Ovarian Cancer
Ovarian cancer is one of the most common types of cancer in women.
Ovarian cancer is when abnormal cells in the ovary begin to grow and divide in an uncontrolled way, and eventually form a growth (tumour).
If not caught early cancer cells gradually grow into the surrounding tissues and may spread to other areas of the body.
Types of Ovarian Cancer
Epithelial ovarian cancer : This is the most common type of Ovarian cancer. This starts in the cells covering the ovaries and are the most common type of ovarian cancer. Around 90 out of 100 (90%) of ovarian tumours are this type.
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: Fallopian tube cancer starts in the fallopian tubes which connect the ovaries to the womb. The treatment is very similar to ovarian cancer.
Teratoma of the ovary: Ovarian teratoma is the most common type of germ cell tumour. 5 out of 100 women with ovarian cancer (5%) have cancerous germ cell tumours.
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.
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.
Symptoms
The symptoms of ovarian cancer can be very vague, particularly when the disease is in its early stages.
Common symptoms include:
- feeling full quickly
- loss of appetite
- pain in your tummy (abdomen) or lower part of your abdomen that doesn’t go away
- bloating or an increase in the size of your abdomen
- needing to wee more often
Other possible symptoms
- tiredness that is unexplained
- weight loss that is unexplained
- changes in your bowel habit or symptoms of irritable bowel syndrome, especially if this starts after the age of 50
Causes
The exact cause of ovarian cancer is unknown. Your risk of developing ovarian cancer depends on many things including age, genetics, lifestyle and environmental factors. These factors can increase your risk:
- a family history of ovarian cancer
- genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
- obesity
- no history of pregnancy
- endometriosis
- the use of certain fertility drugs or hormone therapies
- a personal history of breast, uterine, or colon cancer
Older age is another risk factor. Most cases of ovarian cancer develop after menopause.
It’s possible to have ovarian cancer without having any of these risk factors.
Likewise, having any of these risk factors doesn’t necessarily mean you’ll get ovarian cancer.
Diagnosing Ovarian Cancer
It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect.
As the tumor grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.
Your doctor may also do the following tests:
- Transvaginal ultrasound (TVUS). This is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine whether tumors are cancerous.
- Abdominal and pelvic CT scan. If you’re allergic to dye, they may order a pelvic MRI scan.
- Blood test to measure cancer antigen 125 (CA-125) This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
- Biopsy. This involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.
Treatments
The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:
Chemotherapy
Chemotherapy medicine is usually given as a drip into the vein, but is sometimes given as tablets. You’ll need to come into hospital to receive the treatment, but can normally go home the same day.
Treatment is given in cycles, with a period of treatment followed by a period of rest to allow your body to recover.
Radiation
Radiotherapy uses carefully directed beams of radiation to kill cancer cells. It’s not used very often to treat ovarian cancer, but may be used after surgery for early ovarian cancer, to kill any cancer cells left behind to shrink tumours and reduce symptoms if ovarian cancer has spread and can’t be cured
Surgery
Surgery is the main treatment for ovarian cancer.
The goal of surgery is to remove the tumor, but a hysterectomy, or complete removal of the uterus, is often necessary. Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue.
Identifying all tumor locations is difficult. In one study, researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.
Targeted Therapy
Targeted therapies, such as chemotherapy and radiation treatments, attack the cancer cells while doing little damage to normal cells in the body.
Newer targeted therapies to treat advanced epithelial ovarian cancer include bevacizumab (Avastin) and olaparib (Lynparza). Doctors only use olaparib in people with mutations in the BRCA genes.
Fertility Preservation
Cancer treatments, including chemotherapy, radiation, and surgery, can damage your reproductive organs, making it difficult to become pregnant.
If you want to become pregnant in the future, talk to your doctor before starting treatment. They can discuss your options for possibly preserving your fertility.
Ovarian Cancer and Clinical Negligence
Ovarian cancer is not easy to diagnose. On rare occasions, the standard of treatment received by a patient may fall short of that which the medical profession itself would expect. This could be a failure to carry out the appropriate tests or failure to diagnose the condition. In the cases where it can be shown that the standard was unacceptable, it is possible you may have a potential clinical negligence claim.