Friday 3 March 2017

Ovarian Cancer - It's Not a Death Sentence!

Part 1 of 2 by Dr Jason Tan, Gynaecologic Oncologist

Ovarian cancer has gained the notorious reputation of being a death sentence. For many women, it is like a death knell when they are diagnosed with ovarian cancer as it leads to more deaths than any other cancer of the female reproductive system.

The rate of occurrence (incidence) of the female reproductive system’s cancer (gynaecological cancer) and its 5-year survival rate in Australia:

The data show that out of 100,000 women, it is estimated that about 10 are diagnosed with ovarian cancer in 2016. The number of women diagnosed with ovarian cancer still living after 5 years from 2007 to 2011: about 4 out of 10.

Cancer Australia estimated that in 2017, the number of Australian women diagnosed with ovarian cancer would be 1,580 and the number of Australian women dying from ovarian cancer would be 1,047. This is equivalent to:

4 Australian women are diagnosed with ovarian cancer every day.

Australian women die from ovarian cancer every day.

Ovarian cancer is the second most common gynaecological cancer after cancer of the uterus (uterine cancer). Compared to other gynaecological cancer, the statistic in terms of survival for women diagnosed with ovarian cancer is not optimistic. 

The main reason is that most women, up to 75% of them, are already at the late stage of the cancer (Stage IIIC) when diagnosed where the cancer is in one or both ovaries or fallopian tubes, and it may have spread to the nearby organs as well.

Who Are at Risk?

Women who are at risk may include those who:

●  Never have had children
●  Have period at an early age or reach menopause at    
    an older age
●  Have a family history of breast cancer or ovarian 
●  Have Ashkenazi Jewish descent 
●  Have inherited gene BRCA 1 or BRCA2 mutation

It is estimated that up to 25% of ovarian cancer may be attributed to the inherited gene BRCA1 or BRCA2 mutation; therefore, offering genetic counselling and testing to all affected patients is important. 

The recent announcement in early 2017 of a new government funding that allows Australian women to claim a Medicare rebate for a genetic test to see if they have a BRCA mutation is recognition of genetic testing for its important role in the screening for ovarian cancer.

First degree relatives of patients with ovarian cancer who are not tested genetically have a four-fold risk of developing ovarian cancer. 

As we gain further knowledge, more genetic mutations apart from BRCA1 and BRCA2 are identified, and these comprise a 'panel testing'.

Panel testing examines a number of different genes simultaneously to search for potentially cancer-causing mutations.

Catching Ovarian Cancer Early

It is often touted that screening is the best way to catch any disease early; however, in the case of ovarian cancer, there is no evidence at present to support that screening can help in prevention or the reduction of death – regular ultrasound scans and CA125 tests do not work.

This is compounded by the fact that the symptoms of ovarian cancer are often vague and most women do not realise something is wrong until it is too late. 

Screening; however, may be advisable for women who are considered to be at high risk such as those with a strong family history, who are carriers of gene BRCA1 or BRCA2 mutation and Ashkenazi Jewish women. 

A thorough family medical history assessment is needed to determine the specific risks and in some cases ‘risk reduction’ preventative surgeries may be advised by your doctor.  

These include patients with a demonstrated genetic mutation and those with a first degree relative with ovarian cancer, or a strong family history of breast and ovarian cancer.
This is the case of filmmaker, actress and special envoy of the United Nations High Commissioner for Refugees, Angelina Jolie. 

Angelina Jolie sees health choices as part of life and not to be feared. 

She is a BRCA1 gene mutation carrier and opted for preventive surgeries. 

She removed both her breasts in 2013 and ovaries and fallopian tubes in 2015. She was 39 years old when she underwent the surgery in 2015. 

Resumption of a normal quality of life after such surgeries is possible with a multidisciplinary approach by medical and allied health specialists that include your gynaecologic oncologist, menopause specialist, sexologist and counsellor, psychologist and physiotherapist. 


Most women will experience some symptoms; however, most are vague that can include:

●  Abdominal or pelvic pain
●  Change in bowel habit
●  Urinary frequency or incontinence
●  Indigestion
●  Unexplained weight gain or loss
●  Fatigue
●  Reduced appetite
●  Abdominal bloating and ‘fullness’ 
●  Pressure in the abdominal and pelvic areas

Investigation, Tests and Diagnosis

Ovarian cancer is not a death sentence!

If it is diagnosed accurately and treated without delay, there are very effective treatments against ovarian cancer.  

A thorough investigation is required to accurately diagnose the condition and determine the best treatment options for the patient.

This involves a combination of:

●  Physical examination
●  Ultrasound scan
●  CT scan
●  Blood tests such as CA125, etc.
●  Family and medical history assessment

The investigation is especially important for women with symptoms that persist for more than a month, and if they are over 40 years old or have a family history for ovarian and breast cancer.

Based on the data available, when Australia is compared to other developed nations, its 5-year survival rate is considered among the best.

Women diagnosed with ovarian cancer still living after 5 years is the highest in Western Australia compared to other states and is among the best in the world.


If a patient has suspected ovarian cancer, she should be referred to a sub-specialist gynaecologic oncologist. 

In Australia, a gynaecologic oncologist is certified by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) to practise in the highly specialised field of gynaecological oncology/cancer. 

Typically, a gynaecologic oncologist goes through an additional three or more years of sub-specialisation training on top of the five to six years of training in the medical specialty of obstetrics and gynaecology.

In Western Australia, the gynaecologic oncology/cancer medical service is available in the public hospital, namely, the King Edward Memorial Hospital and various private medical hospitals and centres. 

In part 2, we will talk about the treatment and management of ovarian cancer, the likely outcome of the treatment and management based on various factors, the latest exciting developments in pharmaceutical and molecular diagnostics, and awareness as prevention.

Sources: American Cancer Society   Anuradha, S., Webb, P. M., Blomfield, P., Brand, A. H., Friedlander, M., Leung, Y. et al. (2014). Survival of Australian Women with Invasive Epithelial Ovarian Cancer: A Population-based study. The Medical Journal of Australia, 201(5): 283-88.   Cancer Australia   Cancer.Net  Jolie Pitt, A. (2015, March 24). Diary of a Surgery. The New York Times. Retrieved from here.   National Cancer Institute   National Centre of Biotechnology Information   O’Leary, C. (2017, January 31). Ovarian Cancer Drug on PBS.  The West Australia.  Retrieved from here.   The MSD Manuals 

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IMPORTANT: The information on this blog is for informational purposes only and not intended to be a substitute for professional medical advice, diagnosis or treatment in any manner. Always seek the advice of your doctor or other qualified health provider with any questions you may have concerning your health or anything related to it. 

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