Property Search
Cars Online
Buy DVDs online
Local sleepovers
Book flights online!
Work money smarter
Wine of the Week
Life Insurance Quote
Online Dating
Save on your insurance
Houses for sale
Go shopping!
Convert anything 
Henrie's Recipes
About Ovarian cancer
Posted Tue, 30 May 2000
Ovarian cancer is one of those malignancies which most women do not really consider. It doesn't get the press coverage which breast or cervical cancer do. However, the lifetime risk of developing ovarian cancer is about 1%, which is the same as that for developing cervical or endometrial cancer.
In developing countries the overall incidence of ovarian cancer seems to be falling which may have something to do with increasing rates of hysterectomy with accompanying oophorectomy, removal of the ovaries.
Who gets ovarian cancer?
Most cases of ovarian cancer are sporadic, with about 5% of cases occurring in those with a family history of the disease. The most common type of family history is one of breast and ovarian cancer.
Another type of family history is an association between breast, endometrial, colon and ovarian cancer.
Other high risk factors include age more than 50 years, few or no children, and being of Northern European descent. There is a possible link with using fertility drugs, and a high fat diet, using talc and a history of mumps may also be weak risk factors for developing ovarian cancer.
The risk of developing the disease is less in those who have had many children, use the oral contraceptive pill, and have had a hysterectomy. Sterilization by tubal ligation may also protect against ovarian cancer.
Can you screen for ovarian cancer?
We hear a lot about breast and cervical cancer screening. Can you do the same for ovarian cancer?
Any screening test must be highly sensitive, specific and cost-effective. Several studies have investigated screening since ovarian cancer is relatively common in Western communities, and has a high mortality. However, unfortunately none have come up with a sufficiently sensitive and specific screening test. All they have shown is that regular internal examinations by either a GP or a gynaecologist are inadequate.
Measuring levels of serum CA 125, a tumour marker, is no use for routine screening as this test does not easily pick up small, potentially curable, ovarian tumours.
Ultrasound will pick up small ovarian tumours, but large screening programs using this technique have resulted in many women being diagnosed with benign tumours, and of those with a malignancy, half already have spread of the disease, making them incurable. However, in those with a strong family history of the disease a combination of ultrasound and CA 125 testing may be useful.
Where there is a strong family history, that is two or more family members with a history of ovarian cancer, and, in particular those with relatives with ovarian, bowel or breast cancer before menopause, women should have a full assessment by a gynaecologist specializing in cancers. Many people recommend that such women have their ovaries removed after they have had their children to prevent ovarian cancer developing.
How is ovarian cancer diagnosed?
One of the problems with ovarian cancer, and probably the main reason that it still has such a high mortality, is that it is difficult to diagnose. It is rare before the age of 40, and most common in women in their 60's.
The symptoms and signs are very non-specific. The most common symptoms are increasing waist size, frequently put down to the weight gains common as we age. Appetite may decrease. There may be pressure symptoms such as discomfort during intercourse or when passing a bowel motion. There may also be a change in bowel habit. Some women complain of shortness of breath as the ovarian mass pushes other abdominal structures up towards the diaphragm. Your GP may notice that you are mildly anaemic.
Uncommonly there may be colicky abdominal pain, vaginal bleeding, weight loss and acute uterine prolapse.
A combination of investigations is used when ovarian cancer is suspected. Serum CA 125 is measured, and if greater than 35U/ml, there is a 78% chance of any ovarian mass being malignant. If the value is greater than 200U/ml, the chances of malignancy rise to 88%. However, treat this test with caution in women who are premenopausal, since CA 125 can be elevated by endometriosis, pelvic inflammatory disease, fibroids and pregnancy. This test is much more specific in postmenopausal women.
Ultrasound is the other investigation used, and is more specific than CT scanning when looking for spread of the cancer.
How is ovarian cancer treated?
Surgery is the main form of treatment. The extent of the surgery will depend on the stage of the cancer and whether it has spread beyond the pelvis.
About 25% of patients are detected early and, in general, survival in this group is more than 80% at five years, as long as they have well differentiated tumour types.
However, most patients are diagnosed late and will already have spread of the disease. Surgery in these patients is aimed at clearing as much tumour from the pelvis as possible, and freeing any bowel which is involved.
Chemotherapy is generally recommended as well as surgery, even for those who have disease confined to the ovary if they have a strong risk of recurrence after surgery. Results from recent studies of newer chemotherapy regimes are encouraging, as they generally show increased survival times.
Radiotherapy is no longer frequently used due to the advances in chemotherapy. However, it may be used in a small group of women who have very little disease remaining after surgery and a low risk of recurrent disease.
Links
There are many sites dealing with cancers of all types. These links provide starting points for further searching and are are not meant to be comprehensive. The Cancer Web Project is a British site with a mass of information on all cancers and links to other cancer sites. Also British is the UK Health Centre: a guide to UK medical information on the Web. A search for ovarian cancer will provide plenty of information. An American site is Med Web: gynaecology and women's health, which has a section on ovarian cancer.
