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It may not be the most common cancer in Australia for women, sitting at eighth on the list, but that number isn’t a clear representation of the impact ovarian cancer can have. ‘Silent’ in many ways, ovarian cancer is a disease that is rarely discussed, with symptoms that women can easily miss. As a result, the diagnosis is usually made at an advanced stage meaning a lower survival rate – but if the cancer is diagnosed and treated early, between 80-100 per cent of patients will survive more than five years. That’s the trick, though, catching it early – the signs are definitely there, but what are they and how can women ensure they’re not missed?
Bloated? Then have it checked
In February 2015, magazine photographer Liz Cotter, now 53, was shocked to learn she had advanced ovarian cancer. “I had been to see my GP because for more than a year I was getting a sharp pain in my abdomen and feeling very bloated and tired. I knew something wasn’t right. As a precaution, he sent me for a scan, which led to further tests. Two days later he looked grey when he told me I had advanced ovarian cancer that had spread to other parts of my body.
“I was in too much shock to cry – instead I felt strangely detached from my body. I had always led such a healthy lifestyle. I swam to keep fit, read nutrition books, ate a healthy diet and only drank a little alcohol, so I couldn’t believe I had cancer.
“One week later I had eight and a half hours of surgery. Three weeks later I started chemotherapy, which made me feel sick and lowered my immunity. It kept the cancer at bay for 14 months, but in September 2016, it returned. Since then I have had another round of chemotherapy treatment.
“Looking back I realise I had signs of ovarian cancer for about three years, but I put them down to other causes. So I want women to know that if you have ongoing digestive or gynaecological issues and they change or worsen, even if you think you know the cause, have them thoroughly investigated. I have just started immunotherapy drugs as part of a trial. I am hoping they help prevent more cancer growth. Meanwhile, I live my life as fully as possible and try to make the most of every day.”
Causes of ovarian cancer
Though it barely registers as a blip on the health radar of most women, worldwide, ovarian cancer is the second most common gynaecological cancer. In Australia, four women are diagnosed with ovarian cancer every day on average. This so-called ‘silent’ disease occurs due to abnormal cell growth in one or both ovaries. These small almond-shaped organs on either side of your pelvis are attached to the fallopian tubes and produce eggs and the hormones oestrogen and progesterone, which regulate your menstrual cycle.
“The most common type of ovarian cancer grows from the cells on the outside of the ovary (and so it’s name epithelial, referring to the cells in the surface layer). The less common types arise from the cells which produce eggs or from tissues on the inside of the ovary, ” explains Professor Sanchia Aranda from Cancer Council Australia.
When tumours grow, the symptoms that usually emerge are often seen as gastrointestinal issues because the tumour is pressing on those organs. So for women who experience things like bloating or an urge to pee frequently when they are premenstrual or menopausal, it can be difficult to differentiate between such discomfort and what may be early warning signs. Even doctors may be slow to recognise the signs because they are so nondescript. According to research by Ovarian Cancer Australia, 49 per cent of women with ovarian cancer see their GP to discuss symptoms at least twice before being referred for further tests, while 21 per cent see their doctor for three or more visits before being referred to a specialist and diagnosed.
There’s no early detection test available so knowledge of your body and what is normal for you is an important starting point when it comes to recognising what might be a symptom of ovarian cancer. Physical changes to note are things like persistent bloating and continence issues, (such as the urge to urinate more frequently or urgently), according to a Mayo Clinic study. “Unfortunately, women often put these symptoms down to issues such as stress or peri-menopause and menopause so they may not ask their GP to investigate them,” Aranda says.
In addition to urinary issues and bloating, ovarian cancer may sometimes cause a feeling of fullness (even after eating only a small amount), pain in the back, abdomen or pelvis, constipation, menstrual irregularities, fatigue, indigestion and pain during sexual intercourse.
It’s also important to know your family history: “Women from Ashkenazi Jewish background and those who have a history of breast and ovarian cancer in their family may have greater risk of ovarian cancer,” Aranda says.
These are constantly improving for ovarian cancer and usually include at least two or three of the following.
Surgery: “This usually involves taking out the entire ovary,” explains Elizabeth Cooch, specialist cancer nurse from Ovarian Cancer Australia. “In some cases the fallopian tubes and uterus (including the cervix) may also need to be removed a well as other tissue if the cancer has spread.” After surgery, tissue-sampling tests confirm the cancer diagnosis and how aggressive it is.
Chemotherapy: This is used after surgery to try to eliminate all disease identified by scans and the CA125 blood test.
Radiation therapy: Aims to reduce any possible cancer cells that have spread to the pelvis or other sites in the body. It may be used on its own or after chemotherapy.
Biologicals: This newer breed of drugs is showing great promise in treating ovarian cancer, particularly if it has returned after surgery and chemo. “Biologicals can interfere with the signals or blood supply that make cancers grow or block the DNA repair in cancer cells,” says Cooch. “They may include immunotherapy drugs, which boost the body’s own immune system to fight against and kill cancer cells.”
Taking care of yourself
Science may not yet have found a way to prevent ovarian cancer, but as with other cancers, lifestyle factors such as smoking, being overweight, and eating a diet high in fat can increase your risk. Taking care of yourself through adopting a healthy diet and getting regular exercise may reduce your ovarian cancer risk.
Take note of any physical changes and if you’re concerned talk to your GP. Because the symptoms are quite common and can be the cause of other problems, your doctor is likely to go through a process of elimination. If treatment for more common issues such as heartburn or tummy bugs don’t work, then further investigation will be done, including a blood test for CA125, a protein that’s often higher than normal in women with ovarian cancer. They are also likely to do a transvaginal ultrasound, which gives a clearer picture of the ovaries than an abdominal or external ultrasound.
If you have a family history of cancer, make sure your GP knows, then they may consider the possibility of cancer sooner and progress their investigations more quickly. During this process, don’t be shy about seeking a second medical opinion if you have already seen a doctor but would like a more thorough check of any potential symptoms.
For more information:
• Cancer Council Australia: cancer.org.au, 131 120
• Ovarian Cancer Australia: ovariancancer.net.au, 1300 660 334