Ovarian Cancer

Ovarian cancer starts in the ovaries or fallopian tubes, affecting the female reproductive system. It develops when cells in these organs grow abnormally, forming tumours that can spread to other parts of the body. As symptoms often appear late, ovarian cancer is frequently diagnosed at an advanced stage.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG) | MRCOG (UK) | MMed (OBGYN) (SG)

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Ovarian Cancer

Women experiencing ovarian cancer may notice several signs that typically develop over time. These symptoms often become more noticeable and frequent as the condition progresses.

Abdominal Bloating: The abdomen becomes persistently swollen and uncomfortable, occurring daily and lasting for extended periods without relief from usual remedies.
Pelvic Pain: Women experience discomfort or pain in the pelvic region that may be constant or intermittent, often increasing in intensity over time.
Changes in Appetite: Tumour growth can cause pressure on surrounding organs, leading to feelings of fullness quickly or difficulty eating normal portions.
Urinary Changes: Increased frequency of urination or a persistent urge to urinate develops as tumours press against the bladder and surrounding structures.
Fatigue: Unexplained tiredness and low energy levels persist despite adequate rest and normal daily activities.
Back Pain: Lower back pain develops as tumours grow and press against surrounding tissues and nerves, often distinct from routine muscle strain.

Causes and Risk Factors

Several factors influence a person’s likelihood of developing ovarian cancer, though having risk factors does not guarantee developing the condition.

Age

Women over 50 have a higher occurrence rate, with most cases diagnosed between ages 60-70.

Genetic Mutations

Inherited changes in BRCA1 and BRCA2 genes increase the risk of ovarian cancer, with carriers having a 40-60% lifetime risk.

Family History

Having two or more close relatives with ovarian, breast, or colorectal cancer raises risk levels significantly.

Reproductive History

Never having children or having your first pregnancy after age 35 can increase the risk due to increased lifetime ovulation.

Hormone Therapy

Long-term use of hormone replacement therapy, particularly oestrogen alone for more than five years, may increase risk.

Types of Ovarian Cancer

Epithelial Ovarian Cancer

This is the most common type, developing from the cells that cover the outer surface of the ovary or fallopian tubes. It includes subtypes such as serous, clear cell, and endometrioid carcinomas. Treatment depends on the specific subtype and stage at diagnosis.
Germ Cell Tumours

These tumours develop from the cells that produce eggs and are more common in younger women. They often respond well to chemotherapy, and in some cases, fertility-preserving surgery may be an option.
Stromal Cell Tumours

These rare tumours develop in the hormone-producing cells of the ovary. They can sometimes be detected early due to hormone-related symptoms. Surgery is usually the main treatment, often combined with other therapies depending on the stage and type of the tumour.

Diagnostic Methods

Physical Examination

A pelvic examination is performed to check for masses or abnormalities in the ovaries and surrounding organs. This initial assessment helps determine the need for further tests and provides insight into the extent of the condition.

Blood Tests

CA-125 testing measures levels of this protein, which often increases with ovarian cancer. Additional blood markers, including HE4, AFP, and CEA, may be tested depending on the suspected type of tumour.

Imaging Studies

Transvaginal ultrasound provides detailed images of the ovaries and can reveal masses or abnormalities. CT scans and MRIs help determine if cancer has spread beyond the ovaries and guide surgical planning.

Genetic Testing

Analysis of BRCA1, BRCA2, and other relevant genes helps assess hereditary risk and may guide treatment decisions, particularly regarding the use of targeted therapies.

Treatment Options

Treatment for ovarian cancer typically involves a combination of approaches tailored to the specific type and stage of cancer.

Non-Surgical Treatment
- Chemotherapy:This treatment uses drugs to destroy cancer cells throughout the body. Standard protocols typically involve platinum-based drugs combined with taxanes, administered over 6-8 cycles with regular monitoring of response.
- Targeted Therapy:Specific medications target particular features of cancer cells, such as PARP inhibitors for BRCA-mutated cancers. These treatments can help extend progression-free survival, especially when used as maintenance therapy.
- Hormone Therapy: Some stromal tumours respond to hormone treatments that block or reduce hormone production. This approach proves effective in specific cases where tumours demonstrate hormone sensitivity.
Surgical Treatment
- Debulking Surgery: Removes as much visible cancer as possible, including affected organs and tissues. The procedure may involve removal of ovaries, fallopian tubes, uterus, nearby lymph nodes, and portions of other affected organs based on disease spread.
- Minimally Invasive Surgery: Selected for early-stage cases where cancer appears confined to one ovary. This approach involves smaller incisions and typically allows faster recovery, though it may not suit all patients or cancer types.

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Prevention and Management

Regular gynaecological check-ups enable monitoring of changes that may indicate ovarian cancer. Women with high-risk factors may benefit from risk-reducing surgery after completing childbearing. Maintaining a healthy weight through regular exercise and a balanced diet supports overall health during and after treatment. Following treatment, scheduled follow-up appointments allow monitoring for recurrence and management of treatment effects.

Frequently Asked Questions (FAQ)

How does ovarian cancer affect fertility?

Treatment often involves removing reproductive organs, affecting fertility. Fertility preservation options exist for some early-stage cancers or specific tumour types, including egg freezing or ovarian tissue preservation.

How often should screening occur for high-risk individuals?

Women with BRCA mutations or strong family history typically undergo CA-125 testing and transvaginal ultrasound every six months starting at age 30-35. Individual screening schedules are adjusted based on specific risk factors, age, and medical history.

Can ovarian cancer recur after treatment?

Yes, ovarian cancer can return, particularly in advanced-stage cases. The likelihood of recurrence depends on factors such as cancer type, initial response to treatment, and time since remission. Regular follow-ups, imaging scans, and blood tests help monitor for any signs of recurrence.

Dr. Harvard Lin

Obstetrician & Gynaecologist

MBBS (SG)|MRCOG (UK)|MMed (OBGYN) (SG)

Dr. Lin has a clinical focus on female pelvic medicine and reconstructive surgery, encompassing the management of urinary incontinence, overactive bladder, and prolapse.

Dr. Lin completed his medical training at the National University of Singapore and obtained advanced certifications in Obstetrics and Gynaecology. He is a Member of the Royal College of Obstetricians and Gynaecologists in the UK.
Dr. Lin serves as a clinical tutor at NUS and contributes to laparoscopic and pelvic floor workshops. His research includes stem cell therapy, synthetic meshes, and translational medicine, with publications in peer-reviewed journals and textbooks.

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