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Ovarian cancer is a cancer in one or both of the ovaries. It is important to know the signs and symptoms of ovarian cancer as there are no tests or screening available to detect it. These can include bloating, frequent urination (with no infection), back pain, heartburn, pain during intercourse and unexplained bleeding.

Ovarian cancer is difficult to detect in the early stages. It usually starts in cells on the surface or inside the ovary or from the fallopian tubes, and gradually enlarges. As there is room for it to grow, it does not cause symptoms until it is quite large.

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What is ovarian cancer?

Ovarian cancer is a cancer that forms in one or both of the ovaries. The ovaries are made up of three main kinds of cells – epithelial cells, stromal cells and germ cells. Each of these cells can develop into a different type of tumour.

Some cancers are called borderline as they usually are slow growing, confined to the ovary and are treated by surgery alone. About 15% of ovarian tumours are borderline and usually affect young women between 20 to 40 years. Very rarely do they spread outside the ovary, with a small risk of coming back or turning into a more active cancer.

The three types of ovarian cancer are:

1. Epithelial

This type of cancer starts in the cells lining in the surface layer of the ovary – epithelium

  • 90% of ovarian cancers are in this group
  • Usually occurs in women over 50 years of age.

Research suggests that many epithelial ovarian cancers may start in the fallopian tubes.

These cancers can be cystic and contain watery fluid (serous) or mucous-like fluid (mucinous).

2. Germ cell

This ovarian cancer starts in the cells that produce eggs

  • 5% of ovarian cancer cases
  • Develops in women younger than 30.

3. Stromal cell and other rare types

Ovarian cancer that starts in the tissues that support the ovary and produce different cells. It also includes sex-cord stromal cell ovarian cancer, stromal tumours and sarcomas.

  • Rare
  • Occurs at any age.

How common is ovarian cancer?

Ovarian cancer is the eighth most commonly diagnosed cancer in women in Australia. Every year around 1800 women are diagnosed with ovarian cancer in Australia.

Even though ovarian cancer is less common than lung cancer or breast cancer, it is important to be aware of its signs and symptoms as early diagnosis improves treatment outcomes. If a woman is diagnosed early, while the cancer is localised (Stage 1), survival rate is over 90%. However, only 29% of women diagnosed at a late stage will survive for more than five years.

Currently there are no reliable early detection tests for ovarian cancer and therefore no screening programs are available.

Risk factors

What increases your risk of ovarian cancer?

The exact causes of ovarian cancer are unknown. However, there are some factors that increase the risk of developing ovarian cancer including:

Age
  • Getting older is the biggest risk factor. Most cases are in women after the menopause with the average age of diagnosis being 64 years
  • However, it can occur at any age, even in teenagers
Hereditary factors
  • One or more close relatives with ovarian, breast or other cancer (colorectal or endometrial)
  • BRCA 1 or 2 positive genes
  • Being of Ashkenazi Jewish descent
Other factors
  • Never having children
  • Never taking combined hormone contraceptives
  • Having endometriosis, a previous breast cancer or diabetes
  • Smoking, in particular, mucinous cancers, both invasive and borderline
  • Being overweight/obese
  • Being on long-term menopausal hormone therapy (MHT, formerly called hormone replacement therapy, HRT) either oestrogen alone or oestrogen and progestogen.

What reduces your risk of ovarian cancer?

Just as there are factors that increase your risk, there are also factors that can reduce the risk of developing ovarian cancer. These include:

  • having children
  • having taken combined hormone contraceptives
  • surgical removal of the ovaries and fallopian tubes.

If you are concerned about your risk, talk to your doctor.

There is currently no proven method of preventing ovarian cancer. Even removing the ovaries of a woman with a strong family history does not always prevent cancer with a very small risk of it occurring in the lining (peritoneum) of the abdomen.

Signs & symptoms of ovarian cancer

Ovarian cancer is difficult to detect in the early stages. It usually starts as a painless lump or cyst on or in the ovary and gradually enlarges. As there is room for it to grow, it does not cause symptoms until it is quite large.

