Dr Juman Farjo & Dr Rhonda Farrell of Prince of Wales Private Hospital share some important information.

Ovarian cancer is a cancer that starts in the ovaries, fallopian tubes or the peritoneum (tissue lining the pelvis and abdomen) of women. Each year, around 1750 Australian women are diagnosed with ovarian cancer, and each woman has around a 1 in 80 chance of getting ovarian cancer in their lifetime. 

Age is one of the risk factors as over 80% of women diagnosed with ovarian cancer are over the age of 50 but it is important to note that it can affect women of any age. Some other risk factors include:

• Genetic factors
• Family history of ovarian or breast cancer
• Having an Ashkenazi Jewish ancestry

A major risk factor for ovarian cancer is an inherited fault in the BRCA 1 or BRCA 2 genes or other similar genes, which are present in around 20% of high grade serous cancers (the commonest subtype of ovarian cancer). If you do have a family history of breast or ovarian cancer in your immediate relatives (sister, mother, daughter), or in multiple relatives particularly if the cancer was diagnosed under the age of 50, you can be referred to your local area hereditary cancer clinic for a discussion and possible testing for these genes. You may be offered risk reducing gynaecological surgery (removal of your ovaries and tubes) to prevent cancer if you are found to be at significant risk.

The symptoms of ovarian cancer are quite vague and are very similar to other common conditions which makes it difficult to diagnose early.  However, symptoms to watch out for include:

• Pressure, pain or discomfort in the abdomen or pelvis
• Swollen or bloated abdomen
• Changes in toilet habits
• Feeling very tired
• Changes to periods such as heavy or irregular bleeding, or vaginal bleeding after menopause

If you have any of these symptoms and they are new for you, are severe or continue for more than two weeks, it is best to have a check-up with your doctor for review and examination.

The diagnosis starts with pelvic examination and is combined with blood tests and a pelvic ultrasound. The blood test is to check for proteins produced by the cancer cells called tumour markers and the most common one for ovarian cancer is CA 125.

CA 125 can also rise for other reasons like uterine fibroids, endometriosis, liver and kidney disease so is not used for screening for ovarian cancer if you don’t have any symptoms.

The pelvic Ultrasound is used to assess the type of ovarian mass and determines if it is more likely to be cancerous, borderline, or a benign tumour of the ovary. Other imaging modalities may also be used like CT scan, MRI or PET scan.

Once the suspected diagnosis of ovarian cancer is made, you will be referred by your GP or your Gynaecologist to a Gynaecologist Oncologist who specialises in the treatment and management of ovarian cancer and works with a multi-disciplinary team that will be able to manage different aspects of your care.

Treatment of ovarian cancer has improved significantly over the last decade and survival rates are improving. Although the standard treatment is a combination of chemotherapy and surgery, there are newer targeted treatments available in addition to these treatments. Approximately one half of all women diagnosed with high grade serous ovarian cancer now have PBS-funded access to a drug that targets BRCA-like mutations in the tumour, called a PARP inhibitor. This has resulted in significantly improved survival in many women. The good news is that there is lots of research going on to find similar targeted treatments for other mutations in the different types of ovarian cancer. This should continue to improve outcomes in women with ovarian cancer.

Survival rates are also improved if women with ovarian cancer receive their care by a specialised team which includes a gynaecological oncologist, a medical oncologist, and other team members who work within a dedicated gynaecological cancer centre. Outcomes are best where the initial surgery for ovarian cancer is performed by a certified gynaecological oncologist.

The following resources are useful for further reading if you would like to know more about ovarian cancer:

• Cancer Council NSW https://cancercouncil.com.au or call 11 13 20 to talk with a health professional
• Ovarian Cancer Australia https://www.ovariancancer.net.au
• eviQ eviq.org.au For patients and carers.
• ANZGOG: Australian and New Zealand gynaecological oncology group  https://www.anzgo