Ovarian Cancer

The ovaries are part of a woman’s reproductive system, and are located in the pelvis. Each ovary is the size of an almond. The ovaries make the female hormones – estrogen and progesterone. They also release eggs. An egg travels from an ovary through a fallopian tube to the womb (uterus). When a woman goes through her menopause, her ovaries stop releasing eggs, resulting in far lower levels of hormones being produced. The ovaries contain primitive cells, which are cells that go on to become eggs, and epithelial cells. Primitive cells that become cancerous are called germ cell tumours. Epithelial cell cancers of the ovary are more common than germ cell cancers.

Ovarian Cancer is the 5th most common cancer in Singaporean women. Its incidence is increasing in Singapore. Ovarian Cancer is known as the deadliest gynaecological cancer because it is usually detected in its later stages of development and spread. The main reason for this is that the ovaries are located deep in the body cavity and hidden away in this manner, pre-cancerous and early cancerous changes are not only difficult to medically detect but also are not obvious or apparent to the women with these early changes.

The CA125 blood test and other related tumor marker blood tests are NOT effective screening tests for Ovarian Cancer. Regular ultrasounds of the ovaries in normal healthy women with no obvious family history of ovarian, breast or colon cancers are also NOT effective in screening for Ovarian Cancer. These tests are often offered as part of routine health screening packages and may help to pick up other non-cancerous conditions, but are NOT effective in detecting Ovarian Cancer in the general population. If you are in good general health and your mother, her sisters or your sisters have never had ovarian, breast or colon cancer, inform your healthcare provider that you would like to decline the CA125 blood test.

The most effective early detection tool against Ovarian Cancer is yourself, armed with the knowledge of early symptoms, being aware of your own body and having regular pelvic examinations by your gynaecologist.

Unfortunately, early Ovarian Cancer often does not cause obvious symptoms. This is why it is often known as a "silent killer". But, as the cancer grows, symptoms may include:

• Pressure or pain in the abdomen, pelvis, back, or legs
• A swollen or bloated abdomen caused by a build-up of fluid or a tumour
• Nausea, indigestion, gas, constipation, or diarrhoea
• Trouble eating or feeling full quickly
• Feeling very tired all the time
• Less common symptoms include:
  • Shortness of breath
  • Feeling the need to urinate often
  • Unusual vaginal bleeding (heavy periods, or bleeding after menopause)

Most often these symptoms can also be caused by problems other than cancer, only a doctor can tell for sure. Any woman with these symptoms should consult her doctor right away.

If you have a symptom that suggests Ovarian Cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history.

You may have one or more of the following tests:

Your doctor checks general signs of health. Your doctor may press on your abdomen to check for tumours or an abnormal build-up of fluid. A sample of fluid can be taken to look for Ovarian Cancer cells.

Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size.

Your doctor may order blood tests. The lab may check the level of several substances, including CA-125. CA-125 is a substance found on the surface of Ovarian Cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose Ovarian Cancer. This test is approved by the Food and Drug Administration for monitoring a woman's response to Ovarian Cancer treatment and for detecting its return after treatment.

The ultrasound device uses sound waves that people cannot hear. The device aims sound waves at organs inside the pelvis. The waves bounce off the organs. A computer creates a picture from the echoes. The picture may show an ovarian tumour. For a better view of the ovaries, the device may be inserted into the vagina (transvaginal ultrasound).

A biopsy is the removal of tissue or fluid to look for cancer cells. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose Ovarian Cancer.

The doctor inserts a thin, lighted tube (a laparoscope) through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early Ovarian Cancer. It may also be used to learn whether cancer has spread.

The following are risk factors of Ovarian Cancer:

• Family history of Ovarian Cancer
• Personal history of cancer (Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer)
• Late pregnancy or women who have never been pregnant
• Early onset of menstruation / Late menopause
• Menopausal hormone therapy (Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for ten or more years may have an increased risk)

For Ovarian Cancer, most women have surgery and chemotherapy.

The surgeon makes a long cut in the wall of the abdomen. This type of surgery is called a laparotomy. If Ovarian Cancer is found, the surgeon removes:

• both ovaries and fallopian tubes (salpingo-oophorectomy)
• the uterus (hysterectomy)
• the omentum (the thin, fatty pad of tissue that covers the intestines)
• nearby lymph nodes
• samples of tissue from the pelvis and abdomen

If the cancer has spread, the surgeon removes as much cancer as possible. This is called "debulking" surgery.

If you have early Stage I Ovarian Cancer, the extent of surgery may depend on whether you want to get pregnant and have children. Some women with very early Ovarian Cancer may decide with their doctor to have only one ovary, one fallopian tube, and the omentum removed.

Chemotherapy uses anticancer drugs to kill cancer cells. Most women have chemotherapy for Ovarian Cancer after surgery. Some women have chemotherapy before surgery. Chemotherapy is given in cycles. Each treatment period is followed by a rest period. The length of the rest period and the number of cycles depend on the anticancer drugs used. You may have your treatment in a clinic, at the doctor's office. Some women may need to stay in the hospital during treatment.