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The ovaries are the female reproductive organs that are located on both sides of the pelvis. During the reproductive years the ovaries release an egg each month in preparation for fertilisation. The ovaries vary in size from 3-5 cm, and then shrink after menopause by about 50%.
There are a number of different types of cells in the ovary and each can possibly become cancerous including:
- the surface lining (epithelial layer with subgroups including serous, mucinous, endometroid & clear cells)
- the germ cells (released as an ovum each month for possible fertilisation with subgroups including teratoma or dermoid, & choriocarcinoma)
- inner cells (with subgroups including granulosa cells, thecoma, & fibroma)
How likely is Ovarian Cancer (OC)?
The incidence is about 1% & increases significantly beyond age 50. Ovarian cancer is often detected at a more advanced stage. The 5 year survival rate is around 85% for early disease, and 30% for advanced disease that has spread to other organs. Women at higher risk of OC include:
- family history of OC
What are the early warning signs?
One of the difficulties with OC detection is that the ovaries are internal organs that can enlarge silently. Symptoms are often vague and intermittent and include:
- Abdominal or pelvic pain.
- Increased abdominal size or persistent abdominal bloating.
- Needing to urinate often or urgently.
- Difficulty eating or feeling full quickly.
- It is important to see your family doctor early if you have concerns.
What tests can be done?
Tests that can be arranged include a pelvic ultrasound and a blood test to check for ovarian tumour markers such as Ca125, CEA, inhibin, AFP & BHCG. Further testing may involve a CT scan to check if other structures in the abdomen may be involved such as the liver and lymph glands.
Is screening recommended?
Because of the low incidence of ovarian cancer, and the high costs of large scale testing, universal ovarian cancer screening is not recommended. Targeted screening is recommended for women who have a family history of ovarian cancer, or other related cancers such as bowel & breast cancer.
Are all ovarian cysts dangerous?
Each month, during the female reproductive years, the ovary forms a small cyst ( usually less than 20mm) to release the egg. Occasionally this cyst will persist and take several months to dissolve. An ultrasound may be ordered if there are symptoms of pelvic pain. Simple cysts usually had a thin wall with no solid components within. Ovarian cancer is rare under the age of 50.
What treatments are needed?
Surgical treatment is usually required with removal of the affected ovary either by key hole (laparoscopy) or open surgery. If other structures are involved additional surgery may involve removal of the uterus (hysterectomy), the fatty apron under the bowel (omentum), lymph glands, or even resection of part of the bowel.
Depending on the nature of the ovarian cancer & any spread, additional treatment may be needed after the initial surgery, such as chemotherapy and radiation therapy.