Dr Lim Hwee Yong, senior consultant oncologist at Mount Elizabeth Novena Hospital, sheds light on the symptoms, diagnosis and treatment of ovarian cancer.
What is ovarian cancer?
Ovarian cancer is cancer that begins in the ovaries. It is the 5th most common cancer in Singaporean women and accounts for more deaths than any other cancer of the female reproductive system.
Ovarian cancer mainly affects older women. About half of the women diagnosed with ovarian cancer are above 60 years of age. Other than age, the risk of getting ovarian cancer is increased with obesity, later age of pregnancy, having never been pregnant, early onset of menstruation, late start of menopause, having a family history of certain cancers, and certain genetic predispositions.
Detecting ovarian cancer
Ovarian cancers tend to be very difficult to detect early on because they rarely exhibit early symptoms or signs. In most cases, the symptoms are vague and may persist for several months before being recognised and diagnosed. These symptoms include bloating, pelvic pain and discomfort, abdominal distension, loss of appetite, and change in bowel habits.
Only about 20% of ovarian cancers are found at an early stage. When ovarian cancer is found early at an early stage, the chances of cure with treatment becomes significantly higher and long-term survival rates may be more than 85%.
Pelvic ultrasounds and CT scans of the abdomen and pelvis may help in the detection of abnormal masses. An operation or biopsy acquiring tissue samples would eventually be required to ascertain if the cancerous cells arose from the ovaries.
Treating ovarian cancer
Treatment is dependent on the stage of cancer, the patient's current clinical conditions as well as the wishes of the patient and their family. It should be undertaken after a full discussion with the patient's oncologist about the benefits and risks of each available treatment option.
Surgery remains an important method in treating early-stage ovarian cancer. Often, surgery may also be done to properly assess the extent and stage of the cancer. This has to be performed by a surgeon experienced in ovarian cancer surgery. During the procedure, the doctor will examine the peritoneum and will send tissues from various areas of the abdomen, as well as the primary ovarian site of the tumour for microscopic examination.
For more advanced stages, the surgeon may perform cancer debulking surgery to remove as much of the tumour as possible. This may sometimes involve removing a section of the colon.
Chemotherapy, the treatment of cancer using medication, is an effective means of treating ovarian cancer. Epithelial ovarian cancer often shrinks in response to chemotherapy and may even seem to disappear with treatment. However, with chemotherapy as the only treatment for ovarian cancer, the cancer cells may eventually begin to grow again. If the disease recurs, the patient may be treated with the same combination of medication or proceed to treatment with other kinds of medications.
Progress in treatment methods for ovarian cancer
In recent years, there has been significant progress in the treatment of ovarian cancer with new drugs. Targeted therapy is a type of chemotherapy that targets specific molecules associated with tumour growth and progression. Such therapy has shown increased effectiveness in treating ovarian cancer. Some of these treatment strategies involve anti-angiogenesis (molecular drugs that block the signal cancer cells send out to recruit new blood vessels that nourish new tumours) which achieves excellent treatment response outcomes. Good control of the side effects of chemotherapy can also be readily achieved nowadays, with the advent of new supportive medications.
In this day and age, there are effective treatment options to help even patients diagnosed with late-stage ovarian cancer live active, good quality and meaningful lives.
Surgery and chemotherapy remain the mainstay of ovarian cancer treatment. Frequently, even in relatively early-stage cancer, the patient will still require post-operative chemotherapy to achieve a heightened level of cure for this cancer. Radiation and hormonal therapy are not highly effective treatments for ovarian cancer and are thus not often used.