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Ovarian cancer is the 6th most common cancer among women in Hong Kong. According to the statistics provided by the Hong Kong Cancer Registry, ovarian cancer accounts for 3.9% of cancers in women, with 598 new cases diagnosed in 2016. As the 7th leading cause of cancer-related death among women, ovarian cancer killed 229 women in the same year.

 

Approximately 10% of ovarian cancers are attributable to hereditary causes. Women with BRCA1 or BRCA2 gene mutations have a ten-fold higher risk of developing ovarian and breast cancer than women at average risk. To keep ovarian cancer at bay, women with a personal or family history of ovarian cancer should undergo genetic testing as early as possible and screen regularly for ovarian cancer.

 

The following is an overview of the latest information about ovarian cancer and treatment options, including ovarian cancer screening, diagnosis and treatment, ovarian cancer symptoms and FAQs.

What is Ovarian Cancer?

Ovarian cancer occurs when cells in the ovary begin to grow abnormally and form a malignant tumour. There are three major types of ovarian cancers depending on the location the abnormal cell growth. Approximately 90% of cases are epithelial, where ovarian cancer develops in the cells covering the surface of the ovary. Another type is stromal tumour where the cancer develops from connective tissue cells that hold the ovary together and those that produce the female hormones. The third type is germ cell tumour where the cells that produce the ova or eggs become cancerous. Germ cell malignancies tend to occur in teenagers and women before their thirties.

 

You should consult your doctor should the following ovarian cancer symptoms persist:

Symptoms and Signs of Ovarian Cancer

  • Pelvic or abdominal pain or cramping
  • Abdominal fullness, bloating or pressure
  • Ingestion or upset stomach
  • Changes in appetite, such as a loss of appetite or feeling full sooner
  • Nausea
  • A more frequent or urgent need to urinate
  • Constipation
  • Menstrual irregularities, or unexplained bleeding after menopause
  • Fatigue
  • Pain during sexual intercourse

Ovarian cancer symptoms are not apparent in the early stages, not until the disease has progressed to an advanced stage. Most ovarian tumours in the early stage are hard or impossible to feel. Commonly, ovarian cancer symptoms are mistaken for minor ailments such as stomach-aches or minor abdominal pain. Statistically, a stromal tumour is relatively easily detected and diagnosed in the early stages when compared with other types of ovarian cancer.

Ovarian Cancer Causes and Risk Factors

It is unclear what causes ovarian cancer and there are no established means for effectively preventing it. In Hong Kong, the median age of a woman diagnosed with ovarian cancer is 53. In general, women’s lifetime risk of ovarian cancer before the age of 80 is 1.3%, however, if a woman has mutations in either BRCA1 or BRCA2 genes, her chances of getting ovarian cancer will increase by 44% and 17%, respectively. In families with a history of ovarian cancer, breast cancer or uterine cancer will also significantly increase the risk of developing ovarian cancer.

 

Ovarian cancer risk factors include:

  • Never having been pregnant
  • Being overweight or obese
  • Smoking
  • Previous hormone therapy
  • Having a family history or personal history of ovarian cancer, breast cancer or uterine cancer
  • BRCA1 or BRCA2 gene mutations
  • Having a period at a younger age
  • Having late menopause

Ovarian Cancer Screening Options

An ovarian cancer assessment is comprised of a laparoscopy, a pelvic examination, blood tests, and imaging tests. The assessment procedure is simple and can be completed within a day at a specialist clinic. Tests that assess ovarian cancer include:

Laparoscopy

This procedure looks at the ovaries and other organs and tissues in the pelvic area using a thin, lighted tube which is inserted through a small incision (cut) in the lower abdomen and is a minimally-invasive procedure for screening for ovarian cancer.

Pelvic Exam

During a pelvic exam, the physician examines the patient’s uterus, rectum, and pelvis through her vagina to determine whether lumps have developed.

Blood Test

Some patients with ovarian cancer or malignant transformation of benign ovarian tumours will have higher CA-125 levels, although some early-stage ovarian cancer patients have normal CA-125 levels.

Imaging Test

Image Tests include pelvic ultrasound, transvaginal ultrasound, abdominal ultrasound, MRI, PET/CT.

They detect the location of the tumour and examine the spread of cancer cells, whilst assisting with ascertaining the size and shape of the ovaries.

