduction, or who had children after the age of 35 may be slightly more at risk.
• lifestyle factors – some types of ovarian cancer have been linked to smoking or being overweight
• hormonal factors – including early puberty or late menopause. Some studies suggest that menopause hormone therapy (MHT), previously called hormone replacement therapy (HRT) may increase the risk of ovarian cancer, but the evidence is not clear.

Most women who have these risk factors do not develop ovarian cancer.

Symptoms

In its early stages, ovarian cancer usually has no symptoms. This means it is typically diagnosed when the cancer is more advanced and has spread to other organs.

Occasionally, symptoms of ovarian cancer do occur before the disease is diagnosed. These symptoms may include:

• pressure, pain or discomfort in the abdomen or pelvis
• a swollen or bloated abdomen
• changes in appetite, such as not feeling like eating, or feeling full quickly
• changes in toilet habits (e.g. constipation, diarrhoea, passing urine more often, increased wind)
• indigestion and feeling sick (nausea)
• feeling very tired
• unexplained weight loss or weight gain
• changes in pattern of periods, or vaginal bleeding after menopause
• pain during sex

These symptoms do no necessarily mean you have cancer – they might be caused by another health condition. If you have these symptoms and they are new for you, are severe, or continue for more than a few weeks, it is best to arrange an appointment to see your general practitioner (GP). These symptoms can also occur in many other conditions and do not necessarily mean you have cancer, but it is best to have a check-up.

Diagnosis

The tests and scans described below can show if there are abnormalities, but they cannot provide a diagnosis. The only definitive way to confirm a diagnosis of ovarian cancer is by taking a tissue sample (biopsy) and looking at the cells under a microscope. This is usually done during surgery, which means that the diagnosis is confirmed and the cancer is treated at the same time.

• Pelvic examination – The doctor will check for any masses or lumps by feeling your abdomen. A pelvic examination is not painful but it may be uncomfortable. You can ask for a family member, friend of another staff member to be present during the examination if you prefer.
• Digital rectum examination – the doctor may perform this examination to feel the tissue behind the uterus where cancer cells may grow.
• Blood test – to check for chemical proteins produced by cancer cells.

Other tests include:

• CT scan – uses x-ray beams to take pictures of the inside of your body.
• MRI scan – uses magnetism and radio waves to build up very detailed cross-section pictures of the body.
• PET Scan – highlights abnormal tissues in the body.
• Pelvic Ultrasound – uses echoes from soundwaves to create a picture of your uterus and ovaries on a computer.
• Colonoscopy – some women have a bowel examination to make sure that their symptoms are not caused by a bowel problem.

Some tests may be repeated during or after treatment to check how well the treatment is working. Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a healthcare professional, or call Cancer Council 13 11 20.

Treatment

The treatment for ovarian cancer depends on what type of ovarian cancer you have, the stage of cancer, whether you wish to have children, whether you have a faulty gene, your general health and fitness, and your doctors’ recommendations.

• epithelial ovarian cancer stage 1 – usually treated with surgery alone, may be offered chemotherapy after surgery if there is a high risk of the cancer coming back
• epithelial ovarian cancer stages 2, 3 and 4 – usually treated with a combination of surgery and chemotherapy. New targeted therapy drugs are being offered to people with BRCA gene fault. In some cases radiation therapy is offered.
• germ cell – usually treated with surgery and/or chemotherapy
• stromal cell – usually treated with surgery, sometimes followed by chemotherapy or targeted therapy
• borderline tumours – usually treated with surgery only

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of the disease in a particular person. Your doctor will consider many factors in assessing your prognosis. These include test results; the type of ovarian cancer and its stage and grade; genetic factors; your response to treatment; and other factors such as your age, fitness and overall health

Discussing your prognosis and thinking about the future can be challenging and stressful. It may help to talk with family and friends. You can also call Cancer Council 13 11 20 if you need more information or emotional support.

Support for Queenslanders

Whether you have been diagnosed with an ovarian cancer, or have a family member or friend who is affected by cancer, there are times when you may need support. Our professional services and support programs are here to help you.

Find out more about:

• Phone support
• Email support
• Cancer counselling
• Practical and financial support
• Support groups
• Information sessions

You don’t have to face cancer alone – we’re here to help.

Resources

For more information on ovarian cancer please see these resources