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Understanding Ovarian Cancer

Ovarian cancer is relatively uncommon, yet it unfortunately still accounts for more than 7,000 (Source: NHS Choices) new cases in the United Kingdom each year (4% of all cancers diagnosed in women). Most of these cases are sporadic, occurring in women with no family history. However, approximately 5% of ovarian cancers are the result of BRCA1 or 2 genetic mutations, which are associated with an increased incidence of breast and ovarian cancer in families.

The signs and 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.

In women who have symptoms, 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.

Early diagnosis appears to improve the prognosis, and women with stage one or two disease are much more likely to be cured than women with late stage disease. 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.

Surprisingly, 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.

The quality of surgery varies enormously across the United Kingdom. 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. What we know for sure, is that if all visible cancer is removed, it can make a big difference to the long-term outcome. Surprisingly, the complication rate for more extensive surgery is not higher than those less extensive. Even if the cancer comes back after treatment, surgery may offer improved chance of survival in appropriate cases.

A cure for ovarian cancer might still be a ways away, however the length and quality of life that women achieve after diagnosis is improving daily. Researchers are working hard to improve the survival of women with this disease, and the results of large and promising screening studies will be published in the near future.

Angus-McIndoe We’d like to extend a warm thank you to Mr Angus McIndoe of The McIndoe Centre for this informative and comprehensive article on Ovarian Cancer. Mr Angus McIndoe is one of the foremost UK consultants working in the field of Gynaecological Oncology today and is recognised as both a leader and pioneer in robotic surgery.

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