“Ask Dr. HKSH” - Ovarian Cancer

Dr. TAM Kar Fai

Specialist in Obstetrics and Gynaecology

Q1.  What are the types of malignant ovarian tumours?

Malignant ovarian tumours can be classified into three major types based on their cellular origins. The ovaries contain different cells. The most common malignant tumour is epithelial carcinoma. Generally, ovarian cancer refers to this type of malignant tumour. It accounts for approximately 80% to 90% of all cases, a very high proportion. The other two types are stromal tumours and germ cell tumours.

Q2. How can ovarian cancer be detected early if the early symptoms are not obvious?

Ovarian cancer is usually detected at a later stage. Many patients are diagnosed at an advanced stage, at stage 3 or 4. However, some cases can be detected at an early stage, as patients may seek medical attention due to a feeling of fullness, bloating and other discomforts. A gastroenterologist is most consulted first, with tumours detected during investigations. This is quite a common situation.

Tumours are sometimes detected in late-stage patients when they experience abdominal distension, difficulty breathing, or even abdominal pain. These symptoms are common at advanced stage diseases. Some early-stage patients may exhibit no symptoms at all, and are only diagnosed with ovarian cancer accidentally during regular health checks.

Q3. Which types of women are at higher risk of ovarian cancer?

About 10% of ovarian cancer cases have genetic mutation in a gene called BRCA. Women who carry this gene have a higher lifetime risk of developing ovarian cancer. There are two types of BRCA mutations. The cancer risk of BRCA1 carriers is nearly 60%, while those with BRCA2 having a lower risk of about 10% to 30%. Despite the absence of genetic mutations, women with family members diagnosed with ovarian cancer still carry a higher risk of developing ovarian cancer.

Some women may have benign ovarian conditions. A very tiny proportion of them may turn into cancer, such as endometriomas, commonly known as "chocolate cysts." According to various studies, patients with this type of cyst have a future cancer risk of 1% to 3%.

Q4. How is ovarian cancer diagnosed and staged?

Ovarian cancer is usually detected by imaging. Malignancy cannot be confirmed by image studies. Tissue samples are often obtained during surgery to confirm if the tumour is malignant. In case of malignancy, the standard treatment involves surgical removal of the uterus, ovaries and fallopian tubes. Cancer staging is also necessary to determine the extent of the disease. There are four cancer stages: stage I to stage IV, and is determined based on the pathological examination of organs removed during surgery, including lymph nodes, peritoneal tissue and omental tissues. The necessity of postoperative treatment would then be determined.

Most ovarian cancer patients require postoperative chemotherapy, and the specific treatment approach, medications, and schedules depend on the final histology. For some patients with advanced ovarian cancer, immediate surgery may not be the best option. They may need a biopsy to obtain cells or tissue for diagnosis, and receive chemotherapy once the diagnosis is confirmed. Surgery may be considered if the response to chemotherapy is good. It is up to the doctor to decide whether if one should first undergo surgery or chemotherapy.

Q5.  Is ovarian cancer preventable?

Ovarian cancer does not have a premalignant condition. It is unlike cervical cancer, which can be prevented by excision of the premalignant disease. The only measure to improve survival is early detection, which can be done through regular check-ups.

There have been major overseas studies trip to look into the cost effectiveness of ovarian cancer screening in improving the survival. However, data collection and achieving a significant finding have been very difficult. We believe that regular gynaecological examinations can detect most tumours early and increase the chances of recovery. Women are generally recommended to have regular check-ups for prompt management.

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