Genetic Tests

Genetic testing looks for hereditary cancer. Assessment consists of collecting a saliva or blood sample. This test is recommended for women with a family history of ovarian cancer, breast cancer and uterine cancer.

If the above tests fail to rule out or diagnose ovarian cancer, doctors might need to use surgical methods for the assessment, diagnosis, and treatment. Doctors would start by collecting live tissue samples for pathological analysis to identify the type of cells and the stage of the cancer. If the patient is classified as high risk for ovarian cancer, other assessment tests might need to be administered to ascertain the extent of the tumour, including chest and lung X-rays, esophagoscopy and colonoscopy.

 

Ovarian cancer assessment is also recommended for women with a high risk of developing ovarian cancer but that have not yet presented with cancer symptoms. It is particularly important for women with personal/family history of ovarian cancer to get BRCA tested as early as possible. The test helps to rule out the possibilities of ovarian cancer, identify the risk of developing breast cancer and uterine cancer. BRCA-related mutations are one of the most common hereditary causes that increases risk for ovarian cancer, and can be divided into BRCA1 and BRCA2 mutations. Before considering a BRCA genetic test, you should consult a doctor, who can refer you to an accredited clinical laboratory where your lab results will be examined and explained to you in detail by medical professionals.

 

Once a BRCA gene mutation is confirmed, the doctor normally advises various preventive methods. For example, in the case of women of 40 years old or above or for women who are post-partum, they may consider the removal of their fallopian tubes and ovaries to reduce the chance of developing ovarian cancer. By taking special hormone therapy that can lower the chance of the cells mutating, and then also undergo periodical ovarian cancer assessments.

Ovarian Cancer Staging and Treatment Approaches

The primary ovarian cancer treatment option is surgery plus chemotherapy. The lower the ovarian tumour grade is, the better the chances of a cure.

 

The amount of surgical resection that will be necessary is determined by the stage of the cancer, including the degree of metastasis to the ovaries, fallopian tubes, uterus, greater momentum, surrounding lymph nodes and other tissues.

Frequently Asked Questions About Ovarian Cancer Screening and Treatment

  • Q1. If I have my ovaries removed – does it affect my fertility?

    Ovarian cancer surgery does not necessarily affect the patient’s ability to conceive. If the patients are at a young age when diagnosed and are at an early stage of ovarian cancer, it may be possible for the physician to only remove the affected ovary, leaving behind the womb, fallopian tube for hormone production and your ability to conceive.

  • Q2. Do I have to undergo chemotherapy after ovarian cancer surgery?

    The doctor will decide this based on the patient’s health and post-operative condition. The purpose of chemotherapy is to minimize the chances of ovarian cancer recurrence. For patients with recurrent ovarian cancer who might need to receive second-line chemotherapy treatment, the choice of chemotherapeutic drugs depends on the patient’s previous reaction to treatment and the side effects experienced. Furthermore, should the tumour be difficult to remove due to its size or type, chemotherapy treatment might be administered to first shrink the size of the tumour for a better chance of a successful surgical resection and cure.

  • Q3. How can I reduce the risk of recurrence after ovarian cancer surgery?

    Observation and monitoring are the key to preventing recurrences. This includes undergoing pelvic exams, CA-125 blood tests, chest X-Rays, and abdominal CTs regularly.

Selected References:

1. Understanding: Ovarian Cancer. Cancer Fund. 2015. (Accessed 7 July 2020, at https://www.cancer-fund.org/wp-content/uploads/2017/04/Ovarian-Pdf-2015C.pdf) 2. BRCA Mutations: Cancer Risk and Genetic Testing. National Cancer Institute. 2018. (Accessed 7 July 2020, at https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q2) 3. Responses to BRCA gene mutation & related medical issues. Hong Kong Academy of Medicine. (Accessed 7 July 2020, at https://www.hkam.org.hk/news/press_release/130528_HKAM_BRCA_statement_Chi_Final.pdf) 4. Ovarian Cancer. Mayo Clinic. 2019. (Accessed 7 July 2020, at https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/diagnosis-treatment/drc-20375946) 5. Ovarian Cancer. Smart Patient, Hospital Authority. (Accessed 7 July 2020, at https://www21.ha.org.hk/smartpatient/SPW/en-us/Disease-Information/Disease/?guid=e7cdd1a8-8f9c-4c59-9f5f-7cffe95d93fa)

 

Reviewed: July 7, 2020