Ovarian cancer represents the 8th most commonly diagnosed malignancy for women in Australia. Whilst not one of the most common cancers diagnosed, it has one of the poorest outcomes for women. The average five year survival rate is only 49% (1). Compare this to the five year survival rate of breast cancer (92%), uterine cancer (84%) and cervical cancer (74%), it is clear that more needs to be done to tackle this disparity.
Around 80% of women diagnosed with ovarian cancer are over the age of 50, but ovarian cancer can occur at any age (2). Symptoms are vague and non-specific which can lead to late diagnosis when treatment options are reduced and outcomes are poorer. With no screening test available, the challenge is in improving earlier diagnosis. It is therefore vital to improve public awareness of ovarian cancer symptoms in order to encourage prompt review with their doctor. In rural settings, the challenges are even harder with reduced access to both GP and specialists.
“Each year, around 1,815 women will be diagnosed with ovarian cancer in Australia. That is nearly five women each day. The exact cause of ovarian cancer remains unclear. Undoubtably, genetics play a role in the development of ovarian cancer; how large or how small that role is however, remains unknown.”
Causes and risk factors
Several genes have been linked with ovarian cancer; the significance of each of these has not been established. Variants in the BRCA1 and BRCA 2 gene, more commonly discussed in relation to breast cancer, have been linked to an increased incidence of ovarian cancer (3).
Risk factors that may increase the likelihood of developing ovarian cancer include;
- a family history of ovarian cancer, breast cancer or colon cancer
- increasing age; ovarian cancer can be diagnosed at any age, however it is more commonly seen in post menopausal women, with the average age of diagnosis 64 years old.
- genetic predisposition; such as an inherited BRCA gene variant, and
- smoking
Symptoms
Ovarian cancer can be overlooked as symptoms tend to be vague and non-specific leading to mis-diagnosis of more common and benign conditions. OCAM looks to improve awareness of the potential symptoms of ovarian cancer to encourage women to seek medical attention. New, persistent, troublesome or unusual symptoms should always make you consider a visit to your regular doctor for further investigation.
Symptoms of ovarian cancer include (4);
- increased abdominal size or bloating
- abdominal or back pain
- unexplained weight loss or weight gain
- unexplained fatigue and reduced appetite
- changes in menstruation
- changes in bowel habits
- early satiety (feeling full quickly)
- indigestion
- frequent urination
Critically, there is no screening program available for ovarian cancer. It is almost entirely dependent on patients presenting to their doctors with symptoms prompting further investigations that leads to a diagnosis. It is estimated that around 70% of new cases of ovarian cancer are diagnosed at an advanced stage – either Stage III or IV, meaning that the cancer has spread beyond the ovaries (5). Without the creation of a screening program, improving early diagnosis of ovarian cancer will be largely dependent on educating the public on these symptoms.
Investigation and diagnosis
Tests to investigate for ovarian cancer can include;
- blood tests – to check for a common tumour maker CA125
- a pelvic ultrasound – this may be either abdominal or trans-vaginal
- a CT scan
- a MRI scan
- a PET scan
Screening does not exist for ovarian cancer the same way it does for breast and cervical cancer. This is because there is not one single test which exists that can allow for a definitive diagnosis of ovarian cancer. For example, whilst the CA125 marker in the blood may be raised in some cases of ovarian cancer; endometriosis and ovarian cysts can also cause an elevated level. Additionally, nearly half of women with early stage ovarian cancer do not have a raised CA125 level (6). It is therefore often used in combination with an USS to reach a diagnosis. Further imaging with either a CT scan, MRI scan, or PET scan helps with the staging of disease.
The only way to reach a definitive diagnosis of ovarian cancer is by a biopsy of either the suspected cancerous tissue, or of fluid in the abdomen that may or may not be present. This biopsy can either be taken during surgery, or can be taken by imaged guided biopsy (7).
Treatment
Treatment options for ovarian cancer is dependent on a number of factors. These include:
- extent of the cancer
- the cell type of the cancer
- and your general health
Ovarian cancer treatment options include surgery, chemotherapy, radiation therapy and targeted therapy. Commonly, it is a combination of these options that are offered to patients. A treatment plan would be made in collaboration with your doctor.
Often termed a “silent killer” it is clear to see the challenges that face us in improving ovarian cancer survival rates. Vague non-specific symptoms, a lack of screening tests and advanced disease at diagnosis all contribute to a poorer five-year survival outcome for women when compared to other gynaecological cancers. There is some positive news however, with the five-year survival between the period of 1990-1994 compared to 2015-2019, increasing from 39% to 49% (1). It is the aim of future research to create an effective, accurate, non-invasive, and accessible screening test that would enable early detection and and treatment.
References
1 – Cancer Australia. (2023). Ovarian cancer statistics in Australia. [online] Available at: https://www.canceraustralia.gov.au/cancer-types/ovarian-cancer/ovarian-cancer-statistics-australia.
2 – Cancer Council NSW. Ovarian cancer. [online] Available at: https://www.cancercouncil.com.au/ovarian-cancer/about-ovarian-cancer/.
3 – Cancer Australia. (2024). Family history. [online] Available at: https://www.canceraustralia.gov.au/cancer-types/ovarian-cancer/family-history [Accessed 16 Feb. 2025].
4 – Cancer.org.au. (2023). Ovarian Cancer | Causes, Symptoms & Treatments. [online] Available at: https://www.cancer.org.au/cancer-information/types-of-cancer/ovarian-cancer?_gl=1.
5 – Cancer Council NSW. (n.d.). Staging & Prognosis for Ovarian Cancer. [online] Available at: https://www.cancercouncil.com.au/ovarian-cancer/diagnosis/staging-prognosis/.
6 – www.cancer.org.au. Early detection of ovarian cancer. [online] Available at: https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/early-detection-of-ovarian-cancer.
7 – Cancer Council NSW. (n.d.). Tests. [online] Available at: https://www.cancercouncil.com.au/ovarian-cancer/diagnosis/tests/.
