The importance of ovarian cancer awareness

Ovarian cancer is the seventh most common cancer in women, with the highest mortality rate. It is the 18th most common cancer overall, with close to 300,000 new diagnoses each year. If diagnosed early, ovarian cancer is easier to treat. When a woman is diagnosed with ovarian cancer at an early stage, statistics show that her chance of survival for five years or more doubles from just 46% to more than 90%. Unfortunately, many women are unaware of the symptoms and many GPs only pick up the symptoms in later stages. This is the case of Hannah Catton.

Last year Catton was diagnosed with ovarian cancer and is currently undergoing chemotherapy in Melbourne, Australia. Glamour Magazine sat with Hannah to share her story. Hannah shared that she had visited doctors about Urinary Tract Infections (UTIs) she developed before her monthly periods but was sent home with antibiotics with the assurance she had nothing to worry about. Her periods became irregular and painful, she was bloated, had diarrhea, constipation and UTIs. Hannah did not know these were all symptoms of ovarian cancer. 

Catton, over 3 months at a time, visited doctors to seek treatment for her symptoms, yet they told her she was young and healthy. One doctor advised her that her BMI was in the overweight range, and she should focus on losing weight to reduce the symptoms. After this comment, Catton stopped visiting the doctor. She told Glamour, “To have the pain I was feeling be reduced to a weight problem meant I didn’t trust anything else this doctor had to say.” One day she suffered a UTI so bad, she required emergency treatment. In this unfortunate circumstance, Catton got lucky that the only doctor in her area that could attend to her on short notice saw a need for her to be referred to specialist doctors- a gynaecologist and a urologist. 

The gynaecologist found a mass and waitlisted Catton to have surgery to remove what they thought was a uterine fibroid, a muscular tumor that grows in the wall of the uterus. Two months later, Catton collapsed and was taken to the emergency room where doctors thought she was having an ectopic pregnancy. After further testing, a 20cm tumour was found and Catton was subsequently diagnosed with ovarian cancer. We wish Hannah Catton the very best in her treatment and recovery.

Two thirds of patients diagnosed with ovarian cancer are diagnosed too late when the cancer has already spread. In the United Kingdom, about 7,500 people with ovaries are diagnosed with ovarian cancer annually. It is unfortunate that this research is quite underfunded with limited awareness..

In an effort to spread awareness and limit the spread of cancer cells from the ovaries, we were delighted to Interview Dr. Trisha Sankar, MB.BS, MRCOG., on the topic of ovarian cancer awareness.

TNF: Why is Ovarian Cancer Awareness important?

Dr. Sankar: As with all cancers, patient education on the risk factors, screening tests, symptoms and management options are important. Especially with ovarian cancer, which is a cancer that is usually diagnosed in the later stages due to its very vague symptoms. Because of this, ovarian cancer has a poor prognosis (outcome).

TNF: What are the signs and symptoms of ovarian cancer?

Dr. Sankar: There are not very specific signs and symptoms of ovarian cancer, which makes early diagnosis difficult. Usual symptoms include bloating, pelvic or abdominal pain, change in appetite (usually eating less), weight loss and urinary symptoms such as frequency or urgency. These symptoms can be attributed to pathology in the urinary system, gastrointestinal system or reproductive system which makes early detection less likely.

TNF: Are there different types of ovarian cancer?

Dr. Sankar: Yes, the ovary is a multipotent organ so there are different cell types of ovarian cancer. Epithelial cancer arises from the surface of the ovary, germ cell arises from the reproductive cells of the ovaries and stromal cancer arises from the connective tissue cells. The most common type is usually epithelial in origin. 

TNF: Can you tell us more about detection? Is it a type of cancer that shows up pretty late? Can it be detected early? In your opinion, was this an avoidable situation?

Dr. Sankar: Hannah’s story was very sad and unfortunate. I wish her well with her treatments. Unfortunately because of the non-specific nature of her symptoms and the effect covid had on the health care system, she was not investigated in a timely fashion. 

A Transvaginal ultrasound would usually reveal an ovarian cyst with specific features which make the clinician suspicious of cancer. Blood tests for specific tumor markers can also be requested. Because there are different cell types of ovarian cancer, different tumors can release different markers we can detect in the blood.  Ovarian cancer can only be diagnosed histologically when the pathologist reviews the tissue and determines the type and grade of cancer. 

In Hannah’s case she was diagnosed when the tumor was already 20 cm. If investigations were requested sooner it would have been picked up at an earlier stage.

TNF: How is this type of cancer treated?

Dr. Sankar: A gynaecological oncologist will do a debulking surgery depending on the stage at diagnosis. This can include removing the ovaries, fallopian tubes, uterus, lymph nodes and omentum (organ that covers the bowel). The goal of this surgery is to remove as much of the tumor as possible. It is usually followed by a few rounds of chemotherapy to kill any other circulating cancer cells. 

TNF: Are there any key risk factors?

Dr. Sankar: A family history of ovarian cancer is one of the most important risk factors. A first or second degree relative with ovarian cancer increases your chances by three times. Other risk factors include a strong family history of breast cancer, a type of colorectal cancer called Lynch Syndrome or presence of BRCA1 or BRCA2 gene mutations. 

TNF: Are there any preventative measures?

Dr. Sankar: The prolonged use of the oral contraceptive pill (>5years) has been associated with a risk reduction for ovarian cancer. The pill prevents ovulation and damage to the outer cortex of the ovary. It is speculated that the damage done to the cortex each month with ovulation when it is being repaired can lead to cancerous changes. So if ovulation is inhibited then the risk is decreased. During pregnancy and exclusive breastfeeding ovulation also does not occur, so pregnancy has a protective benefit as well. 

Studies have shown a link between obesity and ovarian cancer, therefore maintaining a healthy body mass index through diet and exercise will help reduce your risk. 

TNF: Is there any screening for ovarian cancer that should be done as often?

Dr. Sankar: Unlike cervical cancer which uses regular pap smears to screen for cancer cells, ovarian cancer does not yet have a good screening test. Blood levels of Ca-125 can be checked routinely but can also be elevated in benign conditions like endometriosis, diverticulitis or fibroids. Transvaginal ultrasound scans will detect ovarian cysts which may have suspicious features and lead to further testing. 

TNF: Do you recommend any other risk reducing behaviours?

Dr. Sankar: Maintaining a healthy lifestyle with a proper diet and exercise will reduce your risk of most major conditions. Regular check ups with your healthcare provider will aid in detecting conditions at earlier stages so management options will be more effective.

We thank Dr. Sankar for the informative interview. 

90% of women are unaware of the four major symptoms of ovarian cancer. Awareness will save so many lives. If you have ovaries, we strongly advise seeking out gynaeological medical attention should you experience any of the symptoms. Ovarian cancer does not have to be as fatal as it is, it is possible to detect it sooner once the right investigations and procedures are done. 

For more information on Ovarian Cancer, the symptoms, testing and research, check out Ovarian Cancer Action https://ovarian.org.uk