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Ovarian Cancer Symptoms, Assessment and Treatment

Ovarian cancer is the 6thmost 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 7thleading 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[1]. Women with BRCA 1 or BRCA 2 mutations have a significantly higher risk of developing ovarian and breast cancer than most women at average risk[2]. To keep ovarian cancer at bay, women with a personal or family history of ovarian cancer should take a genetic test as soon as possible and undergo regular screening for ovarian cancer.

Below is an overview of the latest information about ovarian cancer treatment and options, including ovarian cancer screening, diagnosis and treatment, ovarian cancer symptoms and frequently asked questions.

What is Ovarian Cancer?


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

What is Ovarian Cancer?


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If the following ovarian cancer symptoms persist, consult your doctor as soon as possible:

  1. Pelvic or abdominal pain or cramping
  2. Abdominal fullness, bloating or pressure
  3. Ingestion or upset stomach
  4. Changes in appetite, such as a loss of appetite or feeling full sooner
  5. Nausea
  6. A more frequent or urgent need to urinate
  7. Constipation
  8. Menstrual irregularities, or unexplained bleeding after menopause
  9. Unexplained fatigue
  10. Pain during sexual intercourse[3]

Ovarian cancer symptoms are not apparent in the early stages until the disease has progressed to an advanced stage. Most of the ovarian tumors in the early stage are hard or impossible to feel. Most of the time, ovarian cancer symptoms tend to be mistaken for minor ailments such as stomachache and abdominal pain. Statistically, stromal tumor is relatively easier to be detected and diagnosed in the early stages, as compared with other types of ovarian cancer.

Ovarian Cancer Causes and Risk Factors


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It is unclear what causes ovarian cancer so there are no proven ways to effectively prevent 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[4]. A family history of ovarian cancer, breast cancer or uterine cancer will also significantly increase the risk of developing ovarian cancer.

Ovarian cancer risk factors include:

  1. Never having a full-term pregnancy
  2. Being overweight or obese
  3. Smoking
  4. Using hormone therapy
  5. Having a family history or personal history of ovarian cancer, breast cancer or uterine cancer
  6. Mutations in BRCA1 or BRCA2 genes
  7. Having a period at a younger age
  8. Starting menopause late

Ovarian Cancer Assessment and Diagnosis


Ovarian cancer assessment is comprised of laparoscopy, 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:

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Laparoscopy

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

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Pelvic Exam

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

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Blood Test

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

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Imaging Test

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

It detects the location of the tumor, examines the spread of cancer cells and helps identify the size and shape of the ovaries.

Genetic Tests

Genetic testing is to look for hereditary cancer. Assessment can be conducted by collecting a saliva or blood sample. This test is recommended to 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 assessment, diagnosis, and treatment, collecting live tissue samples for pathological analysis to identify the type of cells and the stage of cancer. If the patient is classified as high risk for ovarian cancer, other assessment tests might need to be administered to confirm the extent of the tumor, including chest and lung X-ray, esophagoscopy and colonoscopy.

Ovarian cancer assessment is also recommended to women with a high risk of developing ovarian cancer but has never displayed cancer symptoms. To rule out the possibility of ovarian cancer or identify the risk of getting cancer, it is particularly important for women with a personal or family history of ovarian cancer, breast cancer or uterine cancer to get BRCA tested as soon as possible. As one of the most well-known hereditary causes that could result in a significantly higher risk of developing ovarian cancer, BRCA-related mutations can be divided into BRCA 1 and BRCA 2 mutation. Before considering a BRCA genetic test, you should consult a doctor, who can refer you to a verified clinical laboratory where lab results will be examined and explained thoroughly by medical professionals.

Once a BRCA gene mutation is confirmed, the doctor normally advises various preventive methods. For example, in the case of women at 40 years old or above or who just gave birth, they could consider removing fallopian tubes and ovaries to reduce the chance of developing ovarian cancer. They could also receive hormone therapy, keeping cells from mutations, and have a routine ovarian cancer assessment[5].

Ovarian Cancer Treatment[6] [7]


The primary ovarian cancer treatment option is surgery plus chemotherapy. The lower ovarian tumor’s grade is, the better the chances of getting cured. Ovarian cancer can be classified into four stages. Stage I means that the cancer tumor is only in the ovary (or ovaries). Stage II means that the cancer tumor is in one or both ovaries and has spread to other organs within the pelvis. Stage III refers to cancer that has spread to the retroperitoneal (pelvic and/or para-aortic) lymph nodes. Stage IV ovarian cancer describes the spread of cancer cells to other major organs such as liver and lung. The amount of surgery will be determined by the cancer stages, including ovaries, fallopian tubes, uterus, greater omentum, surrounding lymph nodes and other tissues that have spread to other areas of the body.

Frequently Asked Questions About Ovarian Cancer Screening and Treatment


Ovarian cancer surgery does not necessarily affect the patients’ ability to get pregnant and have a baby. If the patients are at a young age when diagnosed and with early-stage ovarian cancer, it might be possible that the physician only removes the affected ovary, leaving behind the womb and fallopian tube for hormone production and reproductive function.

The doctor will determine according to 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 will depend on the patients’ past reactions to treatment and side effects. Besides, if the tumor is inoperable by nature or because of the size, chemotherapy treatment might be administered to shrink the size of their tumor for a better chance of operability and cure.

Ovarian cancer surveillance to monitor for potentially recurrent ovarian cancer is the key. This includes a routine pelvic exam, CA-125 blood test, chest X-Rays, and abdominal CT.

References:

  1. https://www.cancer-fund.org/wp-content/uploads/2017/04/Ovarian-Pdf-2015C.pdf
  2. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q2
  3. https://www.cancer-fund.org/wp-content/uploads/2017/04/Ovarian-Pdf-2015C.pdf
  4. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q2
  5. https://www.hkam.org.hk/news/press_release/130528_HKAM_BRCA_statement_Chi_Final.pdf
  6. https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/diagnosis-treatment/drc-20375946
  7. https://www21.ha.org.hk/smartpatient/SPW/zh-HK/Disease-Information/Disease/?guid=e7cdd1a8-8f9c-4c59-9f5f-7cffe95d93fa

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