Ovarian cancer: what do you need to know?

Ovarian cancers are cancers that begin in the ovaries. Women have two ovaries on either side of the uterus and produce eggs as well as hormones, progesterone and oestrogen.

Ovarian cancer occurs when abnormal cells in the ovary divide in an uncontrolled way and form a tumour. If these abnormal cells spread to other parts of the body then the cancer is called metastatic ovarian cancer.

Early-stage ovarian cancer hardly causes symptoms which means that ovarian cancer is often detected late making it more difficult to treat. Even late stage or advanced ovarian cancer symptoms can be mistaken for other conditions. This is why screening for this cancer is very important.

What are the symptoms of ovarian cancer?

"Detection of ovarian cancer is very difficult and it often presents late," says Oncological Gynaecologist Dr Trudy Smith. This is because presenting symptoms are often vague tummy-related issues such as:

• a feeling of fullness or bloating
• dyspepsia, or indigestion
• pain in the abdomen or pelvis
• general discomfort
• an increase in the urgency to urinate

- Read Sherene Grobler's journey through ovarian cancer, which started with a stomach ache which she thought was linked to having a spastic colon.
- And, Linda Greeff, an oncology social worker and cancer survivor herself, shares insights from her own experience of ovarian cancer.

"Gastroenterologists see many patients for these symptoms, which are often confused with Irritable Bowel Syndrome," she continues, "And it's often only when the abdomen becomes distended that the problem is found - which usually means the cancer is at an advanced stage". According to the American Cancer Society, only about 20% of cases are diagnosed early.

That's why ongoing symptoms should never be ignored, and Dr Smith advises always consulting a doctor if:

• There's a family history of breast or ovarian cancer
• The feeling of being bloated is ongoing
• Any of the other above-mentioned symptoms persist.
• You have any signs or symptoms that worry you

What types of ovarian cancer are there?

According to the Mayo Clinic, three types of cells exist in the ovaries and ovarian cancers can occur in all three:

• Epithelial tumors which start in the thin layer of tissue on the outside of the ovaries (around 90% of ovarian cancers are epithelial tumors).
• Stromal tumors which start in the hormone-producing cells in ovarian tissue (around 7% of ovarian cancers are stromal tumors).
• Germ cell tumors which develop in the egg-producing cells (more rate and tend to occur in younger women)

What are the risk factors for ovarian cancer?

Most ovarian cancers occur sporadically, explains Dr Smith. "However there are several dominant hereditary forms of ovarian cancer that account for about 20 to 25% of cases.

The most common and best known hereditary forms are linked to the presence of the BRCA 1 and BRCA 2 genes (breast cancer genes 1 and 2) which catapulted to 'fame' in 2013 when Angelina Jolie went public about being a BRCA 1 carrier, having inherited the gene from her mother.

Studies have shown an increased risk for ovarian cancer in women with a personal or family history of breast and ovarian cancers - which is why Jolie elected to undergo preventative double mastectomy surgery.

In addition to a number of other known hereditary contributors, another recently discovered genetic ovarian cancer risk factor is an X-linked gene called the MAGE3 gene which researchers believe may be carried by the father, but more research is needed on this front.

According to Professor Michael C Herbst, health specialist at CANSA the causes of ovarian cancer remain generally unknown. "What we do know is that it usually affects women over 55 who have gone through menopause, and that there are certain risk factors that tend to increase a woman's chance of developing ovarian cancer. That said, younger women are also affected, and while many women with certain risk factors remain ovarian cancer-free, there are many women who develop ovarian cancer who have no risk factors at all."

Professor Herbst explains that there are also a number of other factors that appear to increase ovarian cancer risk including being infertile or having fertility treatment (having children at a younger age, or having more children, tends to decrease the risk of ovarian cancer), while research also seems to suggest that women who have endometriosis and who smoke or are obese, are at a slightly higher risk.

Are there any preventative measures when it comes to ovarian cancer?

Professor Herbst insists that because no early detection tool is available, women and medical professionals need to become more aware of ovarian cancer symptoms and to immediately act on these. There are several blood tests, for example, that women who are at high risk of ovarian cancer can undergo.

"There's no doubt that early detection of ovarian cancer saves lives," continues Dr Smith. "Survival rates linked to ovarian cancer are related to the stage of the disease with the five-year survival of a stage 1 cancer being 90%. However this rapidly drops to approximately 25% in stage 4 ovarian cancer."

"And although there is currently nothing that can be done to prevent ovarian cancer," adds Professor Herbst, "there are some protective factors that could reduce the odds of developing ovarian cancers, although of course, as with all forms of cancer, there are no guarantees."

These include:

• Making healthy lifestyle changes such as stopping smoking, exercising regularly and eating a healthy, balanced diet
• Getting enough vitamin D - although more research is required, this may  reduce the risk of developing a number of cancers, including ovarian cancer
• Refraining from using talc - recent research has demonstrated a possible carcinogenic link between ovarian cancer and the use of genital talc
• Having prophylactic surgery. Options include: 
  • removal of the uterus (womb)
  • removal of the ovaries
  • having the fallopian tubes tied
  • having the fallopian tubes removed

"Prophylactic surgery is certainly an option to decrease the risk of ovarian cancer but removing a young woman's ovaries comes with its own inherent problems, which is why this needs to be thoroughly discussed with a surgeon," says Dr Smith.

"However, that discussion will only take place after genetic testing. It's important that anyone with a family history of cancer who is a candidate for genetic testing undergoes genetic education and counselling before doing so," she adds. "As this will enable a woman to make informed decisions with her specialist about whether or not to undergo surgery."

All medical information found in this article is for educational and informational purposes only. Discovery Health publishes this content to help empower cancer patients and their families by promoting a better understanding of cancer. The views expressed by all of the contributing healthcare providers are their independent, professional medical opinions and do not necessarily constitute the views of Discovery Health Pty (Ltd).