Prevention, detection, and management of ovarian cancer

1. What is ovarian cancer – how is it diagnosed, screened for & what does it look like?

Ovarian cancer is a malignant tumour that begins in the female organs that produce eggs (ovaries). It begins in one or both ovaries, the fallopian tubes or the peritoneum (lining of pelvis).

There are many types of ovarian cancer. 90% are epithelial type or from the surface cells of the ovary.

Ovarian cancer often goes undetected (as it often has no symptoms in the early stages) until it has spread within the pelvis and abdomen. Later stages are associated with symptoms, but they can be non-specific. This results in many women being diagnosed when they are at the advanced stages of the cancer. At later stages, ovarian cancer is more difficult to treat and associated with significantly reducing survival rates.

There is no early detection test for ovarian cancer.

Cervical cancer screening does not detect ovarian cancer! Many women incorrectly believed a pap smear detects ovarian cancer.

2. Facts on ovarian cancer - who is most affected and what are the survival rates

Ovarian cancer is the eighth most commonly diagnosed cancer in Australian females.

Ovarian cancer can occur at any age, though it is more prevalent in women over 40 years.

The average age at diagnosis is 66 years old. The risk of being diagnosed before age 85 is 1 in 77 to 85.

It is estimated that in 2022 in Australia more than 1,300 (up to 1800) people were diagnosed with ovarian cancer.

The chances of surviving longer than five years once diagnosed with ovarian cancer is 48% overall.

Ovarian cancer has the highest death rate at 4.8% of all female cancers per year.

If a woman is diagnosed at Stage 1, while the cancer is localised, her survival rates are over 90%.

However, approximately 70% of all ovarian cancer cases in Australia are diagnosed in Stages 3 or 4. Only 29% of women diagnosed in a late stage will survive for more than 5 years.

Unlike many other cancers, survival rates for epithelial ovarian cancer have seen little improvement in the past 30 years.

3. Risk Factors

Hereditary: A family history of Ovarian Cancer is the strongest risk factor for developing the disease. Inheriting a faulty BRCA1 (breast cancer 1) or BRCA2 (breast cancer 2) gene is involved in most cases of hereditary ovarian cancer.

Women who inherit a mutation in the BRCA1 gene have approximately a 40% lifetime risk of developing ovarian cancer, while women who inherit a faulty BRCA2 gene have approximately 10-15% risk of developing ovarian cancer. Around 5% of all breast cancers and up to 15% of ovarian cancers can be explained by an inherited gene fault in BRCA1 or BRCA2.

Several other genes have also been identified that increase the risk of Ovarian Cancer. Other factors that are associated with a higher risk of developing ovarian cancer include:

  • Being of Ashkenazi Jewish descent
  • A family history of ovarian cancer – the risk of developing ovarian cancer is higher if one or more blood relatives (such as mother, sister or daughter) has had ovarian cancer
  • Family history of breast or colon (bowel) cancer
  • Increasing age (risk increases for women over 50)
  • Medical conditions such as endometriosis
  • Early onset of periods (before 12 years) and late menopause
  • Women who have not had children or had their first child after the age of 35
  • Infertility and hormonal factors • Smoking
  • Obesity

4. Prevention

There is no proven method of prevention. Oophorectomy (removal of ovaries) in women with a strong family history does not always prevent cancer.

Some factors that may reduce the risk of developing ovarian cancer include using the oral contraceptive pill for several years, having your fallopian tubes tied or removed, having children before the age of 35 and breastfeeding.

5. What are the symptoms?

Many symptoms are non-specific and can be caused by other conditions. You can have no symptoms. There are often no obvious signs of ovarian cancer, however you may have one or more of the following symptoms:

  • Pain: in the back, abdomen or pelvis
  • Gastrointestinal: bloating, change in bowel habits (constipation or diarrhoea), indigestion, difficulty eating, feeling full quickly, or nausea
  • Abdominal: abdominal fullness, fluid or lump in the abdomen Whole body: fatigue or loss of appetite
  • Other: unexplained weight loss or gain, frequent or urgent urination, menstrual irregularities

6. When should a gp refer to a specialist

GPs generally refer when there is a pelvic mass, elevated tumour marker or symptoms that need further investigation and management.

