Ovarian cancer is the 5th most common cancer among women in Singapore and the 2nd most common female genital tract cancer. Ovarian Cancer occurs when abnormal cells in the ovary begin to mutate, multiplying out of control and forms a tumour. The ovaries are made up of three types of cells. Each cell may develop into a different type of tumour or cancer:
Epithelial Ovarian Cancer
This Cancer is the most common type of Ovarian Cancer – accounting for 90% of all cancers of the ovaries. Cancerous cells develops from the outer surface of the ovaries.
Germ Cell Ovarian Cancer
These tumours develop from the ova or egg cells.
Stromal Ovarian Cancer
This rare type of cancer occurs in the connective tissues that holds the ovaries together and those that produce female hormones (estrogen & progesterone)
There is no direct cause of Ovarian Cancer. However, there are several factors that causes or reduces its risks.
Ovarian Cancer Symptoms
Symptoms of Ovarian Cancer are less noticeable in its early stages. They get more pronounced only when the tumour has grown to a rather large size.
1. Physical Examination
The doctor will first take your medical history and do a physical exam to look for signs of ovarian cancer. Your doctor will likely do a pelvic exam to check for an enlarged ovary, and check for signs of fluid in the abdomen (which is called ascites).
2. Blood Test
High levels of CA-125 are often found in women with Ovarian Cancer.
High levels of horionic gonadotropin (HCG), alpha-fetoprotein (AFP), and/or lactate dehydrogenase (LDH) are often found in women with Ovarian Cancer. These tumour markers will indicate if a woman has Ovarian Cancer – in particular Germ Cell Ovarian Cancer
High levels of inhibin, estrogen and testosterone. These levels are checked in a doctor suspects that a woman has Ovarian Stromal Cancer.
3. Imaging Tests:
A. CT (Computed Tomography) Scan
The CT scan is an x-ray test that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.
CT scans do not detect small ovarian tumors accurately, but they can see larger tumors, and may be able to see if the tumor is growing into nearby organs. A CT scan may also find enlarged lymph nodes, signs of cancer spread to liver or other organs, or signs that an ovarian tumor is affecting the kidneys or bladder.
B. Pelvic Ultrasound Scan
Ultrasound (ultrasonography) is the use of sound waves to create an image on a video screen. A small probe will be placed in a woman’s vagina or on the surface of her abdomen. A computer translates the echoes made by soundwaves as the probe enters the ovaries and other organs, into a picture.
An ultrasound test can be useful in finding an ovarian tumor and seeing if it is a solid mass (tumor) or a fluid-filled cyst. It can also be used to get a better look at the ovary to see how big it is and how it looks inside (the internal appearance or complexity). These factors help the doctor decide which masses or cysts are more worrisome.
Surgery is required for diagnosis and to determine the stage of Ovarian Cancer.
In many cases, women usually have to undergo both surgery and chemotherapy to be fully treated.
For patients diagnosed with ovarian cancer during surgery, a surgeon will carry out surgical laparotomy. During a laparotomy, the surgeon makes an incision down the middle of the abdomen and attempts to remove as much of the cancer within the abdomen and pelvis as possible. Laparotomy aims to accurately diagnose and stage the cancer and gain prognostic information that can determine whether additional therapy is necessary.
A typical laparotomy includes:
Total Hysterectomy – removal of the uterus
Bilateral Salpingo – removal of both fallopian tubes and ovaries
Omentectomy – removal of a flap of fatty tissue covering the bowel in the abdomen
Lymphadenectomy – removal of lymph nodes
Despite surgical removal of the tumor, many patients will have microscopic cancer cells (micrometastases), that have migrated away from the original site. With current available tests, these microscopic cancel cells remain undetectable. Local therapies like surgery cannot treat micometastic cancer. Hence, additional systemic treatment like chemotherapy is required to treat these stray cells. As most patients are at the advanced stages on diagnosis, the majority of patients will receive chemotherapy as part of the overall treatment plan.
What kind of support is available?
It is important to know that you do not have to go through this alone. Finding comfort and support is vital to your mental well-being.
CanHOPE, is a non-profit cancer counselling & support service initiated by Parkway Cancer Centre.
Jaga-Me provides professional home nursing care for your loved one. Whether it is post-chemotherapy care at home, or ensuring your loved one gets home safely from the hospital, our trained nurses are able to assist him or her. If you need personalised caregiver training, simply contact us at our hotline. We will assess the condition of the patient and provide you with a personalised care plan, making you a better, more confident caregiver.