Ovarian Cancer Treatment

Overview

What is Ovarian Cancer?

Ovarian cancer occurs when the cells in the ovaries undergo abnormal and uncontrolled growth and division. It is the fifth most common cancer among women. Over time, these cells form a tumour or solid mass of tissue within the ovary. If left untreated, this tumour has the potential to spread to other parts of the body. Ovarian tumours can be classified as benign (non-cancerous and non-spreading), malignant (cancerous and capable of spreading), or borderline (where there is a small chance of malignancy).

Types of Ovarian Cancer

Ovarian cancer can be classified into tthree main types. These include:

Epithelial ovarian cancer is the most common type of ovarian cancer and originates from the tissue layer covering the ovaries. While there are various subtypes of epithelial ovarian cancer that can affect different cells in the body, the treatment approach is generally similar regardless of the specific subtype.
Germ cell tumors are uncommon and primarily affect girls and young women up to their early thirties. They develop from the cells in the ovary responsible for producing eggs. Germ cell tumors are typically treatable, and surgical removal of the tumor is often performed. Chemotherapy may be utilized if the tumor has progressed to a cancerous stage.
Stromal tumors arise from the tissue cells responsible for producing hormones like estrogen and progesterone, which are essential for sexual and reproductive development. These tumors are extremely rare, accounting for approximately 1% of all ovarian cancer cases. They are often diagnosed at an earlier stage compared to other types of ovarian cancer.

Gynaecology Consultations

Receive expert advice and treatment plans in a confidential and relaxing environment.

Book now

Straightforward, reassuring care

What are the symptoms of Ovarian Cancer?

Ovarian cancer typically does not present with specific or noticeable symptoms. Instead, women often experience vague symptoms such as abdominal swelling or bloating, general abdominal discomfort, early satiety (feeling full quickly), loss of appetite, indigestion, fatigue, frequent urination, or changes in weight (either gain or loss). Some women may develop unexplained ascites, which is the accumulation of fluid in the abdominal cavity, adding to the discomfort. Due to the non-specific nature of these symptoms, identifying and diagnosing ovarian cancer can be challenging since they can be attributed to other conditions as well.

What causes Ovarian Cancer?

The exact cause of ovarian cancer remains unclear, but certain factors can contribute to an increased risk of developing the condition. Advanced age, being overweight or obese, and having a genetic predisposition or family history of ovarian cancer are among the factors that can elevate the likelihood of its development.

Jason Yap - Consultant Gynaecologist

Consultant Gynaecologist, Gynaecological Oncologist & Lead Clinician for Vulval Disease

Find out more

Diagnosis

How can Ovarian Cancer be diagnosed?

Pelvic Exam:

During a pelvic exam, you will be asked to remove your clothing from the waist down and a sheet will be provided to cover you. A speculum, a smooth tube-shaped tool, will be gently inserted into your vagina to allow for better visualization. Your consultant will then use gloved fingers to feel your pelvic organs and check for any abnormal lumps or tender areas. They will also visually examine your vagina and cervix.

This examination should not cause any pain, and you have the option to request a female consultant or have a friend, partner, or family member present to make you feel more at ease.

Imaging Tests:

Your consultant may conduct imaging tests to assess your ovaries for any abnormal growths. Transvaginal ultrasound (TVUS) is commonly used, using sound waves to examine your uterus, fallopian tubes, and ovaries. It provides a visual image to determine the presence of tumors, although it cannot differentiate between benign and malignant growths. CT scans may also be employed to assess the size, shape, and structure of your ovaries. Abnormalities in size or shape can indicate the presence of a tumor.

Blood Tests:

A blood test may be performed to measure the levels of a substance called CA-125 in your blood. Elevated CA-125 levels are often observed in women with ovarian cancer. However, it's important to note that these tests alone cannot definitively diagnose ovarian cancer, as noncancerous conditions can also lead to increased CA-125 levels. Nonetheless, these blood tests can provide valuable information when making a diagnosis.