If you are experiencing any of these symptoms, contact your local doctor.

7. Diagnosis of ovarian cancer

If you are experiencing possible symptoms of ovarian cancer your doctor may suggest several tests to look for cysts, tumours or other changes. These may include:

  • Physical examination - abdomen for lumps or swelling, internal vaginal examination
  • Blood tests – tumour marker for ovarian cancer, CA 125 (A normal result does not exclude ovarian cancer)
  • Pelvic ultrasound – to look at uterus, tubes and ovaries
  • CT or PET Scan – to check for cancer and look for spread

It is often difficult to diagnose ovarian cancer as common tests and scans can only show abnormalities instead of providing a diagnosis. The only way to currently confirm a diagnosis is by taking a biopsy and looking at the cells under a microscope.

8. What are the treatment options

  • Treatment depends on the Stage (extent) of the cancer.
  • Surgery and chemotherapy are generally used to treat ovarian cancer.
  • Surgery is used to determine the extent of disease, to remove the uterus, fallopian tubes and ovaries and if spread remove as much as possible.
  • Chemotherapy uses anti-cancer drugs to destroy cancer cells. Most women will have chemotherapy after surgery (adjuvant chemotherapy) to destroy any remaining cancer cells.

Some women will have chemotherapy before surgery (neoadjuvant chemotherapy) with the aim to shrink tumours and make them easier to remove.

If you are not well enough for an operation, chemotherapy may be used as the main treatment.

Chemotherapy may be given with a curative intent, to prolong life or to reduce symptoms.

Radiation therapy can be used to treat the pelvis or other sites of cancer that have spread. It may be used on its own or after chemotherapy.

9. Who will look after you?

You will be looked after by team of Specialists called a MULTIDISCIPLINARY CANCER CARE TEAM who work together to diagnose and develop personalised treatment plans for people with cancer and reviews their treatment during and after completion. The team may include:

  • Gynaecologist (Gynaecological Oncologist or surgeon)
  • Medical Oncologist (chemotherapy)
  • Radiation Oncologist (radiation Treatment)
  • Gynaecological pathologist- examines tissue removed from the abdomen
  • Geneticist – who looks at hereditary cancers
  • Palliative Care (helps quality of life and to relieve symptoms)
  • Radiologist- interprets diagnostic scans
  • Cancer nurse - assists with treatment and provides information and support
  • Allied health professionals - such as social workers, pharmacists, dieticians, rehabilitation specialists and counsellors
  • Complimentary and Alternative Care Providers

10. How are Gps involved in ovarian cancer care

GPs are involved in all stages of the patient's cancer journey (prevention, screening, diagnosis, treatment, follow-up and education).

They are involved in screening and diagnosis by investigating, interpreting the results, and referring to a Gynaecologist.

GPs also provide symptom management and surveillance in partnership with the Cancer Care Team.

GPs play a key role in providing support with advanced care planning and family support.

11. Ongoing and upcoming research

Ovarian cancer researchers aim to:

  • Discover how ovarian cancer starts.
  • Discover a screening test for early diagnosis.
  • Develop better ways to treat ovarian cancer including targeted therapies.
  • Assess new ovarian cancer treatments in laboratory models and clinical trials.
  • Establish markers that predict a patient’s response to treatment.
  • Prevention

12. Acknowledgements /sources

  • Cancer Council – www.cancercouncil.org.au
  • Cancer Australia – www.cancer Australia.gov.au
  • Australian Cancer Research Foundation – www.acrf.com.au
  • Mayo Clinic – www.mayoclinic.org
  • Ovarian Cancer Research Foundation - ocrf.com.au
  • cureovariancancer.org