Ovarian Cancer
What are ovaries and ovarian cancer?
The ovaries are part of a woman’s reproductive system, which is made up of the:
- vagina
- womb or uterus (which includes the cervix)
- fallopian tubes
- ovaries
There are two ovaries, one on each side of the body. The ovaries produce an egg each month in women of childbearing age.
Ovarian hormones
The ovaries also produce the female sex hormones. These are:
- oestrogen
- progesterone
The ovaries produce these hormones throughout the years when women can become pregnant. The hormones control the menstrual cycle. As you get older and closer to menopause, the ovaries make less and less of these hormones and periods eventually stop. More recently doctors have learned that ovarian hormones also help to protect the heart and bones and maintain brain and immune system health. The ovaries also produce a small amount of the male hormone testosterone. It is not completely clear what role testosterone has in women. But doctors think it helps with muscle and bone strength. And it may have a role in a woman’s sex drive (libido).
In young women, the ovaries are about 3cm long. After menopause they tend to shrink. Doctors can’t usually feel the ovaries during a medical examination, except in young, thin women. Some women have cysts on their ovaries. Cysts are fluid-filled sacs.
They are not usually cancerous. In women of childbearing age, small cysts develop in the ovary every month as an egg develops. This is normal and they usually disappear without treatment within a few months. You should have tests if the cysts:
There are different types of ovarian cancer. The type depends on the type of cell the cancerstarted in. Most cases of ovarian cancer are epithelial ovarian cancers. This means the cancer started in the surface layer covering the ovary.
Why have I developed ovarian cancer?
More than half of ovarian cancer cases are diagnosed in women aged sixty five and over. We don’t know exactly what causes the most common type of ovarian cancer, which is epithelial ovarian cancer. But some factors may increase or reduce the risk.
Possible risk factors for ovarian cancer.
The following factors may increase the risk of ovarian cancer:
Getting older: As with most cancers, the risk of developing ovarian cancer increases as you get older. Most cases of ovarian cancer happen in women who have had their menopause.Â
Inherited faulty genes: Most ovarian cancers are due to gene changes that develop during a woman’s life and are not inherited. But between five and 15 out of 100 ovarian cancers (5 to 15%) are caused by an inherited faulty gene. Faulty inherited genes that increase the risk of ovarian cancer include BRCA1 and BRCA2. These genes also increase the risk of breast cancer. If you are worried about your family history of ovarian cancer, speak to your doctor. They can tell you whether you need a referral to a genetics service. Previous breast cancer: Breast cancer and ovarian cancer can sometimes be due to the same faulty genes. Women who have had breast cancer have up to double the risk of developing ovarian cancer compared to other women in the population, and if their breast cancer was diagnosed before the age of 40, their risk is even higher.
Being infertile or having fertility treatment: Some older studies showed a link between taking fertility drugs and an increased risk of ovarian cancer. But more recent research doesn’t support this. It is more likely that infertility itself increases ovarian cancer risk, rather than fertility treatment being the cause. More research is happening to clarify this.
Having endometriosis: Research has shown that women with endometriosis have an increase in their ovarian cancer risk compared to women who do not.
Smoking: Smoking can increase the risk of certain types of ovarian cancer such as mucinous ovarian cancer. The longer you have smoked, the greater the risk.
What are the symptoms?
- Bloating
- Pelvic or abdominal (belly) pain
- Trouble eating or feeling full quickly
- Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)
What investigations will I be subjected to?
MRI scan, CT or PET scan. May need biopsy sometimes.
What are the types of ovarian cancers?
Epithelial ovarian cancer is the most common type of ovarian cancer. Rare types include germ cell tumours, stromal tumours and sarcomas. Primary peritoneal cancer is similar to epithelial ovarian cancer and is treated in the same way.
Epithelial ovarian cancer: Epithelial ovarian cancer is the most common type of ovarian cancer. About 90 out of 100 tumours of the ovary (90%) are epithelial.
Teratoma of the ovary: Ovarian teratoma is a type of germ cell tumour. Cancerous teratomas are rare, and usually affect girls and young women up to their early 20s.Teratoma of the ovary
Granulosa tumour of the ovary: Granulosa tumours are a type of sex cord stromal tumours. Less than 5 out of 100 women with ovarian cancer (5%) have this type.
Primary peritoneal cancer: Primary peritoneal cancer (PPC) is a rare cancer of the peritoneum. It is very similar to the most common type of ovarian cancer called epithelial cancer.
Fallopian tube cancer: Cancers of the fallopian tubes is rare. Only around one in 100 (1%) of the female reproductive system are of this type.
Borderline ovarian tumours: Borderline ovarian tumours are abnormal cells that form in the tissue covering the ovary. They are not cancer and are usually cured with surgery.
At what stage is the cancer?
The stage of a cancer tells you how big it is and whether it has spread. This helps your doctor decide which treatment you need.
Stage 1: Cancer confined to the ovary.
Stage 2: Confined to the lower part of the abdomen and involving the structures around it.
Stage 3:Â Spread to other parts of the abdomen including the lymph nodes and upper abdomen.
Stage 4:Â Spread to other parts of the body beyond the abdomen and may be involving the liver.
What treatment is needed?
Your treatment depends on where your cancer is, how big it is, whether it has spread anywhere else in your body, and your general health. A team of doctors and other professionals discuss the best treatment and care for you.
Treatment decisions:
Find out about how your doctor decides which treatment you need, the types of treatment you might have and treatment by stage.
Surgery:  Find out about the different types of surgery for ovarian cancer, what happens before surgery and how you might feel after your operation. Surgery is done for early cancer, symptomatic cancer and advanced cancer with an intention that very small amount or no cancer will be left after surgery.
Chemotherapy:  Medical Oncology (chemotherapy) doctors will give more details about chemotherapy for ovarian cancer, and the possible side effects. It is usually indicated in high grade early cancers and advanced cancers.
Radiotherapy:Â Radiotherapy uses high energy X-rays to kill ovarian cancer cells and is rarely needed.
What kind of surgery is done for ovarian cancer?
Surgery is done to remove an ovarian mass and make a diagnosis or for suspicion of ovarian cancer or possible ovarian cancer that has spread to other parts of the tummy. It includes removal of the mass, ovary or both ovaries with or without hysterectomy (womb, fallopian tubes and cervix). The mass can sometimes be sent for a rapid diagnosis to pathology lab (frozen section) to establish a diagnosis to see if it is looking cancerous. If suspicion of cancer, then the fatty curtain called the omentum in the tummy will be removed and lymph glands (pelvic and para-aortic lymph nodes) will be sampled (to see microscopic spread). Some women may need more extensive surgery than others and this will be discussed with you. The surgery is done by key hole operation if it is a small size mass with no spread or by a vertical cut on the tummy if it is big or has spread. The aim of the operation is to safely remove the mass, tumour or cyst, to establish a diagnosis, to remove all tumour possible if it has spread to other organs with no visible tumours left after operation.
