What Are Ovaries?

Ovaries produce eggs and female hormones during a woman’s reproductive life. Women have two ovaries, one on either side of the uterus (womb) in the lower abdomen.

How Does Ovarian Cancer Develop?

The organs and tissues of the body are made up of tiny building blocks called cells. When your body’s cells are healthy, they grow and divide to make new cells. When old cells die, new ones take their place.

Cancer is a disease of these cells. A cancerous tumour starts from one abnormal cell. However, the exact reason why a cell becomes cancerous is unclear.

Cancerous tumours have the ability to spread beyond the original site, and if left untreated, it may invade and destroy surrounding tissues. Sometimes, cells break away from the original (primary) cancer and spread to other organs in the body via the bloodstream or lymphatic system. When these cells reach a new site they may continue to divide and form a new tumour, often referred to as “metastasis”.

Types Of Ovarian Cancer

There are various types of ovarian cancer. They are classified by the type of cell from
which the cancer originates.

• Epithelial ovarian cancer is the most common. This type of cancer develops from one of the cells that surround the exterior of each ovary.
• Germ cell ovarian cancer develops from germ cells (the cells that make the eggs).
• Stromal ovarian cancer develops from connective tissue cells (the cells that fill the ovary).

In many cases, women with cancer of the ovary in the early stage do not display any symptoms. Symptoms may only be noticed when the cancerous tumour has become
quite large.

Common Early Symptoms Include

Other Symptoms May Include Factors

• Loss of appetite
• Increased urinary frequency
• Change in bowel habits such as constipation or diarrhoea.
• A more marked swelling of the abdomen. This is caused by ascites which is a collection of fluid in the abdomen. The growth and spread of the cancer inside the abdomen causes fluid to accumulate.
• Bleeding from your vagina in-between periods or after menopause (This is not a common sign for ovarian cancer. However, it may be a possible sign of other types of cancer. You should always get unusual bleeding checked).

In most cases, the reason why an ovarian cancer develops is not known. However, there are some factors which increase your risk.

Factors That Increase Your Risk

Factors That Decrease Your Risk

Initial tests

• Examination by a doctor
  Your doctor may feel an enlarged ovary or discover a suspicious abnormality.

• Ultrasound scan
  This is a painless test used to see the structures inside your body. The probe may be placed on your abdomen or inside your vagina to scan the ovaries.

• Blood test
  A protein called CA-125 can be detected in a blood sample. The level of CA-125 can be high in women with ovarian cancer. Blood test is also often used to monitor the effects of treatment for ovarian cancer. 

Further Tests
You may be advised to go for further tests depending on the symptoms that you have and the results of the initial tests.

• CT or MRI scan of the lower abdomen can provide details of the internal organs structure and help to determine the extent of the disease.

• A chest X-ray to check if the cancer has spread to your lungs.
• Blood tests to assess your general health and to check if the cancer has affected the function of your liver or kidneys.
• Scans of the bowel or urinary tract eg. Colonoscopy (a procedure to look inside
  your bowel). These tests are more likely to be needed if you have symptoms such as constipation or urinary frequency which may indicate that the cancer has spread to these areas.

• Aspiration of fluid. If your abdomen is swollen with fluid leading to ascites, a sample of fluid will be taken. This is done by numbing a small area of skin on the abdomen with local anaesthetic. A fine needle is inserted through the abdominal wall and some fluid is removed. This fluid is examined under the microscope to look for cancer cells.

Surgery For Ovarian Cancer

Surgery is required for diagnosis and to determine the extent of the disease (staging). Ovarian cancer surgery is preferably done by a gynaecological oncologist to achieve a desirable outcome. Gynaecological oncologists are specialist cancer surgeons who are specially trained in the management of women’s cancers.

Total Hysterectomy With Bilateral Salpingo-oopherectomy With Omentectomy And Lymphadenectomy

This is the removal of the uterus with cervix (total hysterectomy), both ovaries and the tubes (bilateral salpingo-oopherectomy), the fat ‘apron’ in the abdomen (omentectomy) and lymph nodes (lymphadenectomy). In some cases, the cancer may have spread into other nearby structures. Therefore, a more extensive operation is needed to remove as much of the cancer as possible. This is called debulking surgery which may involve removal of the bowel. This will usually be done through a midline or vertical incision in the abdomen.

Fertility-Sparing Options

Younger women who desire fertility may want to speak to your doctor for advice.

Risks And Complications Of Surgery

There are risks and complications associated with any major surgery. Due to some blood loss during your operation, blood transfusion is sometimes required. In rare cases, there may be internal bleeding after the operation, making a second operation necessary.

Occasionally, it is possible to develop blood clots in the veins of the leg, pelvis or in rare cases, in the lungs. Moving around after your operation can help prevent blood clots. Our physiotherapist will visit you after your operation to advise and assist with your mobility. To reduce the risk of blood clots, you will also be given injections to thin your blood during your stay in the hospital.

During any major operation involving the pelvic organs, there is a small risk of injury to the bladder and bowel. If this occurs, the injury will be repaired. There may be a small risk of developing an infection in the chest, wound, pelvis or urine. To reduce this risk, you will be given an antibiotic just before the operation.

In rare cases, wound breakdown (dehiscence) may occur and re-suturing of the wound maybe required.

What Are The Different Stages Of Ovarian Cancer?

Ovarian cancer is “staged” based on the findings at the time of surgery and the extent of the disease.

There are four stages of ovarian cancer. Knowing the stage of cancer helps your doctor to decide on the most appropriate treatment.

Further Treatment

The final pathology report is usually received about one or two weeks after surgery. The pathology slides will be reviewed by a panel of gynaecologic cancer experts, including the medical oncologist at the Gynaecological Cancer Centre (GCC)’s weekly Tumour Board Meeting. Recommendations for any further treatment will be made by your doctor and will be discussed with you and your family.

Chemotherapy

The majority of women with ovarian cancer will require chemotherapy after surgery. However, chemotherapy can also be given before surgery. Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. You will be referred to a medical oncologist for advice on chemotherapy treatment (Please refer to the Chemotherapy brochure).

Follow-up care

Even after the completion of chemotherapy treatment, follow-up examinations are recommended every three months for the first two years and subsequently four to
six-month intervals in the following years.

Despite treatment, there is a risk that cancer may recur and further treatment may be required.

Contact us

For enquiries or more information, please contact our KK Gynaecological Cancer Centre at +65 6394-8803/2160 during office hours.