Ovarian Cancer

Ovarian cancer is the abnormal growth of cells that begins in the ovaries, which are part of the female reproductive system. It is one of the most common cancers among women in Malaysia and is commonly seen in women aged 40 and above.

Most cases are diagnosed at an advanced stage which can lead to poor outcomes. Generally, ovarian cancer is the 5th most frequent cause of death in women.

There are several types of ovarian cancer:

• Epithelial ovarian cancer
• The most common type of ovarian cancer which makes up almost 90% of all ovarian cancers
• Refers to tumours forming in the outermost layer of the ovary
• Includes several subtypes such as serous, endometrioid, clear cell, and mucinous cancer
• Germ cell ovarian cancer
• Originates from the ovarian cells that develop into oocytes (germ cells)
• More likely to affect girls and young women
• A rare type of ovarian cancer which can be non-cancerous (benign) or cancerous (malignant)
• A rare type of ovarian cancer which can be non-cancerous (benign) or cancerous (malignant)
• Originates from the cells in the ovaries
• It is rare but are usually detected at an early stage
• More likely to affect women aged 50 and above
• The affected cells may produce hormones such as oestrogen and testosterone

The exact cause of ovarian cancer is unclear, but the following risk factors may increase your risk of developing ovarian cancer:

• Older age: 40 years and above
• Family history of ovarian cancer
• Personal history of breast cancer
• Genetic mutations such as BRCA1, BRCA2 or those associated with Lynch syndrome
• Endometriosis
• Usage of hormone replacement therapy (HRT)
• Early menarche or late menopause
• Smoking
• Obesity

Ovarian cancer, in its early stages, produces few or non-specific symptoms. Vague symptoms often result in the disease progressing undetected until it reaches an advanced stage.

To aid in earlier detection, even vague symptoms should be carefully evaluated. Symptoms of ovarian cancer include:

• Abdominal bloating or fullness
• Lower abdominal or back pain
• Loss of appetite
• Unexplained weight loss
• Vaginal bleeding (after menopause)
• Abnormal vaginal discharge
• Urgent or frequent need to urinate
• Changes in bowel habits (constipation or diarrhoea)
• Fatigue
• Nausea
• Vomiting

Staging describes the location of cancer and the extent of spread to other parts of the body. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) classification is used for ovarian cancer staging.

Staging is done based on physical examination, scans, and biopsies. It ranges from stages 1 to 4, where greater stages indicate a poorer prognosis of ovarian cancer. The lowest stage indicates the cancer is limited to one ovary and the highest stage indicates the cancer has spread to other parts of the body.

Diagnosis is made based on various investigations. Your doctor would first question your general health, symptoms and conduct a thorough physical examination.

• Blood test: Tumour marker CA125
• Imaging tests: Ultrasound, computed tomography (CT scan), magnetic resonance imaging (MRI)
• Biopsy: A small tissue sample would be taken and sent to the laboratory for evaluation
• Pelvic exam: The ovaries and other pelvic organs are felt (palpated) by the doctor for any lumps or abnormalities

Learn more about the different types of screening and diagnostic procedures performed to diagnose ovarian cancer.

The treatment of choice for ovarian cancer depends on the type and stage of cancer.

1. Surgery

Typically, ovarian cancer surgery is a major procedure. Your surgeon must ensure that as much cancer as possible is removed. The procedures are called:

• Bilateral salpingo-oophorectomy (BSO) – removal of both ovaries and fallopian tubes
• Total abdominal hysterectomy – removal of the ovaries, fallopian tubes, uterus (womb) including the cervix

In the early stages of ovarian cancer, it may be possible to remove only the affected ovary and fallopian tube and not the unaffected ovary and fallopian tube. This means that women might still be able to conceive and have a baby afterwards.

In advanced ovarian cancer, surgery to remove as much of the cancer as possible may be combined with chemotherapy.

2. Chemotherapy

Chemotherapy is a cancer treatment that employs potent cancer-killing medications. It can be given in combination with radiotherapy, before surgery to reduce the size of the tumour or after surgery to kill the remaining cancer cells to reduce the rate of spread of cancer.

3. Targeted therapy

Targeted therapies are medications aimed at inhibiting the progression of advanced ovarian cancer. By targeting specific weaknesses in cancer cells, targeted drugs can destroy cancer cells and help the body control the growth of cancer.

4. Radiotherapy

Radiotherapy uses high-energy radiation to shrink tumours and destroy cancer cells. It is used to relieve symptoms associated with advanced cancer. However, it is not used often to treat ovarian cancer.

5. Hormone therapy

Some ovarian cancers depend on hormones to grow. Hormone therapy inhibits the production of oestrogen, a female hormone, thus preventing the progression of cancer. However, it is rarely used to treat ovarian cancer.

Learn more about the different types of treatment technologies to treat ovarian cancer.

Currently, there are no practical ways to prevent ovarian cancer. However, there are various ways you can reduce your risk of developing ovarian cancer:

• Usage of combined oral contraceptive pill
• Having children
• Tubal ligation or hysterectomy
• Breastfeeding

There are no recommended screening tests to detect ovarian cancer early. Ovarian cancers are very rarely found through Pap smear tests and if found, the cancer is usually at an advanced stage. If you are at high risk, blood tests to check tumour marker CA-125 levels can be done to check for abnormal CA-125 levels.

Discuss with your doctor to understand if you would benefit from screening for ovarian cancer.