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Ovarian Cancer

1 person dies of ovarian cancer every 48 hours in New Zealand – that’s higher than our melanoma rates! Out of the 5 gynaecological cancers, ovarian cancer has the highest rate of deaths.

85% of people diagnosed with ovarian cancer are diagnosed in the later stages of disease when treatment options are limited.

A pap/cervical smear DOES NOT detect ovarian cancer – pap/cervical smears are used only to detect cervical cancer.

Early detection is only possible if YOU know the signs and symptoms. Please educate yourself and please share them- save yourself or a beloved one the heartbreak of a late stage diagnosis!

Early detection is VITAL to survival.

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The Ovaries

The ovaries are part of the female reproductive system. They are about the size of almonds, one on each side of the uterus and close to the ends of the fallopian tubes. The ovaries make the female hormones oestrogen and progesterone. They also produce eggs which travel through the fallopian tubes to the uterus. During menopause the ovaries stop releasing (producing) eggs and hormone production is greatly reduced.

Ovarian Cancer – Types

There are four main types of ovarian cancer:

1. Epithelial Ovarian Cancer

This starts in the epithelium (the cells that cover the ovary). Nine out of ten ovarian cancers are epithelial.

2. Germ Cell and Sex-Cord Stromal Cell

Germ cell and sex cord-stromal tumors are rare gynecologic malignancies, comprising less than 15% of ovarian cancers combined. In general, these types of tumors affect young women and present in early stage disease.

3. Sex-Cord Stromal Cell Cancers

These start in the cells that make female hormones and can
happen at any age. Germ cell and sex-cord cancers respond
well to treatment. If only one ovary has cancer, it may still
be possible for younger women to have children after treatment.

4. Borderline Tumours

A group of epithelial tumours which have a lower risk of
spreading than other types of tumours.

Signs and symptoms may include:
  • increased abdominal size / persistent bloating – not bloating that comes and goes
  • fatigue
  • pain during sex
  • frequent need to urinate or an urgency to go
  • change in bowel habits (loose stools/constipation is a VERY common symptom)
  • abdominal or pelvic pain
  • back pain/aches
  • menstrual irregularities
  • indigestion
  • unexplained weight loss or weight gain
See your GP or a gynaecologist if you notice any changes or experience any persistent symptoms that worry you. Any changes should ALWAYS be investigated.

Ovarian Cancer – Risk Factors

Risk factors for ovarian cancer can include but are not exclusive to:

Family history
Ovarian cancer can occur within families. Your chances of getting ovarian cancer are increased if other family members have previously been diagnosed with the disease. Please note that Increased risk for ovarian cancer can come from your mother or father’s side. Personal or family histories of other cancers including those of the breast, uterus, colon or rectum, also increase the likelihood of ovarian cancer.

Having a family cancer syndrome.
Hereditary breast and ovarian cancer syndrome is caused by inherited mutations in the genes BRCA1 and BRCA2, as well as possibly some other genes that have not yet been found.
This syndrome is linked to a high risk of breast cancer as well as ovarian, fallopian tube, and primary peritoneal cancers (peritoneal cancer is a rare cancer, It develops in a thin layer of tissue that lines the abdomen. It also covers the uterus, bladder, and rectum.
The lifetime ovarian cancer risk for women with a BRCA1 mutation is estimated to be between 35% and 70%. This means that if 100 women had a BRCA1 mutation, between 35 and 70 of them would get ovarian cancer.
For women with BRCA2 mutations the risk has been estimated to be ebetween 10% and 30% by age 70.
In comparison, the ovarian cancer lifetime risk for the women in the general population is less than 2%.

Age
The risk of developing ovarian cancer gets higher with age. Please note that ovarian cancer can affect people of ALL ages, it does not discriminate, it is the risk that increases with age only.

Having children later in life or never having a full-term pregnancy
People who have their first full-term pregnancy after the age of 35 or who have never carried a pregnancy to full term have a higher risk of ovarian cancer.

Being overweight
Obesity has been linked to a higher risk of developing many cancers.

Taking hormone therapy after menopause
Some research suggests that using estrogens after menopause can increase the risk of developing ovarian cancer. The risk seems to be higher in those taking estrogen alone (without progesterone) for many years. The increased risk is less certain for women taking both
estrogen and progesterone.

You have previously been diagnosed with breast cancer
If you have had breast cancer, you might also have an increased risk of developing ovarian cancer. Why? Some of the reproductive risk factors for ovarian cancer can also increase breast cancer risk. The risk of ovarian cancer after breast cancer is highest in those people with a family history of breast cancer. A strong family history of breast cancer can be caused by an inherited mutation in the BRCA1 or BRCA2 genes.

Ovarian Cancer – Diagnosis

There has been a lot of research to develop a screening test for ovarian cancer, but there hasn’t been much success so far. The 3 tests used most often to check for ovarian cancer are a transvaginal ultrasound, CA-125 blood test and a pelvic examination.

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Pelvic Exam
A doctor or nurse examines your vulva and your internal reproductive organs — your vagina, cervix, ovaries, fallopian tubes, and uterus. This exam requires the doctor to place one or two fingers into a woman’s vagina and another over her abdomen to feel the size, shape, and position of the ovaries and uterus. Ovarian cancer is rarely detected in a pelvic exam and usually in an advanced stage if it is.

