There are three types of ovarian cancer: the common epithelial type (90% of cases) that arises from the cells on the outside lining of the ovary; the germ cell type that arises from the cells which produce eggs; and the uncommon stromal type arising from supporting tissues within the ovary.
Ovarian cancer is the eighth most common cancer-affecting women in Australia.
The background risk for women having ovarian cancer is 1 in 70 without any family history of breast or ovarian cancer. This risk can be as high as 1 in 2 in some inherited conditions (such as the Breast and Ovarian Cancer gene BRCA 1). Dr Farrell will conduct a thorough family and personal history to determine any significant risk factors in your history such as a history of ovarian or breast cancer.
There are often no obvious signs of ovarian cancer in the early stages, however you may have one or more of the following symptoms:
- abdominal bloating
- difficulty eating or feeling full quickly
- change in bowel habit (constipation, or diarrhea)
- frequent or urgent urination
- back, abdominal or pelvic pain
- menstrual irregularities
- pain during sexual intercourse.
If any of the above symptoms persist for more then one a few weeks, particularly over the age of 40 or with a family or personal history of breast or ovarian cancer, an ultrasound of the pelvis and tumour markers (CA125, CEA, CA19.9) are recommended to further investigate the problem. CT scanning may also be utilised depending on the situation as this has a more global look at the rest of the abdomen, which can often be involved, with cancer of the ovary. As much information as possible from imaging, blood tests, history and examination will allow Dr Farrell to give you the most accurate assessment preoperatively and ultimately the correct and complete treatment first time.
Ovarian cancer often presents when it has spread beyond the ovaries. A common staging system is the FIGO (International Federation of Gynaecology and Obstetrics) system, which records the extent by whether it remains in the ovary (Stage 1), has spread to other pelvic structures (Stage 2), or has spread into the lining of the abdomen, with or without fluid (ascites) (Stage 3). Physical examination (including a pelvic exam), CT scans and/or PET CT scans, and a blood test to measure CA125, are used to investigate the clinical stage of the cancer.
Treatment depends on the extent of the cancer and the type of cancer cell. Surgery is used to determine the surgical stage (extent) of disease. If the ovarian cancer is localized and of low-grade type, surgery is the mainstay of treatment and chemotherapy may not be required. If the cancer has spread, or is of high-grade type, both surgery and chemotherapy will be required. Fertility sparing procedures for appropriate tumours may be possible and will be discussed fully preoperatively.
The important aims of treatment are to remove as much of the cancer as possible with expert surgery to the pelvis and abdomen, with the use of chemotherapy before and/or after surgery to kill any remaining microscopic cells. All treatment decisions will be individualised to suite patient’s needs and requirements.
All cancer results are reviewed weekly by expert gynaecological pathologists and presented by Dr Farrell at a multidisciplinary tumour meeting to ensure the highest possible standards of care are attained.
Dr Farrell is a Certified Gynaecological Oncologist (CGO) and has the special training and expertise required to enable the highest probability of achieving the goal of removing all of the cancer cells (no visible disease). Studies show that if all of the disease visible to the naked eye can be removed surgically, survival is improved. Dr Farrell also works with other specialised surgeons (peritonectomy surgeons, and trained upper GIT and colorectal surgeons, where needed), and they work together when required to ensure the best surgical result is achieved.
Choices for chemotherapy following surgery include chemotherapy infused through the veins (intravenous), or heated chemotherapy given into the abdominal cavity immediately following the surgical procedure (heated intraperitoneal chemotherapy, or HIPEC, if performed at St George Hospital), or a combination of both types of treatment.
Dr Farrell keeps up to date constantly with the evidence for the best treatments available to ensure that you receive the highest standard of care for the best survival outcomes following a diagnosis of gynaecological cancer.
Dr Farrell will coordinate follow up after treatment is completed, with 3 monthly reviews for 2 years, then 6 monthly reviews for a further 3 years at minimum.
For more information follow the link to the Cancer Council Booklet for ovarian cancer information on this website.