Ovarian Cancer

What is ovarian cancer?

The ovaries are two small glands that make up part of the female reproductive system. They have two main functions: to produce and store eggs for reproduction, and to produce the female sex hormones oestrogen and progesterone.
Ovarian cancer occurs when abnormal cells in the ovary start to multiply, creating a tumour. If the tumour is malignant it is cancerous and, left unchecked, may grow and spread to other parts of the body.

 

Types of ovarian cancer

There are three types of ovarian tumour: epithelial, germ cell and sex-cord stromal. Around 90% of ovarian cancer tumours are epithelial, the majority of which are known as serous epithelial ovarian cancer. These tumours occur most commonly in women between the ages of 40 and 60.

Stages and grades of ovarian cancer

When a woman is diagnosed with ovarian cancer she will be told what stage it is at. The stage represents how far the cancer has spread inside her body. There are four stages of ovarian cancer. At stage 1 the cancer is contained within one, or both of the ovaries. As the stages progress the cancer will spread further. By stage 4 it may have reached places such as the liver, the lungs and the brain. The earlier the cancer is diagnosed the easier it is to treat. A woman who is diagnosed with ovarian cancer will also be told what grade the tumour is. Grading predicts how quickly the tumour is expected to spread. 

Ovarian cancer is the fifth leading cause of cancer death in New Zealand women. Ovarian cancer begins in a woman's ovaries. They are part of a woman's reproductive system. There are two ovaries, one on each side of the body.

Types of ovarian cancer

Epithelial carcinoma. Epithelial cancer makes up 9 out of 10 of ovarian cancers. This type of cancer begins in cells on the outer surface of the ovary or the ‘epithelium’.

  • Germ cell tumor. This type of ovarian cancer develops in the egg-producing cells of the ovaries, and is very uncommon.
  • Sex-cord stromal cell tumor. This is a rare form of ovarian cancer. It develops in the ‘connective tissue’ cells that produce female hormones hold the ovaries together. 

What are the symptoms?

Symptoms of ovarian cancer may be confused with less serious, noncancerous conditions.  If you experience persistent symptoms for more than a few weeks or notice a change in your ovarian health, consult a doctor.

Common symptoms may include:

  • Abdominal bloating, indigestion or nausea
  • Changes in appetite, such as a loss of appetite or feeling full sooner
  • Pressure in the pelvis or lower back
  • A more frequent or urgent need to urinate and/or constipation
  • Changes in bowel movements
  • Increased abdominal girth
  • Tiredness or low energy
  • Changes in menstruation

    If your symptoms are:

    • Persistent
    • Severe
    • Frequent
    • Out of the ordinary

    You should make an appointment to see your GP as soon as possible.  Keep a record of what symptoms you are experiencing to take with you.  This will help your GP make a speedier diagnosis.  You can download our paper symptoms diary here.

    Ovarian cysts, masses or tumors 

    A pelvic mass may represent either benign (non cancerous) or malignant (cancerous) conditions.  Symptoms of ovarian cysts, masses or tumors may include:

    • Pelvic pain
    • Nausea or vomiting
    • Pain shortly before or after the start of your period
    • Pressure, swelling or pain in the abdomen
    • A dull ache in the lower back and thighs
    • Difficulty emptying your bladder
    • Pain during sex
    • Abnormal bleeding

    See your doctor for an evaluation if you suspect you have a pelvic mass.  During a physical exam, your doctor may be able to feel the mass.  He or she may then order an ultrasound to determine the size, shape, location and composition of the lump before recommending what you should do next.

    I have symptoms - what next?

    Make an appointment to see your GP

    If you are experiencing symptoms that could point to ovarian cancer, you should make an appointment to see your GP.  Track your symptoms so your GP can see how persistent and severe they are.  We’ve produced a symptoms diary to make this easier.  Download a paper copy here

    At the GP surgery

    Explain your symptoms and concerns and present your symptoms diary if you have used one.  Your GP should conduct a physical examination which may include feeling around your stomach area for any unusual lumps and bumps, and possibly an internal vaginal exam.

    Your GP will then take a blood sample to test your levels of a protein called CA-125.  Elevated levels of this protein can sometimes be an indicator of ovarian cancer.  Ask you GP for an ultrasound scan at the same time as your blood test as a blood test on its own can miss half of early ovarian cancers.

    Half of early ovarian cancers will have a normal CA-125.  If your blood test results are normal but you continue to experience symptoms it is important to let your doctor know.

    If your CA-125 test comes back positive

    This does not necessarily mean you have ovarian cancer but that further investigation is required. If you have not had an ultrasound scan, you will be referred to your local hospital for an ultrasound scan.  There are two types of ultrasound scan you might have: transabdominal - which involves a device being passed over the stomach, or transvaginal - which involves a probe being inserted into your vagina.  The ultrasound scan is to find out whether or not you require further tests.

    Gynaecologist referral

    If your ultrasound scan indicates that you need further tests you will be referred to a gynaecologist. They will arrange for further tests to establish whether or not you have ovarian cancer. These may include: a CT scan, MRI scan, a laparoscopy or a laparotomy. 

    If you feel you are not being taken seriously

    It is important to remember that GPs will see these symptoms in women every single day, and the majority of the time it won’t be due to ovarian cancer.  However, if you feel your symptoms are persistent, severe, and are not getting any better then consider the following options:

    • Ensure your symptoms diary is filled in as comprehensively as possible so you are giving your GP as much information as you can
    • Take someone with you for moral support and to help explain your concerns
    • Ask your GP for a second opinion
    • Make an appointment to see a different GP at your practice 
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