The symptoms of ovarian cancer are often vague and non-specific. Almost every woman will experience these symptoms at various times and in most cases the symptoms will not be caused by ovarian cancer.

The most commonly symptoms of ovarian cancer are:

  • increased abdominal size or persistent abdominal bloating
  • abdominal or pelvic (lower tummy) pain
  • feeling full after eating a small amount
  • needing to urinate often or urgently.

Additional symptoms may include:

  • changes in bowel habits
  • unexplained weight gain or loss
  • excessive fatigue
  • lower back pain
  • indigestion or nausea
  • bleeding after menopause or in-between periods
  • irregular periods
  • pain during sex or bleeding after.

These symptoms can occur in many women at various times and be unrelated to cancer, which is why ovarian cancer might not be diagnosed until it is quite advanced.

Daughter with cancer being hugged by mum

How is ovarian cancer diagnosed?

If you experience some of the symptoms of ovarian cancer for more than two weeks, and they are a change from what is normal for you, ask your doctor about the possibility of ovarian cancer.

Your doctor will initially ask questions about your symptoms, past health history and family health history. A physical examination will then be conducted, including a pelvic examination to check your vulva, vagina and cervix, and a manual vaginal examination to check your uterus and pelvis.

If no other cause can be determined for your symptoms, a transvaginal ultrasound examination (internal ultrasound via the vagina) can be performed. This is a test for identifying abnormalities in the ovaries and in the pelvis.

Other imaging tests such as computerised tomography (CT) and positron emission tomography (PET) scans can be used to check for cancer and other abnormal tissue.

Your doctor may also order a simple blood test called a CA-125 (a common tumour marker), but this test is not always reliable.

Referral to a gynaecological oncologist

If your assessment and investigations suggest ovarian cancer is a possibility, ask your doctor for an immediate referral to a gynaecological oncologist.

Gynaecological oncologists are specialists gynaecologists who treat cancers such as ovarian cancer. It has been shown that women with ovarian cancer who are treated by a gynaecological oncologist have better outcomes.

Treatment for ovarian cancer

Treatment for ovarian cancer depends on the extent of the cancer. It may include any of, or a combination of, the following:

  • surgery
  • chemotherapy
  • special therapies, drugs or chemicals, used to target specific cancer cells
  • radiotherapy and immunotherapy are currently being used in clinical trials.

When to see your doctor

Detecting ovarian cancer early leads to the best outcomes. You should visit your doctor if you notice:

  • increased abdominal size or persistent abdominal bloating
  • abdominal or pelvic (lower tummy) pain
  • feeling full after eating a small amount
  • needing to urinate often or urgently.

And these symptoms

  • are a change from what is normal for you;
  • persist for more than 2 weeks;
  • and there is no other explanation for you having these symptoms.

Further information about ovarian cancer can be found at:

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at July 2021.

References

  • 1
    10 most common causes of death from cancer in Australian women (Australian Institute of Health and Welfare, 2017)
  • 2
    Ovarian cancer statistics in Australia (Australian Government, Cancer Australia)
  • 3
    Gompel A, Burger H. A commentary on a recent update of the ovarian cancer risk attributable to menopausal hormone therapy. Climacteric. 2015 June;18(3):376–8.
  • 4
    Kotsopoulos J, Terry KL, Poole EM, Rosner B, Murphy MA, Hecht JL et al. Ovarian cancer risk factors by tumor dominance, a surrogate for cell of origin. Int J Cancer. 2013 Aug 1;133(3):730–9.
  • 5
    Faber M, Kjær SK, Dehlendorff C, Chang-Claude J, Andersen KK, Høgdall E et al. Cigarette smoking and risk of ovarian cancer: a pooled analysis of 21 case–control studies. Cancer Causes Control. 2013 May;24(5):989–1004.doi:10.1007/s10552-013-0174-4.
  • 6
    Bassuk SS, Manson JE, Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. .Ann Epidemiol. 2015 Mar;25(3):193-200
Last updated: 12 October 2021 | Last reviewed: 16 July 2021

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