6 minute read
IPN May 2024
Management and Treatment of Ovarian cancer
What is ovarian cancer? Ovarian cancer is an umbrella term for a multitude of different types of cancer that affect the ovaries, fallopian tubes, and the primary peritoneal cavity. The peritoneal cavity, also known as the peritoneum, is a thin membrane that lines the abdominal cavity and covers many of the organs inside that cavity.
There are different types of ovarian cancer. The type of ovarian cancer you have depends on the type of cell it starts in.
Epithelial ovarian cancer is cancer of the surface of the ovary (the epithelium), and is the most common ovarian cancer. Fallopian tube cancer and primary peritoneal cancer are also included in this type of ovarian cancer.
Germ cell ovarian cancer derives from the reproductive cells of the ovaries. Germ cell ovarian cancer is rare.
Stromal cells ovarian cancer derives from connective tissue cell. Stromal cells ovarian cancer is also very rare.
Small cell carcinoma (SCCO) of the ovary is an extremely rare ovarian cancer and it is not certain whether the cells in SCCO are from ovarian epithelial cells, sex-cord stromal cells or germ cells.3
Ovarian cancer in Ireland:
Ireland has one of the highest rates of ovarian cancer in Europe
Ireland also has the 2nd lowest survival rates for ovarian cancer out of 24 EU countries
On average 387 women are diagnosed and 307 women die each year in Ireland from ovarian cancer2
It is the 6th most common cancer in Irish women after non-melanoma skin cancer and the 4th most common cause of death from cancer
Poor prognosis cancers have in common vague symptoms, late diagnosis, usually at an advanced stage, and a lack of effective treatment options
Ovarian cancer mainly affects women who have been through the menopause (usually over the age of 50)
It can also affect younger women
Lack of screening for ovarian cancer:
There is no reliable screening test for ovarian cancer and every person assigned female at birth is at risk. Delays in diagnoses is common due to this lack of screening and also because symptoms of ovarian cancer are often confused with other conditions. Most people are diagnosed once the cancer has already spread, making it more difficult to treat. While every woman is at risk, ovarian cancer is often overlooked and underfunded.3
Risk factors for ovarian cancer:
Getting older - most cases of ovarian cancer occur between the ages of 50 – 79 but younger people can also get ovarian cancer
Family history - risk is higher for women with a family history of ovarian, breast, endometrial or colorectal cancer
Faulty inherited genes - 5 to 15% are caused by inherited faulty genes, such as faults in the BRCA1 & BRCA2 gene and Lynch syndrome
Ethnicity - women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations and hence have an increased risk of ovarian cancer
Pregnancy & Breastfeeding your risk is higher if you have not delivered children. A decreased number of ovulatory cycles (for example during pregnancy and lactation) reduces the risk of ovarian cancer
The contraceptive pill - for every five years it is taken, hormonal contraception is known to reduce the risk of developing ovarian cancer by 20%
Smoking - an increase the risk of certain types of ovarian cancer such as mucinous ovarian cancer
HRT - slightly increased risk. Discuss with your G.P.
Medical condition endometriosis or diabetes
Being overweight or obese having excess body fat is linked to an increase in risk of ovarian cancer
Having one or more risk factors does not mean that you will definitely get ovarian cancer.3, 6, 7
Symptoms of ovarian cancer:
Let’s B.E.A.T. Ovarian Cancer:
Bloating or an increase in the size of your abdomen
Eating less and feeling full more quickly
Abdominal and pelvic pain you feel most days
Talk to your GP about your symptoms
Other possible symptoms may include:
Needing to pass urine more often
Tiredness that is unexplained
Weight loss that is unexplained
Changes in your bowel habit or symptoms of irritable bowel syndrome, especially if this starts after the age of 50
Abnormal bleeding – Any post-menopausal bleeding should always be checked by your primary health care provider or doctor3, 4
Diagnosis of ovarian cancer:
As mentioned, there is no routine screening test to diagnose ovarian cancer. A HPV cervical screening test (previously known as the Smear) does not check the ovaries and hence it will not detect ovarian cancer. While cervical screening is effective in early detection of cervical cancer, it is not a test for ovarian cancer.
It is very important to speak to your G.P. if you have any of the symptoms listed and if they persist for more than 3 weeks. Particularly if you have family history of ovarian or breast cancer or if you have a family history of the BRCA gene alteration (BRCA1 or BRCA2)
Your GP may do the following tests:
Pelvic exam
Transvaginal or pelvic ultrasound
CA-125 blood test
Your GP may refer you to a specialist (Gynaecologist) who may request further tests to diagnose or rule out ovarian cancer. Tests that may be done include the following:
CT scan - several x-rays are taken from different angles to create a detailed image of your ovaries
Needle biopsy - a needle is passed through your tummy, under anaesthetic, to retrieve a sample of ovary cells or fluid from around the ovaries, so it can be checked for cancer
Laparoscopy - a small opening is made in your tummy under anaesthetic and a tube with a camera is inserted to look at your ovaries, a small tissue sample may also be removed for testing.
If ovarian cancer is diagnosed, these tests can help check if the cancer has spread.5
Treatment for ovarian cancer:
A multidisciplinary team (MDT) will discuss the best treatment option for each individual
Your treatment depends on several factors:
Type of ovarian cancer
Stage of the cancer (Size and Spread)
Grade of the cancer – tells us how the cancer cells look in comparison to normal healthy cells
Your general health
The main treatments for ovarian cancer are:
Surgery
Chemotherapy
Radiotherapy
Targeted Therapies (e.g. PARP inhibitors)
Clinical trials
A combination of treatments may be required 5, 6
References available on request