Transvaginal Ultrasound
A transvaginal ultrasound is a test used to examine a woman’s reproductive organs and bladder, and can often reveal if there are masses or irregularities on the surface of the ovaries and within cysts that form within the ovaries. To administer the test, the doctor inserts a probe into the vagina. The probe sends off sound waves which reflect off body structures. The waves are then received by a computer that turns them into a picture. An ultrasound alone is not an accurate way to screen for ovarian cancer.

The CA-125 Blood Test
Measures the amount of a protein called CA-125 in the blood. CA-125 is a substance in the blood that can increase when a cancerous tumor is present; this protein is produced by ovarian cancer cells and is elevated in more than 80 percent of women with advanced ovarian cancers and in 50 percent of those with early-stage cancers.

It is not a reliable early detection test for ovarian cancer. In about 20 percent of advanced stage ovarian cancer cases and 50 percent of early stage cases, the CA-125 is not elevated even though ovarian cancer is present. As a result, doctors generally use the CA-125 blood test in combination with a transvaginal ultrasound. Because CA-125 misses half of early cancers and can be elevated by non cancerous conditions such as endometriosis and pelvic inflammatory disease.

CT Scan
CT scans take cross-sectional images of the tissues and bones within the body. CT scans help define the boundaries of a cancerous tumor and show the extent of tumor spread, helping a doctor determine where to operate.

None of the above tests are definitive when used on their own. They are most effective when used in combination with each other. The only way to confirm the presence of ovarian cancer suspected by the tests is through a surgical biopsy of the tumor tissue.

Surgery and Biopsy
This is the only definitive way to determine if a patient has ovarian cancer. Doctors will perform surgery after they obtain enough evidence from the above exam and test results and feel that their is sufficient evidence that ovarian cancer is present.

Surgery and Biopsy
A laparotomy or laparoscopy is performed depending on what the CT shows/how large the tumour is or how far the cancer has progressed.

A laparotomy is a surgical procedure involving a long incision in the wall of the abdomen to remove fluid and tissue, such as the ovaries, fallopian tubes, uterus and connecting tissue, depending on how far the cancer has spread.

Laparoscopic surgery is when a thin tube with a camera (a laparoscope) is used and that allows the doctor to see and remove tissue.

Ovarian Cancer – Treatment

Surgery
During surgery, doctors attempt to remove all visible tumors (tumor debulking).

Chemotherapy
Uses drugs to kill or slow the growth of cancer cells. It is usually given if the ovarian cancer is advanced or returns after treatment, and may be combined with surgery or radiotherapy.

Chemotherapy may be given as tablets or by injection into a vein (intravenously). You will usually have a number of treatment sessions, followed by a break.

Ovarian Cancer – Stages

If ovarian cancer is diagnosed, the next step is to identify its stage and grade. All cancers are given a ‘stage’. The stage indicates the extent of the cancers spread throughout the body.
Stage I

Cancer cells affect only the ovary or ovaries and have not spread to another area.

Stage II

The cancer has affected one or both ovaries and also other organs within the pelvis, such as the uterus, fallopian tubes, bladder, or rectum.

Stage III

The cancer affects one or both ovaries and either the lining of the abdomen or lymph nodes in the back of the abdomen.

Stage IV

The cancer has spread to other parts of the body, outside the peritoneal cavity. This cavity includes the abdomen and the pelvis. Areas that may now be affected include the liver, spleen, and the fluid around the lungs.

Ovarian Cancer – Grading

Grading is about how the cancer cells look under the microscope compared with normal cells, it can help predict how the cancer will behave, including how fast it is likely to grow and spread, which may impact on the treatments recommended for you.
Grade 1 (aka low-grade or well-differentiated)

The cancer cells look similar to normal cells and usually grow slowly and are less likely to spread.

Grade 2 (aka moderate- or intermediate-grade)

The cancer cells look more abnormal and are slightly faster-growing.

Grade 3 (aka high-grade or poorly-differentiated)

The cancer cells look very different from normal cells and may grow more quickly.

I believe I have these symptoms – what next?

Please make an appointment to see your GP

Write a list of the symptoms that are present and any other concerns to take with you to your GP or gynaecologist

You should tell them about any changes to your body that you have noticed. You should tell them if you or anybody in your family has had cancer or been tested for genetic faults.

Symptoms can often be attributed to other conditions such as irritable bowel, indigestion, and stress – common complaints that GPs are attending to. It’s extremely important to note that if you feel your symptoms are not the ordinary for you, are persistent and have gotten worse that you advocate for your health.

1. Take a list of the symptoms that are present- give your GP as much information as you can.

2. Consider your whānau/family history and discuss this with your doctor. Call whānau/family and try to get a gauge on what cancers if any have been present. Please note that a gynaecological cancer can be present even if there has been no whānau/family history of one.

3. Ask your GP for a second opinion or referral to a specialist

4. You are by rights allowed to take someone along with you to your GP and specialist visits for moral support, it’s great to have someone there especially when being given a lot of new information.

5. NEVER feel silly or like you are overreacting by seeking the advice of a medical professional YOU know your body better than anyone else.