Ovarian Cancer Awareness Month 1-28 February
What is the role of the ovaries in our body?
‘The ovaries are two small almond shaped organs that are part of the female reproductive system.
They are situated in the pelvic area, with one each side of the uterus (organ where a foetus grows).
The ovaries make eggs and female hormones (oestrogen and progesterone) which regulate your menstrual cycle and affect the development of female body characteristics such as breasts and body hair
Other parts of the female reproductive system include the fallopian tubes, cervix and vagina.
The fallopian tubes are a pair of tubes through which eggs travel from the ovaries to the uterus.’ - Ovarian Cancer Australia
Ovarian cancer is a general term used to describe a cancerous (malignant) tumour starting in one or both ovaries. - Ovarian Cancer Australia
Did you know that: -
According to the Cancer Australian it is estimated that the number of new cases of ovarian cancer (incl. serous carcinomas of the fallopian tube) diagnosed in 2022 is 1815 women.
Ovarian cancer is the 8th most common cancer in women.
The ovarian cancer is the 6th most common cause of death from cancer in woman in Australia.
The average age of women when they are diagnosed with ovarian cancer is age 64.
It is mainly diagnosed in women over the age of 50; however, there are cases diagnosed in younger women. - Ovarian Cancer Australia
The ovaries are made up of three main kinds of cells:
epithelial cells
stromal cells
germ cells.
Each of these cells can develop into a different type of tumour.
Risks and Causes
Ovarian Cancer Australia does not know the exact causes of most ovarian cancers. However, they do know that there are factors that may increase a person's risk of developing ovarian cancer.
Some of the known risk factors for ovarian cancer include:
Increasing age
Getting older is the biggest risk factor for developing ovarian cancer. Ovarian cancer can happen at any age, but it is usually in women who have been through menopause, with the average age of diagnosis being age 64.
Hereditary Factors
These account for approximately 20% of ovarian cancers. Hereditary factors include:
inheriting a faulty gene such as a mutation in BRCA1 or
BRCA2 genes. Women of Ashkenazi Jewish descent have
a higher incidence of BRCA mutations than the general population
having a strong family history of ovarian, breast or some other cancers (colorectal or endometrial).
Other Factors that may increase the risk of ovarian cancer include:
having endometriosis, a previous breast cancer or diabetes
use of hormone replacement therapy (HRT) (this applies to some ovarian cancer types)
being overweight
smoking, which may slightly increase the risk of developing
mucinous ovarian cancer
not having had children – women who have not had children are at a slightly higher risk.
Some factors reduce the risk of developing ovarian cancer. These include:
having children
use of the oral contraceptive pill (the pill)
gynaecological surgery – tubal ligation (having your tubes tied)
What are the signs and symptoms of ovarian cancer?
There is no early detection test for ovarian cancer, so all women need to be aware of the symptoms.
Symptoms for ovarian cancer can be vague and often difficult to diagnosis.
The most commonly reported symptoms for ovarian cancer are:
Increased abdominal size or persistent abdominal bloating
Abdominal or pelvic (lower tummy) pain
Feeling full after eating a small amount
Needing to urinate often or urgently
Additional Symptoms may include:
Changes in bowel habits
Unexplained weight gain or loss
Excessive fatigue
Lower back pain
Indigestion or nausea
Bleeding after menopause or in-between periods
You know your body better than anyone else, so always listen to what your body is saying and trust your instincts.
Track your symptoms in this symptom diary and take this record with you to your doctor.
Types Of Ovarian Cancer
The ovaries are made up of 3 main kinds of cells
Epithelial cells,
Stromal cells and
Germ cells.
Each of these cells can develop into a different type of tumour.
Epithelial ovarian cancer
This is cancer that starts in the cells lining the surface layer (epithelium) of the ovary.
It is the most common type of ovarian cancer, accounting for 9 out of 10 cases.
It most often affects women over 50; the average age of diagnosis is the early 60s.
There are several subtypes of epithelial ovarian cancers, which include:
High-grade serous ovarian cancer
The most common type, aggressive (fast growing)
To begin with, the cancer grows slowly in the fallopian tubes but once it reaches the ovaries it spreads very quickly to surrounding tissues, lymph nodes and organs, as well as other more distant parts of the body (lungs, liver, bones).
This cancer is usually treated with surgery and/or chemotherapy and sometimes targeted therapies.
Endometrioid ovarian cancer
This is the second most common type of epithelial ovarian cancer.
It often presents in younger women and in an earlier stage of disease than high-grade serous ovarian cancer.
Endometrioid ovarian cancer can occur alongside endometrial cancer and is associated with endometriosis and Lynch syndrome.
