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Ovarian cancer is a cancer in one or both of the ovaries. It is important to know the signs and symptoms of ovarian cancer. These can include bloating, frequent urination (with no infection), back pain, heartburn, pain during intercourse and unexplained bleeding.

Ovarian cancer is difficult to detect in the early stages. It usually starts in cells on the surface or inside the ovary that gradually enlarges. As there is room for it to grow, it does not cause symptoms until it is quite large.

What is ovarian cancer?

Ovarian cancer is a cancer that forms in one or both ovaries. There are three types of ovarian cancer:

1. Epithelial

Cancer that starts in the cells lining in the surface layer of the ovary – epithelium

  • 90% are in this group
  • Women are usually over 50 years of age.

Research suggests that many epithelial ovarian cancers may start in the fallopian tubes.

2. Germ cell

Cancer that starts in the cells that produce eggs

  • 5% of cases
  • Develops in women younger than 30.

3. Sex-cord stromal

Cancer that starts in the tissues that support the ovary and produce different cells

  • Rare
  • Occurs at any age.

Ovarian cancer is the sixth most common cause of cancer death in Australian women. Every year around 1500 women are diagnosed with ovarian cancer in Australia.

Even though ovarian cancer is less common than lung cancer or breast cancer, it is important to be aware of its signs and symptoms as early diagnosis improves treatment outcomes. 45% of women are alive 5 years after ovarian cancer diagnosis.

Currently there are no reliable early detection tests for ovarian cancer and therefore no screening programs are available.

Signs & symptoms of ovarian cancer

Ovarian cancer is difficult to detect in the early stages. It usually starts as a painless lump or cyst on or in the ovary that gradually enlarges. As there is room for it to grow, it does not cause symptoms until it is quite large.

The symptoms of ovarian cancer are often vague and non-specific. Almost every woman will experience these symptoms at various times and in most cases the symptoms will not be caused by ovarian cancer.

The most commonly symptoms of ovarian cancer are:

  • increased abdominal size or persistent abdominal bloating
  • abdominal or pelvic (lower tummy) pain
  • feeling full after eating a small amount
  • needing to urinate often or urgently

Additional symptoms may include:

  • changes in bowel habits
  • unexplained weight gain or loss
  • excessive fatigue
  • lower back pain
  • indigestion or nausea
  • bleeding after menopause or in-between periods
  • pain during sex or bleeding after

Because these symptoms can occur in many women at various times and be unrelated to cancer, this is why ovarian cancer might not be diagnosed until it is quite advanced.

 

Risk factors

There are some factors that increase the risk of developing ovarian cancer including:

  • Age
    • Getting older is the biggest risk factor. Most cases occur after the age of 50 with the average age of diagnosis being age 64
    • However, can occur at any age, even in teenagers
  • Family history
    • One or more close relatives with ovarian, breast, or other cancer (colorectal or endometrial)
    • BRCA 1 or 2 positive genes
    • Being of Ashkenazi Jewish descent
  • Never having children
  • Never taken combined hormone contraceptive
  • Having endometriosis, a previous breast cancer or diabetes
  • Smoking, in particular, mucinous cancers both invasive and borderline
  • Being overweight/obese
  • Being on long term menopausal hormone therapy, or MHT (formerly called hormone replacement therapy, or HRT) either oestrogen alone or oestrogen and progestogen

Protective factors

There are several factors that can reduce the risk of developing ovarian cancer.

  • Having children
  • Combined hormone contraceptives
  • Surgical removal of the ovaries and fallopian tubes

If you are concerned about your risk, talk to your doctor.

How is ovarian cancer diagnosed?

If you experience some of the symptoms of ovarian cancer for more than two weeks, and they are a change from the normal for you, ask your doctor about the possibility of ovarian cancer. The following steps can be taken to assess you:

  • Your doctor can perform an abdominal and pelvic examination
  • If no other cause can be determined for your symptoms, a transvaginal ultrasound examination (internal ultrasound via the vagina) can be performed. This is a test for identifying abnormalities on the ovary
  • Your doctor can order a simple blood test called a CA-125 (a common tumour marker), but this test is not always reliable.

Referral to a gynaecological oncologist

If your assessment and investigations suggest ovarian cancer is a possibility, ask your doctor for an immediate referral to a gynaecological oncologist.

Gynaecological oncologists are specialists gynaecologists who treat cancers such as ovarian cancer. It has been shown that women with ovarian cancer who are treated by a gynaecological oncologist have better outcomes.

When to see your doctor

See your doctor if you experience symptoms such as:

  • increased abdominal size or persistent abdominal bloating
  • abdominal or pelvic (lower tummy) pain
  • feeling full after eating a small amount
  • needing to urinate often or urgently

And these symptoms

  • are a change from the normal for you;
  • persist for more than 2 weeks;
  • and there is no other explanation for you having these symptoms.

Visit Ovarian Cancer Australia for more information.

At Your Health Hub, Dr Virginia Baird (Ginny) specialises in women’s health. See Women’s Health Clinic for more information.

References

Published with the permission of Jean Hailes for Women’s Health