Ovarian cancer

Ovarian cancer is one of the main types of gynaecological cancer (defined as cancers originating from the reproductive system). It is a cancerous growth that originates from the ovaries, two organs situated on both sides of the uterus (womb).

The ovaries serve two functions:

• The production of eggs for fertilisation
• The production of female hormones for the enhancement of feminine features

According to the 2015 Singapore Cancer Registry Annual Registry Report, ovarian cancer is the fifth most frequent cancer in females from 2011 to 2015 overall, but with a slightly higher incidence among Indian and Malay females in comparison with their Chinese counterparts. An estimated 383 cases are being diagnosed annually in Singapore. It is also the second most common cancer of the female genital tract. Ovarian cancer is representative of less than 5 percent of all ovarian cysts.

Risk Factors of Ovarian Cancer

Medical science has yet to determine what causes ovarian cancer to develop in women. However, there are a number of risk factors that will increase a woman’s likelihood of developing this disease:

• Postmenopausal women over the age of 50
• Family history of ovarian cancer- having one relative with ovarian cancer increases a woman’s lifetime risk to 5 percent. If a woman has two relatives with this cancer, her lifetime risk increases to 7 percent.
• Presence of associated genetic syndromes – a woman with Hereditary Non-Polyposis Colorectal Cancer (HNPCC), an inherited cancer of the digestive system, has a lifetime risk of cancer of 12 percent. A woman with hereditary breast and ovarian cancer syndrome not only has a lifetime risk of 23 to 54 percent for ovarian cancer; she may also develop breast or pancreatic cancers.
• Genetic mutations – women with the inherited gene mutations BRCA1 or BRCA2 (the same mutations that cause breast cancer) also have an increased lifetime risk for ovarian cancer at 10 to 26 percent.
• Late or no pregnancy
• Low parity – number of times that a woman has carried a pregnancy to term
• Early onset of menstruation (also known as “menarche”)
• Late onset of menopause
• Women on oestrogen replacement therapy for more than 5 years
• History of breast cancer
• History of endometriosis

Signs and Symptoms of Ovarian Cancer

Ovarian cancer in its early stages rarely presents any signs and symptoms. If symptoms do occur, it signifies that the cancer is already at an advanced stage.

Symptoms that you should watch out for include:

• Abdominal discomfort and bloatedness
• Flatulence and indigestion
• Abdominal and/or pelvic pain
• Bowel habit changes, such as constipation
• Loss of weight and appetite
• Back pain
• Increased urinary frequency and other urinary complaints
• Abnormal vaginal bleeding in-between menstrual periods or after menopause

How Ovarian Cancer is Diagnosed

Most cases of ovarian cancer are diagnosed during a routine pelvic examination with a doctor.

On physical examination, the doctor may feel or palpate an enlarged ovary, an abdomino-pelvic lump, or fluid in the abdomen (ascites). In order to further check the organs inside the body, the doctor may perform a transvaginal (wherein a probe is inserted into the vagina) or abdominal/pelvic ultrasound or CT scan. Cysts that are greater than 5 cm in diameter with a complex appearance suggestive features are suspected to be malignant.

The doctor may also order a blood test to determine the presence of the CA-125 protein, the levels of which are increased by 80 percent in women with epithelial ovarian cancer. It should be noted, however, that a high CA-125 test result is not a definitive diagnosis of ovarian cancer since there are benign or non-cancerous conditions that may cause an increase in this protein, such as appendicitis, endometriosis, adenomyosis, fibroids, and pelvic infection.

Other tests that the doctor may order include:

• CT or MRI scan of the abdomen and pelvis – to determine the extent of the cancer
• Chest X-ray – to determine the presence of cancer spread to the lungs
• Routine blood tests
• Abdominal fluid aspiration – this procedure is done if the abdominal swelling is due to the accumulation of fluid or ascites. The fluid is examined for the presence of cancer cells

Treatment of Ovarian Cancer

The definitive diagnosis and treatment of ovarian cancer is surgery. Biopsy of the ovarian growth is necessary for histological evidence of the cancer and also for the determination of the type of ovarian cancer. 

A complete and thorough surgery for the removal of ovarian cancer may involve any or all of the following procedures:

• Total hysterectomy – complete removal of the uterus and cervix
• Bilateral salpingo-oophorectomy – removal of the fallopian tubes and ovaries
• Lymphadenectomy – removal of affected lymph nodes
• Omentectomy – removal of the omentum (abdominal tissue that encloses the stomach, large intestines and other abdominal organs) together with the lymph nodes contained within.

While 60 percent of women undergo primary surgical cytoreduction for tumour size reduction, much success for the same goal has been observed in the 40 percent of women who undergo neoadjuvant chemotherapy. It is important to discuss with the doctor which of these procedures is best suited for their particular ovarian cancer stage.

Sincere Healthcare Group offers comprehensive screening procedures for the early detection and diagnosis of ovarian cancer. Early detection remains the best way to save women’s lives. Greater attention will be given to women with high risk factors, such as a family history of ovarian, breast or colon cancer, and infertility. If you are experiencing any of the ovarian cancer symptoms mentioned above, we strongly advise that you schedule an appointment with any of our experienced and dedicated specialists.