What causes ovarian cancer?
Posted on 29 September 2017
Ovarian cancer, which affects women’s reproductive organs, is both difficult to diagnose and difficult to treat. Here’s what you need to know about it.
There are various kinds of ovarian cancer, all fairly uncommon. Unfortunately, most cancers that affect the ovaries are diagnosed in their advanced stages because there are no reliable early signs – vague and subtle symptoms can include fatigue, abdominal swelling and pain, changes in bladder and bowel habits and shortness of breath.
So what causes it?
‘Ovarian cancer can be hereditary but other than that we have no real evidence about causality,’ says Johannesburg gynaecological oncologist Dr Trudy Smith.
‘Ovarian cancer is associated with a familial or personal history of breast and/or ovarian cancer in as many as 30% of newly diagnosed cases,’ confirms Dr Lizanne Langenhoven, a Cape Town clinical and radiation oncologist.
Women over 65 years old may be more susceptible, while obesity, smoking and endometriosis may also play a role, she adds. And there may be an ever-so-slight increase in patients who’ve had ovulation induction – the stimulation of ovulation by medication.
How is it diagnosed?
‘Screening programmes have not proven to be effective in diagnosing the disease at an early stage when cure is more likely,’ Dr Langenhoven says.
‘There are two tests available to screen for ovarian cancer: pelvic ultrasound and a blood test to check for a tumour marker called Ca125. Neither is 100% reliable,’ says gynaecologist and endoscopic surgeon Dr Natalia Novikova at Mediclinic Cape Town. ‘The advantage of having the screening test is early detection; the disadvantage is the chance of unnecessary surgery for something that is not actually cancer,’ Dr Novikova adds.
Women with a strong family history of ovarian cancer should see a geneticist to discuss BRCA1/2 testing.
What’s the treatment?
The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient. New targeted drugs are available to decrease the side-effects of treatment while improving response and cure rates.
‘The mainstay is to remove both ovaries, the uterus and the omentum, and also to give chemotherapy,’ says Dr Smith. (The omentum is the double layer of fatty tissue that covers and supports the intestines and organs in the lower abdomen.)
‘Where a strong family history is present, the ovaries are usually removed when a woman’s family is complete to prevent ovarian cancer,’ says Dr Langenhoven. ‘Most ovarian cancers start to develop in the part of the fallopian tubes closest to the ovaries, rather than in the ovaries themselves, so skilled surgeons usually remove a part of the fallopian tubes as well as the ovaries when preventative surgery is performed in high-risk individuals.’
These decisions should not be taken lightly and should be done in consultation with a skilled surgeon after thorough genetic counselling and testing.