Surgery is the most common type of treatment, sometimes followed by chemotherapy, depending on the stage of the tumour.
Low-grade serous
These are a type of epithelial ovarian cancer.
They typically occur in younger women but can also start in older women, and they are usually hormone receptor positive.
‘Hormone receptor positive’ describes cells that have proteins that attach to a specific hormone. For example, some ovarian cancer cells have receptors for the hormone oestrogen, so they are hormone receptor positive, and need oestrogen to grow.
Low-grade serous ovarian cancers are aggressive and grow slowly on the surface of cells.
They represent about 10% of epithelial ovarian cancers.
Surgery is the most common type of treatment for these types of cancers. Chemotherapy, targeted therapies, and hormone inhibitors are often used after surgery to help reduce the risk of the cancer coming back. These cancers do not always respond well to chemotherapy.
Mucinous ovarian cancer
This is a rare subtype of ovarian cancer accounting for about 3% of ovarian cancers.
This subtype can appear similar to gastrointestinal cancers and is most common in people under 40 years.
They tend to be large tumours, which means they are often found before they have spread, although they are not always initially easy to diagnose.
Mucinous tumours are distinct from other types of epithelial cancers.
They do not respond well to platinum-based chemotherapy.
As well as cancerous (malignant) tumours, mucinous tumours can be non-cancerous (benign) or borderline.
Clear cell ovarian cancer
This is a subtype of epithelial ovarian cancer usually diagnosed in its early stages.
It is a higher-grade tumour, meaning it grows and spreads more quickly.
Clear cell ovarian cancers account for approximately 10% of epithelial ovarian cancers in Australia, with higher rates in other countries.
Endometriosis increases the risk of developing clear cell ovarian cancer.
Treatment is similar to other ovarian cancer (surgery and chemotherapy).
Clear cell ovarian cancer doesn’t usually respond as well to platinum-based chemotherapy as other epithelial ovarian cancers. Resistance to chemotherapy may develop earlier.
If you have been diagnosed with this cancer, discuss treatment options with your doctors as you may have access to ongoing clinical trials.
Cancers related to epithelial ovarian cancer
Other cancers related to ovarian cancer – primary peritoneal and fallopian tube cancer – have similar symptoms and treatment.
Primary peritoneal cancer
Primary peritoneal cancer is a rare cancer of the cells that line the inside of the abdomen (peritoneum), which are similar to epithelial cells.
Because of its location, it is possible to develop primary peritoneal cancer even if you have had your ovaries and fallopian tubes removed.
Primary peritoneal cancer is always diagnosed in the later stages (stage 3 or 4).
Primary peritoneal cancer is a relatively rare cancer that develops in a very similar way to epithelial ovarian cancer.
People diagnosed with this type of cancer should also be offered genetic testing.
Fallopian tube cancer
The fallopian tubes link the ovaries to the uterus.
Cancer can start in these tubes and spread to the ovary.
Cancer beginning in a fallopian tube is sometimes called ‘fallopian tube cancer’.
Fallopian tube cancer is similar to ovarian cancer. Both cancers are staged and treated in the same way.
Although it has been a rare cancer, it is now thought that many ovarian cancers actually start in the fallopian tube.
Non-epithelial ovarian cancer subtypes
Germ cell ovarian cancer
Germ cell ovarian cancer occurs when abnormal cells form in the cells in the ovary that eventually develop into eggs.
This type of ovarian cancer is rare and accounts for approximately 4% of ovarian cancers.
Germ cell tumours affect mainly teenagers and people in their 20s.
Germ cell ovarian cancer usually only develops in one ovary.
There are 3 main subtypes:
dysgerminomas
immature teratomas
yolk sac tumours.
Germ cell tumours also include choriocarcinoma and embryonal carcinoma.
Symptoms can include:
abdominal/pelvic pain, discomfort
bloating/distention of the tummy
a lump which can be felt when touched (palpable ovarian mass)
twisting of the ovarian tissue causing pain (ovarian torsion)
changes to the menstrual cycle (increased or decreased bleeding)
vaginal bleeding in post-menopausal women.
The causes of germ cell ovarian cancer aren’t well known.
No genetic variants are currently associated with germ cell ovarian cancer.
Treatment often begins with surgery (sparing fertility where possible) followed by chemotherapy if required. Because germ cell tumours are typically fast growing, they tend to respond well to chemotherapy and are curable in most people.
Sex cord stromal cancers
These are rare cancers of the ovary, with granulosa cell tumours being the most common type.
Other types include fibromas and Sertoli-Leydig tumours.
Only about 5% of ovarian cancers are sex cord tumours.