Treatments

What treatments are there for Ovarian Cancer?

There are a range of surgical and non-surgical treatments for Ovarian Cancer. Non-surgical treatments may be recommended by your consultant as a part of your overall ovarian cancer treatment plan or if surgery is not suitable for you due to factors such as the size of the tumor or your general health. These non-surgical treatments can be utilized to manage and treat ovarian cancer effectively.

Non-Surgical Treatments for Ovarian Cancer

Chemotherapy

Chemotherapy is typically administered after ovarian cancer surgery to reduce the risk of cancer recurrence and eliminate any remaining cancer cells. In some cases, chemotherapy may be given before surgery if the tumor size makes surgery unsafe. The treatment usually lasts for a period of three weeks, followed by a CT scan to assess its effectiveness. Chemotherapy employs anti-cancer drugs that hinder the growth of cancer cells. Different types of medications are used to target cancer cells in specific ways, and your consultant will develop a personalized treatment plan based on your condition.

Immunotherapy

Immunotherapy utilizes medications that enhance the natural ability of your immune system to recognize and destroy cancer cells in the ovaries. Ovarian cancer cells produce proteins that help them evade detection by immune cells. Immunotherapy works by interfering with this process and enabling immune cells to target and eliminate cancer cells. However, immunotherapy has not shown significant efficacy specifically for ovarian cancer.

Radiotherapy and targeted therapy

Radiotherapy involves the use of high-energy X-rays to destroy cancer cells and shrink tumor size. It is commonly employed when symptoms, such as vaginal bleeding, cannot be addressed through surgery. Targeted therapy, on the other hand, utilizes specific drugs that target vulnerabilities or weaknesses in cancer cells, causing their demise and reducing tumor size.

Hormone therapy

Hormone therapy utilizes drugs that block the effects of estrogen on ovarian cancer cells. In certain cases, ovarian cancer relies on estrogen for growth, and by inhibiting estrogen, hormone therapy can help control cancer and prevent further cell proliferation. This approach is typically used for slow-growing types of ovarian cancer.

Surgical Treatments for Ovarian Cancer

Surgery for ovarian cancer is performed using general anesthesia, ensuring that you remain asleep throughout the procedure and experience no pain or discomfort.The specific type of ovarian cancer surgery you undergo depends on the particular characteristics of your ovarian cancer and its extent of spread. If the cancer cells are limited to the ovaries without spreading elsewhere, your consultant may recommend the removal of both ovaries and fallopian tubes. The following are the most common forms of ovarian cancer surgery:

Staging surgery

Surgery for low-grade cancer

During staging surgery, your surgeon will thoroughly examine your abdominal and pelvic regions to determine if the ovarian cancer has spread beyond the ovaries. Tissue samples will be taken from various areas in the abdomen and pelvis, and a layer of fatty tissue near the ovaries will be removed. Additionally, abdominal fluid may be collected for laboratory analysis. These tests will help your consultant determine the stage of your ovarian cancer and guide further treatment decisions.In cases of very early-stage ovarian cancer, if you still desire to have children, your surgeon may be able to perform a procedure that preserves your fertility. This procedure involves the removal of the affected ovary and fallopian tube while leaving the other ovary, fallopian tube, and uterus intact. However, if you have reached menopause or do not wish to have more children, your surgeon may recommend removing these reproductive organs as well.

Surgery for advanced ovarian cancer

If the ovarian cancer has spread beyond the ovaries to the pelvis and/or abdominal area, debulking surgery is typically performed. Debulking surgery aims to remove all visible disease by performing a total hysterectomy, which involves the removal of the uterus, ovaries, fallopian tubes, and omentum (a sheet of tissue connecting the stomach with other abdominal organs). Any visible growths within the abdomen will also be removed, and in some cases, a portion of the bowel may need to be resected.