February is Ovarian Cancer Awareness Month and is held each year in Australia to raise awareness of the signs and symptoms of ovarian cancer, to highlight the risk factors, and to educate Australians on ovarian cancer diagnosis and treatment. We spoke to Deborah Smith, Anatomical Pathologist at Mater Pathology to discuss this cancer which has a five-year survival rate of just 45%[1].
“It is estimated that around 1,510 new cases of ovarian cancer are diagnosed in Australia each year and around 300 are diagnosed in New Zealand. Whilst it is not as common as some other cancers, the death rate from ovarian cancer is high – more than 1,000 in Australia and over 200 in New Zealand each year, making it the fifth leading cause of cancer death in women,” said Dr Smith.
Ovarian cancer is the term used to describe malignant tumours which start in one or both ovaries. There are several types of tumours, including epithelial which are the most common and make up 90% of ovarian cancers; germ cell, which are rare and account for 5% of ovarian cancers; and stromal cell and other rare types. Ovarian cancer is mainly diagnosed in women over the age of 50, with the average age being around 64, however there are cases that are diagnosed in younger women[2].
“Because the symptoms of ovarian cancers are non-specific, it has often spread outside the ovary in many women by the time of diagnosis. Common symptoms include increased abdominal size or bloating, some lower abdominal pain, needing to urinate more often, and a sensation of being full after eating only a small amount. Other things include feeling very tired, a change in bowel habits to either constipation or diarrhoea and weight changes,” said Dr Smith.
Initial investigations include simple tests such as a pelvic ultrasound and Ca125 blood tests. If there is anything concerning, additional scans are likely to be undertaken, plus referral to a gynaecologist or gynae-oncology team (depending on local circumstances). A tissue or fluid specimen is needed to make a definite diagnosis; sometimes this can be sampled under radiological guidance as an outpatient, but in other cases the entire ovary needs to be removed surgically for examination. Pathology is essential as it provides a definite diagnosis which guides treatment decisions, provides information about how far the tumour has spread, and can identify any specific treatment targets.
A combination of surgery and chemotherapy remains the most common method of treatment, sometimes with radiotherapy. It is important to note there are currently many ongoing research trials investigating methods for early detection of ovarian cancer, more effective chemotherapy combinations and more personalised treatment regimes for patients.
“There are a number of trials going on at the moment, including drugs which activate the woman’s own immune system to recognise tumour cells as foreign and kill them. Promising trials are also looking at identifying more specific and sensitive cancer markers in blood tests to try and find better screening options, and to establish whether simple drugs like aspirin can prevent ovarian cancer developing.”
“Early detection remains key to higher survival rates, but we currently have no screening tests that can identify early ovarian cancers in the general population reliably enough to make a difference. What we need is to develop a simple non-invasive method of testing and capturing those patients with early stage disease, as treatment at an early stage is more effective. We also need to develop more personalised and effective treatments for ovarian cancers which have already spread,” said Dr Smith.
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This article appeared in the February 2020 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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