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Ovarian CancerWhat is Ovarian Cancer?Of all the gynaecological cancers, ovarian cancer provides the greatest clinical challenge. Ovarian cancers are very silent during their early stages of development, so when the diagnosis is made they are likely to be well advanced, which in turn makes treatment difficult and in the long term affects the cure rate. 70% of women with ovarian cancer are Stage 3 or more at the time of diagnosis. This signals spread of the disease out of the pelvis to other parts of the body. Ovarian cancer is the sixth most common cancer in women in the United States of America. It accounts for 4% of all female cancers. A woman's life expectancy of developing ovarian cancer is about 1.5%, and of dying of ovarian cancer about 1%. The peak incidence of ovarian cancer occurs at about 55 years of age. Approximately 80% of ovarian cancers occur after the age of 40 years, and 40% after the age of 65 years. The incidence of ovarian cancer continues to rise through until the age of 80 years, when the incidence begins to decline. Predisposing FactorsOvarian cancers commonly arise without any obvious predisposing factors. However, some factors have been identified. In particular, ovarian cancer has been associated with low parity and infertility, meaning that it often arises in women who have a history of having few or no children. An increased incidence is also associated with the early onset of the menstrual periods in the teenage years, and the late onset of the menopause at the other end of the fertility cycle. On the other hand bearing children and using the oral contraceptive pill appears to be protective towards ovarian cancer. Women who have had at least two children and who have been on the oral contraceptive pill for five or more years have a relative risk of developing ovarian cancer of 0.3, this equates to a 70% reduction in the risk of developing ovarian cancer. Most ovarian cancers develop sporadically and without hereditary or genetic influence. Familial tendencies and patterns account for between 5 and 10% of ovarian cancers and where there is a strong family history of ovarian cancer, often associated with a history of breast or bowel cancer, genetic testing should be carried out to look for this genetic predisposition. In particular we test for BRCA1 and BRCA2 genes and if positive this confirms that there is a familial tendency to these cancers. Symptoms of Ovarian CancerThe symptoms of ovarian cancer are often non existent or vague until the cancer develops to an advanced stage. At this time abdominal distension may be noted and it is often abdominal discomfort that takes a woman to her doctor. Physical examination and ultrasound of the abdomen and pelvis will in most cases suggest the diagnosis. A tumour marker blood test, CA 125, maybe elevated also and this will tend to aid confirmation of the presumptive diagnosis. Staging of Ovarian CancerThe staging of ovarian cancer is usually confirmed at the time of surgery.
Treatment OptionsThe treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. These treatments are best carried out by specialist teams. Sub specialists called Gynaecological Oncologists are best equipped to carry out this surgery and they are fully backed up by Medical Oncologists who specialise in the management of ovarian cancer, and this twin approach brings about the best outcomes. The surgical approach involves removal of the uterus (hysterectomy) and both ovaries and as much of the cancer from elsewhere as can be removed safely. There is a direct correlation between the small size of the deposits that remain after surgery and eventual outcome or cure rates. A course of chemotherapy enhances what the surgery has already achieved and in recent years very effective chemotherapy agents have been developed for use in ovarian cancers. In spite of modern treatments the overall survival figures for ovarian cancers are disappointing. For all stages there is about a 50% chance of five year survival. For stages three and four however the figure drops to round about 20%, even with good management, whereas with stage one disease the five year survival is close to 100%. So we can see that the key to good results in the treatment of ovarian cancer is early diagnosis. ScreeningUnfortunately no reliable screening tests have yet been found but the search continues. Currently the two most useful investigations are pelvic ultrasound, to look at changes in the ovaries, and the employment of tumour marking testing, in particular CA 125. CA 125 elevation can detect 50% of patients with Stage 1 disease and 60% of patients with Stage 2 disease. So although helpful, there will still be false negatives. Ultrasound examination looks at the ovaries and tries to detect changes in the ovaries which might signify the possibility of malignant or pre-malignant change. The recent use of Doppler Flow technology can detect the rate of blood flow through an abnormal looking ovary and this may enhance the diagnostic value of an ultrasound study. For the future we look forward to the development of specific therapeutic agents for use in the treatment of ovarian cancer. These provide significant hope for the future. Relevant Links |