Early diagnosis is key in improving the prognosis of ovarian cancer. Women with stage one or two are much more likely to be cured than women with a later stage. Unfortunately in many cases, ovarian cancer can occur in women with no family history. Attempts have been made to screen for the disease using either the blood test CA 125 or transvaginal pelvic ultrasound scans, but as yet neither test has been shown to be effective.
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Symptoms of ovarian cancer include increased abdominal size or persistent bloating, pelvic or abdominal pain, or nausea, and difficulty eating or feeling full. Unfortunately, these symptoms are quite vague, and overlap with other conditions including irritable bowel syndrome or premenstrual syndrome. Because of this, it has been difficult to reduce the mortality rate from ovarian cancer, as most cases are diagnosed only after they have spread within the abdominal cavity.
In the early stages, ovarian tumours may be small and produce very mild symptoms. However, once the cancer spreads, fluid may collect within the abdomen (ascites), which makes the disease much more obvious. The best test to exclude an ovarian cancer is a pelvic ultrasound scan performed by a specialist gynaecology scanner. Often a CA 125 blood test is also performed.
Recent evidence suggests that most ovarian cancers start in the fallopian tubes rather than the ovaries. Women at high risk of ovarian cancer because of genetics sometimes have their ovaries removed before disease develops as a prophylactic measure. In these women, a small number would be expected to have very early undetected cancers or even pre-cancers. However, rather than finding these lesions within the ovaries, abnormalities within the fallopian tubes have been found. By the time cancers are diagnosed, the ovaries and tubes are often both involved in a large tumour mass and identifying where the cancer begun proves difficult.
The identification of the fallopian tubes as the probable origin of ovarian cancer raises the possibility of removing the tubes to prevent ovarian cancer rather than needing to remove the ovaries – causing menopause. However, this theoretical possibility has yet to be tested in large trials.
Treatment for ovarian cancer usually includes an operation to remove all of the cancer or as much as possible, and chemotherapy given every three weeks for a total of six cycles over about 4 months. There is some debate over whether it is better to perform surgery at the beginning of treatment or after the first three cycles of chemotherapy. Some surgeons believe that surgery isn’t very important, and others believe that trying to remove as much cancer as possible makes a world of difference. While opinions vary, it is known that if all visible cancer is removed, it can have a big influence on the long-term outcome.
Here at The McIndoe Centre, we do everything in our power to relieve any concerns you may have regarding diagnosis, treatment and beyond. Mr McIndoe is a leader in the treatment of ovarian cancer and and along with his dedicated surgical team, offers the highest standard of care for all of his patients.