Ovarian cancer

In the UK, ovarian cancer is the 6th most common cancer in women, with over 6,500 women diagnosed each year, in St Vincent and the Grenadines it is the 5th commonest cause of cancer death in women.

Most cases occur in women who are postmenopausal and are usually aged over 50, but younger women can also be affected.

It has the highest mortality of all gynaecological cancers, accounting for 6 percent of all cancer deaths.

The reason why ovarian cancer develops is unknown.

Symptoms

Symptoms can be present for more than a year and occurring more than 12 times per month and include persistent abdominal distension, bloating, early satiety and/or loss of appetite, pelvic or abdominal pain, and increased urinary urgency and or frequency, postmenopausal bleeding; unexplained weight loss; fatigue or changes in bowel habit.

The patient can also present with a pelvic or abdominal mass.

A family history of ovarian or breast cancer increases the risk. This can be the result of a faulty gene. The most common faulty genes are BRCA1 and BRCA2 as about 1 in 10 ovarian cancers may be caused by a faulty gene.

Factors that decrease risks include taking the oral contraceptive pill, being pregnant or breastfeeding. The risk increases slightly in women who have not had children and who have a late menopause.

Diagnosis

• Ovarian cancer may be suspected if an ovary appears abnormal on an ultrasound scan.

• Blood tests such as high levels of a protein called CA125 can make it more likely that it is malignant. If these are elevated a CT scan (computed tomography scan) of your abdomen and pelvis will be done.

• Other tests include draining fluid in the abdomen (ascites) or taking a tissue sample via laparoscopy (keyhole surgery).

• Younger women will have other blood tests done to rule out different tumours.

Treatment

• Most patients will have a total abdominal hysterectomy with removal of the ovaries and tubes in addition to the omentum, which is a fatty layer in the abdomen

• Once this is done then the surgical staging is done and then it is determined if these patients will need further treatment in the form chemotherapy.

• Removal of lymph nodes at the time of hysterectomy may be done depending on the stage of disease.

In conclusion, ovarian cancer usually presents late and women complaining of vague symptoms should be reviewed to rule out this disease. Early diagnosis saves lives as this cancer has the highest mortality of all the gynaecological cancers. Any patient with suspected or diagnosed with a pelvic mass should be seen by a gynaecologist with a special interest in gynaecological oncology to adequately investigate and plan conservative or surgical treatment.

Dr John Barker Bsc MBBS MRCOG, Dip (Risk Management) is an Obstetrician/Gynaecologist at Arnos Vale Medical Centre, Consultant Obstetrician/Gynaecologist UK. He has completed the Advanced Training Skills Module in Gynaecological Oncology in the UK and runs gynaecological oncology clinics for diagnosis and management of suspected and confirmed female genital cancers.