Information below has been kindly supplied by Dr Andrea Garrett ( Gynaecology Oncologist )
MBBS FRANZCOG Dip Pall Care CGO
Ovarian Cancer Awareness Month is held each year in Australia to raise awareness of the signs and symptoms of ovarian cancer, to highlight the risk factors for ovarian cancer and to educate Australians on ovarian cancer diagnosis and treatment.
Ovarian cancer is still the deadliest woman’s cancer. Unfortunately, this has not changed in 30 years. Every day in Australia, four women are diagnosed with ovarian cancer and three will die from the disease.
The background risk for Ovarian Cancer is 1.4%. In some women this risk will be higher if there is a family history or an abnormal genetic history. Risk factors for Ovarian Cancer include age, family history, endometriosis, no pregnancies, infertility, smoking, obesity and long term use of Hormone Replacement Therapy.
There are 4 main types of Ovarian Cancer. The most common is Epithelial Ovarian Cancer (80%), with Germ Cell Tumours, Sex Cord Stromal Tumours and Metastatic Tumours comprising the remaining 20% of cases. Fallopian Tube Cancer and Primary Peritoneal Cancer (arising from the peritoneal or lining layer of the abdomen) behave in the same manner as Ovarian Cancer and are treated in a similar fashion and are included in this discussion.
Symptoms
Symptoms are very non-specific but can include pain, abdominal distension, bloating, nausea and vomiting, altered bladder or bowel habit and unexplained weight loss. These symptoms are usually persistent and can occur over a period of many months. Ovarian cancer is often detected late as there is no screening test for the disease.
Diagnosis & Investigations
If ovarian cancer is suspected a pelvic Ultrasound will be performed. Once a pelvic mass has been confirmed a CT scan of the chest, abdomen and pelvis will be required in most instances. This allows visualization of other organs in order to assess extent of disease. Blood tests including Full Blood Count (FBC), Electrolytes, Coagulation Studies and Tumour Markers will be performed. Tumour Markers include CEA, CA19.9 and CA125. In some cases intra-abdominal fluid (ascites) will be drained and tested in order to make the diagnosis. If there are significant gastro-intestinal symptoms or the CEA is elevated a colonoscopy will be performed.
Treatment
The treatment of Ovarian Cancer involves surgery and chemotherapy. In the majority of cases surgery is performed first. The surgical procedure is a debulking procedure aimed at removing all macroscopic disease. This includes procedures such as hysterectomy, removal of both tubes and ovaries, removal of omentum (fatty apron in abdomen), lymph nodes removal or sampling, bowel resection, stripping of diaphragms and removal of any visible deposits of cancer. Removal of all disease is not possible in all cases and some disease may be left behind. Chemotherapy agents are given following surgery to remove all remaining disease. Six cycles of chemotherapy are given in total.
If there is extensive disease or there are medical problems that prevent immediate surgery, chemotherapy is given up front. This is known as Neo-Adjuvant Chemotherapy. Three cycles of chemotherapy are given and then scans and CA125 level are repeated to assess for response. If a good response has occurred a surgical debulking procedure is then performed. Following this three more cycles of chemotherapy are given.
At the end of treatment it is anticipated that there is no residual disease present and the CA125 level has returned to normal. You are then in remission. Unfortunately some women will not respond completely to surgery or chemotherapy, making their disease difficult to eradicate.
Follow Up
Once you have completed treatment for Ovarian Cancer you will be monitored regularly over the next several years. In some cases disease will recur. Further imaging and blood tests will be performed at that time and management options will be discussed. These include further surgery and/or chemotherapy. In some cases radiation therapy may be appropriate.
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