The silent killer
Ovarian cancer is one of the top 5 cancers that hit women in Singapore. It can be treated if it is discovered early. Unfortunately, there is no widely accepted screening test for the disease, and the signs and symptoms can be hard to spot.
Ovarian cancer is the second most common gynaecologic cancer among women in Singapore and is on the rise. It is caused by malignant growth in the ovaries, where the eggs are developed.
Most ovarian cancers are “epithelial” – that is, they arise from the surface (epithelium) of the ovaries. Ovarian cancers may also come from the egg cells (germ cell tumour) or supporting cells (sex cord/stromal).
Ovarian cancer is also one of the top five causes of death from cancer in Singapore. If discovered at an early stage, it can be treated and cured.
Unfortunately, many cases of ovarian cancer are discovered in advanced stages, when options for treatment are more limited. Generally, the chance for cure when the cancer is discovered and treated at Stage 1 or 2 is about 80 per cent.
If the cancer is found at Stage 3 or 4, the five-year survival rate is 50 per cent.
5 facts about ovarian cancer
Fact 1: It is a silent killer
The signs and symptoms of ovarian cancer at early stages can be hard to detect. Often, they are so mild or vague that they are ignored, mistaken for unusual periods or menopause, or confused with indigestion, common stomach problems, or other problems with the digestive system. As a result, the cancer is often diagnosed at an advanced stage.
Look out for the following symptoms. While they may be caused by other conditions, do let your doctor know if you experience one or more of these symptoms frequently and they do not improve within a month:
- Abdominal swelling and discomfort
- Persistent bloating
- Persistent indigestion, gas or nausea
- Changes in bowel habits, such as constipation
- Loss of appetite
- Weight loss
- Back pain
Fact 2: There are no screening tests for now
While there are several tests and diagnostic methods to determine if there is ovarian cancer, there are no known screening tests for the cancer at this moment. Doctors need to do diagnostic tests to confirm if a patient has ovarian cancer.
One of them involves measuring a marker in the blood called CA-125, which tends to go up when epithelial ovarian cancer is present. However, this test is not always accurate, nor adequate for diagnosis, as non-cancerous conditions can also raise the marker.
Another is an ultrasound scan of the ovaries and the uterus, which does not involve radiation. If the scan shows a mass or complex cyst in the ovaries while blood tests show an increase in the CA-125 marker, this indicates that there may be ovarian cancer.
Doctors may also do CT or MRI scans of the abdomen and pelvis, or even chest X-rays.
Often, an operation or biopsy is needed to determine accurately if affected cells are cancerous and whether they originated from the ovaries.
Fact 3: A Pap smear cannot detect ovarian cancer
Pap smears are recommended for women because they can be used to screen for cervical cancer and to check for pre-cancerous and abnormal changes to cells in the cervix. The cervix is located at the lower part of the womb.
Ovarian cancers, however, originate in one or two of the ovaries, and cannot be detected through regular Pap smears. Many women may think that going for Pap smears regularly can help screen for ovarian cancers, but this is not the case.
Pap smears can sometimes detect endometrial cancer. If any abnormal adenocarcinoma is seen in the Pap smear, it may suggest the presence of ovarian cancer, though this is rare.
Fact 4: All women are at risk
While some women may be at higher risk of getting ovarian cancer because of genetic or other factors, all women face the risk of getting the cancer.
The risk factors include:
- Late pregnancy
- Early menstruation
- Late menopause
- Never had children
- History of breast cancer
- Genetic predisposition
- Endometriosis (appearance of endometrial tissue outside the uterus)
Studies show that women whose sister or mother who has had ovarian, breast or colon cancer have a much higher risk of getting the disease. The risk for a woman whose mother has had ovarian cancer can increase by three to four times or more. If there is a strong family history of breast and ovarian cancer – that is, many members of the family have had either of these cancers – the risk of ovarian cancer can increase up to 10 times.
If a woman does not have a family history, she can reduce the risk of ovarian cancer by eating healthily and keeping a normal weight. However, if there is a high familial risk, then she can consider undergoing oophorectomy, a surgical procedure to remove one or both of her ovaries.
Fact 5: The risk increases with age
The risk of getting ovarian cancer tends to increase with age, as it often develops after menopause. Most cases are discovered in women between the ages of 40 and 50. It is rarely found in younger women below 40.
Written by Kok Bee Eng
Tags: cancer diagnosis, cancer fact, cancer ultrasound, germ cell cancer, history of cancer, pap smears, women (gynaecological) cancer