Ovarian cancer affects the ovaries (each about the size of an almond) on either side of the uterus.  It is the 6th most common cancer in women.  Although the cause of the cancer is unknown, it is associated with genetic mutations (such as BRCA1 & BRCA2 genes), women with a family history, older women (between the ages 50-70 years) and women who have early menarche or late menopause.   Being overweight and smoking also increases the cancer risk.

Types of ovarian cancer

• Epithelial cell cancer (most common type accounting for over 90% of ovarian cancers)
• Stromal cancers (these cancers produce hormones)
• Germ cell cancers (rare cancer found mainly in younger women)

Symptoms

Unfortunately, there are few symptoms during the early stage of the cancer when the lesion is small.  The symptoms include

• Abdominal belatedness or swelling
• Weight loss with loss of appetite
• Feeling full even after a small meal
• Change of bowel habits (constipation or diarrhoea)
• Discomfort around the pelvic area
• Increase frequency to urinate
• Irregular periods or bleeding after menopause

Diagnostic Tests

• Blood tests (to detect your blood, liver and kidney profile as well as tumour markers)
• Ultrasound and examination of the vagina, uterus, ovaries and pelvis
• CT or MRI or PET scan (to check for cancer spread)

Stages of ovarian cancer according to International Federation of Gynaecology & Obstetrics (known as FIGO)

Ovarian cancer often goes undetected until it has spread within the pelvis or abdomen where at this late stage, it is more difficult to treat.  Staging of the cancer is one of the most important factors in deciding how to treat the cancer and in determining how successful the treatment might be.

• Stage 1A. The cancer is confined to ONE ovary and fallopian tube but has NOT spread out
• Stage 1B. The cancer is in BOTH ovaries and fallopian tubes but has NOT spread out
• Stage 1C. The cancer is in one or both ovaries and there are cancer cells spilled out of the ovarian capsule
• Stage 2A.  The cancer is in one or both ovaries with cancer spread to the uterus
• Stage 2B.  The cancer is in one or both ovaries with cancer spread to other organs such as bladder, uterus, colon or rectum within the pelvis. 

• Stage 3A.  The cancer has spread into the pelvis and/or retroperitoneal lymph nodes
• Stage 3B.  The cancer has spread out of the pelvis but not bigger than 2 cm 
• Stage 3C.  The cancer has spread out of the pelvis and bigger than 2 cm

• Stage 4A.  The cancer cells are found in fluid around the lung (known as pleural effusion)
• Stage 4B.  The cancer has spread to distant organs such as spleen, liver, bone or lungs

Treatment Options for Ovarian Cancer

• Surgery to remove the affected ovary (or both ovaries) with the fallopian tube(s).  The uterus and surrounding tissues such as lymph nodes, colon or rectum may also be removed if they are affected by cancer spread
• Adjuvant treatment using Chemotherapy and/or Radiotherapy may be required depending on stage and type of cancer cell type
• Targeted therapy (if the cancer cell type is suitable)
• Hormone therapy (if the cancer cell type is suitable)

Follow-up Care

It is important to have regular 3-6 monthly check up with your gynaecologist and get an examination, ultrasound scan and blood tests done to detect any early recurrences after your treatment.

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