Ovarian cancer is a malignancy of the ovaries, the female sex organs that produce eggs and the female hormones oestrogen and progesterone.
It is the fourth most common cancer among women in Peninsular Malaysia, making up five per cent of all female cancer cases, according to the Malaysian National Cancer Registry.
Like many cancers, ovarian cancer may not produce symptoms in the early stages.
At an advanced stage, the woman may have abdominal bloating or a feeling of pressure, abdominal / pelvic pain, frequent urination, and a feeling of fullness even after a light meal. Other symptoms: unexplained weight gain / loss and abnormal vaginal bleeding.
Early detection leads to early treatment and a better chance of recovery.
Two ways to screen for ovarian cancer in its early stages are ultrasound of the ovaries and measurement of levels of a protein called CA-125 in the blood. This tumour marker is grossly elevated in patients with ovarian cancer.
A pelvic examination by the Gynaecologist may reveal a mass which can be felt.
Imaging modalities eg. ultrasound, CT scan, MRI will help differentiate between a fluid filled cyst, solid tumour masses and healthy tissue, but it is only via direct tissue sampling (biopsy) that we know the cell type and final diagnosis.
Staging of ovarian cancer refers to the extent to which it has spread to other organs or tissues.
There are different kinds of ovarian cancer, depending on the type of cell within the ovary that gave rise to the cancer. The large majority of ovarian cancers are epithelial cancers. This cancer forms in the cells that line the surface of the ovary.
Surgery is the mainstay of treatment. It is also done to stage the disease. The ovaries, Fallopian tubes, uterus and cervix are removed. The surgeon often also removes the omentum (a fold of tissue connecting the stomach with other abdominal organs), lymph nodes, fluid and tissue from the other abdominal organs for surgical staging. If the cancer has spread, the surgeon removes as much of the cancer as possible in a process called tumour de-bulking. This in turn reduces the amount of cancer cells that has to be treated later with chemo / radiotherapy.
Chemotherapy is typically given after surgery for all stages of ovarian cancer to kill off the remaining cancer cells. Radiotherapy is less common nowadays due to the introduction of newer and better chemotherapy agents. Other types of treatment that are being tested in clinical trials include targeted therapies against specific molecular abnormalities in the cancer cells.
Individuals with ovarian cancer should seek advice from a team of cancer specialists or multi-disciplinary cancer care. With a combination of surgery + chemotherapy, most patients do have a good response rate and remain disease-free for prolonged periods. However, relapse is also common.