They are often found in the early stages.
Treatment depends on your age, cancer stage and type of tumour.
Surgery is the main treatment. Some people also have chemotherapy.
Some hereditary conditions are associated with sex cord stromal tumours.
Research will hopefully give us a better understanding of the possible gene mutations involved, as well as a more personalised approach to treatment.
Small cell ovarian cancer
This is a rare type of ovarian cancer. It usually occurs in younger people.
Hypercalcaemic tumours make up most of these tumours, with pulmonary and neuro-endocrine small cell ovarian cancers making up the other types.
Symptoms are vague and similar to other ovarian cancers.
Treatment guidelines are being developed. Treatment mainly involves surgery followed by chemotherapy.
Borderline ovarian tumours
Borderline ovarian tumours are abnormal cells arising in the tissue covering the ovary.
These are not usually considered to be cancerous but have the ability to spread through the abdominal cavity if they are on the surface of the ovary. They can turn into a cancer, but this is rare (<1%).
Borderline ovarian tumours usually affect women aged between 20 and 40, and surgery alone is usually curative (there is a risk of recurrence if they have already spread from the ovary at diagnosis, or if the ovary involved is not completely removed).
Fertility-sparing surgery is usually appropriate for women wishing to retain fertility, and long-term surveillance is required.
You can read more on Borderline Ovarian Tumours here.
Diagnosing ovarian cancer
Your GP is usually the first person you go to if you have symptoms.
Several test and possibly an examination will be done.
An ultrasound and blood test may be requested.
Your GP will refer you to a gynae oncologist who will do:
an examination and take your family history of cancer and
further tests to see how the cancer has grown and
if it has spread to other parts of your body.
Further tests may include:
CT scan
Biopsy
Chest x-ray to check if a cancer has spread to the lungs
Removal of fluid from your abdomen if it has built up
Laparoscopy to enable tissue samples to be taken for testing in the laboratory
Laparotomy is offered if a laparoscopy is not suitable.
Should you have any of the above symptom, please don’t delay. Speak to your doctor immediately. It could save your life.
Types Of Treatment
‘Whatever the stage of your cancer, your multidisciplinary team of expert doctors and nurses will discuss which treatment is best for you.
The type of treatment you have will depend on:
the type of ovarian cancer you have
the size of the tumour and how far it has spread (the stage of the cancer)
how aggressive your cancer is (how quickly cancer can grow and spread)
your age
your general health and fitness level.
Not everyone will have the same treatment for their ovarian cancer.
While initial treatment may be similar, maintenance therapy and access to other drugs will be different from person to person.
Your doctor will work out your treatment with your multidisciplinary team based on the stage and grade of your cancer as well as what is best for you.
Treatment options are:
Surgery
Chemotherapy
Biological therapies
Radiotherapy
Personalised medicine
For more info about any of the above mentioned treatments, click here.
The burden of ovarian cancer on women's mental health
Ovarian cancer is a prevalent female cancer often diagnosed late, resulting in a survival rate of just under 49%. A 2023 study by the Liptember Foundation revealed that 50% of women facing ovarian or cervical cancer have severe mental health disorders. 70% of women with an ovarian cancer diagnosis are living with depression, and 25% are experiencing suicidal ideation and self-harm.
Another study by Siqi Hu found that ovarian cancer survivors face an increased risk of mental illnesses within the first 2 years of diagnosis.
“Many studies have concluded that ovarian cancer survivors have increased risks of developing various mental illnesses compared to the general population.
More specifically, they have higher risks of developing psychological disorders including adjustment disorder, anxiety disorder, delirium dementia, cognitive disorder, mood disorder (bipolar and depression disorder), schizophrenia and substance‐related disorders. ”
Being diagnosed with ovarian cancer elicits a range of emotions, including shock, anger, and anxiety.
Psychosocial difficulties, such as low mood, anxiety, and fear of cancer recurrence, persist even for those in remission.
The study suggests the importance of early identification and psychological treatment, advocating for mental health screening among ovarian cancer patients.
“It is important to be aware that mental health may change over the course of diagnosis and treatment.
Cancer patients may need regular mental health consultations to identify issues such as depression and anxiety. Increased support may contribute to prolonging the lives of ovarian cancer survivors.”
Support and resources: -
Information and Support Resources:
Life Following Ovarian Cancer Treatment
Supporting Your Partner Through Ovarian Cancer
Early Menopause From Ovarian Cancer Treatment Factsheet
Emotional and Mental Health Support - If you would like to discuss accessing support from the psychosocial support team, please contact the Helpline on 1300 660 334 (Monday-Friday during business hours AET) or email support@ovariancancer.net.au