Dr Sumayya Ebrahim answers frequently asked questions regarding ovarian cancer.
How common is ovarian cancer?
Worldwide, about 240 000 women are diagnosed each year. This makes it the seventh most common cancer in women. It’s more common in women over 40, with its peak incidence in the fifth and sixth decades of life.
In SA, the prognosis is poor, meaning that many more women will die from this cancer compared to other parts of the first world. This is due to diagnosis been made at a later stage. Our mortality rate, quoted in the available literature, is 70%.
What are the symptoms?
The physical symptoms experienced can often be very vague and generalised and may be confused with gut problems or acid reflux. The common complaints are listed below and can occur in various combinations:
- Pelvic or abdominal pain
- Upset stomach or heartburn
- Menstrual changes
- Changes in bowel habits like constipation or diarrhoea
- Back pain
- Unexplained weight loss
- Pain during sex
- Feeling the need to urinate often with a feeling of fullness over the bladder area
Is there an effective screening test that can pick up early ovarian cancer?
With ovarian cancer, screening is challenging. To date there is no test that will pick up early ovarian cancer.
It’s recommended that each woman keep a lookout for any of the symptoms mentioned; undergoes an annual pelvic or gynaecological examination, which may include an ultrasound of her ovaries; and has a Ca125 blood test when considered appropriate by her doctor.
Ca125 is a protein that is made by inflamed or cancerous cells. It can be high on a blood test if certain cancers, like ovarian cancer, is present in the body.
The problem with this method of detection is that Ca125 remains low in 20% of women who already have ovarian cancer. It can also be raised in many non-cancerous conditions, like uterine fibroids, endometriosis and benign ovarian cysts. This can make diagnosis tricky.
So, it’s critical that the Ca125 count isn’t used in the general population as an isolated test. It should rather be used as part of a series of tests and monitoring as recommended by your doctor.
How do I know if I’m at risk?
You may be at risk, if you have any of the following present:
- Increasing age
- Personal or family history of breast, ovarian, or colon cancer
- Genetic predisposition – families who carry genetic mutations, like BRCA1 and BRCA2
Just having any of the risk factors is not a guarantee that you will get ovarian cancer.
How can I lower my risk?
Although there is no absolute way to reduce your risk, there are measures you can take to make this risk as low as possible. These are:
- Healthy diet – eating a low-fat diet, rich in nutrient dense green leafy vegetables whilst low in animal protein has shown to be protective.
- Exercise – just by working out 30 minutes every day you can decrease your risk by 20%.
- Lifestyle – reducing alcohol consumption to three units per week or less is protective. Avoiding the use and exposure to tobacco products further reduces risk.
- Oral contraceptive pills – studies that have compared women who use birth control pills for three years or more versus those who have never used them, found a 30 to 50% lower risk of developing ovarian cancer in oral contraceptive pill users.
- Pregnancy and breastfeeding – birthing a child before the age of 25 is protective. In addition, if a woman goes on to breastfeed, her risk will fall even lower.
Can ovarian cancer be treated successfully?
Treatment will depend on the stage of the cancer at diagnosis, the type of cancer, and the age of the woman being treated. Generally, it involves various combinations of surgery (removing the ovaries, fallopian tubes and uterus), and chemotherapy.
In early stage disease, we aim for cure but in advance stages we aim for palliation. This means that treatment is aimed at prolonging good quality of life and comfort for as long as possible.
In younger women, consideration of the desire for fertility needs to be accounted for as many treatment options can negatively affect future childbearing ability.
Can I still get ovarian cancer even if my ovaries have been removed?
Usually removing the ovaries will significantly drop the risk of developing ovarian cancer. Though, this risk is not zero. Studies have shown that a small risk remains of developing a cancer called primary peritoneal cancer.
This happens because during foetal development, the peritoneum (coverings of all the internal pelvic organs), the fallopian tubes and the ovaries all share the same origins.
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