Diagnosed with ovarian cancer ~ How to prepare for your Gynaecological Oncologist consult

20 Aug 2021

What to ask your Gynaecological Oncologist
If you’ve been diagnosed with ovarian cancer it’s natural to feel shocked, nervous and emotional. This means that you may be unsure about what you should ask your gynaecological oncologist. You will also meet your disciplinary team who will be taking care of you during your treatment and who will also be able to answer your questions.

We asked our expert for some suggested questions patients could prepare before their appointment. As every person who is diagnosed with ovarian cancer is different, this is a suggested starting list of questions for you to prepare and bring along with you – you may wish to add some queries of your own, depending on your circumstances.

Q: Why wasn’t my cancer detected earlier?
There is no effective screening test for ovarian cancer. There are a number of symptoms (link symptoms) that may prompt your doctor to arrange tests to look for ovarian cancer. The only way to confirm a diagnosis of ovarian cancer is to take a tissue sample with either a biopsy or at the time of surgery. In most cases, a patient doesn’t experience any symptoms of ovarian cancer until it has spread beyond the ovaries to other organs.

Q. At what stage is my cancer?
There are four stages of ovarian cancer:

Stage One: Cancer is in one or both ovaries only
Stage Two: Cancer is in one or both ovaries and has spread to other organs in the pelvis (fallopian tubes, bladder, bowel, uterus)
Stage Three: Cancer is in one or both ovaries and has spread to the pelvis and to the lining of the abdomen or abdominal lymph nodes
Stage Four: The cancer has spread to other organs such as the lung or liver.

Depending on the stage of your cancer, your gynaecological oncologist will be able to plan your treatment.

Q. What treatment options will I be offered to me?
The type of treatment for ovarian cancer depends on the pathological type of ovarian cancer and stage of the cancer. In most instances, surgery and chemotherapy is the mainstay of treatment.

Stage One: Surgery. Chemotherapy may be offered if there is a high risk the cancer will return.
Stage Two: Three and Four: Surgery and chemotherapy. If you have a BRCA gene fault, targeted therapy drugs may be considered.

Q. Will I have to have a hysterectomy?
The standard treatment for patients with advanced ovarian cancer is that the uterus is also removed at the time of surgery. There are some patients where it is safe for the uterus to remain. You can discuss this with your surgeon.

Q. How will my treatment affect my fertility and chances of having children?
Most patients diagnosed with ovarian cancer are over 50. For younger patients with ovarian cancer at an age where this is a relevant concern, it will depend on your type of ovarian cancer and stage as to whether fertility is able to be preserved. If this is an area of concern for you, ask your doctor or fertility specialist to discuss your options.

Q. When can I begin treatment? Will I need to have further tests before treatment can begin?
Your specialist will decide how soon to start treatment. Your specialist may request other tests to be performed, these can vary depending on your individual case.

Q. How long will I need to stay in hospital?
Most patients stay in hospital for several days after surgery. To find out more about your hospital stay, what to bring and how to be prepared, read more here.

Q: Will I need more tests during my treatment?
You will need to have more blood or imaging tests while your treatment is underway. Your team will inform you about these tests and schedule.

Q. What are the side effects of the treatment you’re recommending?
Your specialist will detail the potential side effects of any treatment they are recommending. You will also be provided with written information.

Q. Am I eligible for clinical trials?
Many patients may be suitable for participation in a clinical trial. If there is a clinical trial open that you are suitable for your specialist will discuss this with you along with the standard treatment recommendations. Sometimes there are clinical trials open in other centres, if this is something that is important to you your specialist will be able to refer you for assessment. Participation in clinical trials is voluntary and patients can withdraw at any time if needed.

Q. Can I have genetic testing?
Not all patients with ovarian cancer will undergo genetic testing. About 15-20% of women with ovarian cancer have an inherited fault in the BRCA1 or BRCA2 genes. Other genes which less commonly are associated with ovarian cancer are also tested. If genetic testing is recommended this will be performed by your specialist or you will be referred to a cancer genetic clinic.

Q. If I have a gene fault will this change my treatment plan?
For patients with stage III and stage IV ovarian cancer with a BRCA gene fault, your oncologist will discuss a maintenance therapy with a PARP inhibitor after your complete chemotherapy. If you have a gene fault, you will be referred to your local cancer genetic clinic. They will be able to discuss the implications of this result for you and your family.

Q: Will my specialist discuss the success rate of my treatment?
Yes. Your specialist will be able to provide some guidance as to the potential outcomes. This will depend on your specific cancer and how your cancer responds to treatment.

Q: What my options are if the cancer comes back?
For most patients with recurrent ovarian cancer treatment usually will be chemotherapy. The timing and type of chemotherapy will be discussed with you and varies depending on your individual circumstance. Some patients may be considered for further surgery. Clinical trials may also be an option at this time.

Q: Can I take some time to decide on the treatment plan I choose?
You will always be provided with the opportunity to take some time to decide how you would like to proceed. It is helpful to have a family member or support person with you during your consultation. You will be provided with written information and another appointment, at this time any further questions can be addressed.

Q: What about complementary therapy?
Some complementary therapies may not work alongside some medical treatment, so it’s important you let your specialist or team know of any alternative therapies you are using, or are considering.

Q: Should I change my diet and the amount I exercise during my treatment?
It is recommended you eat a well-balanced healthy. It is not recommended that you make major changes to your diet (such as elimination of major food group, changing to a keto-diet or alkaline-diet etc). Exercise is strongly recommended and if needed you can be referred to an exercise physiologist to support and guide you.

Q. Will I be able to work and carry on with my life as normal?
It depends. Many patients can continue working and carry on with a normal life with minimal disruptions. In general, most side effects with chemotherapy last for a few days to a week after each treatment. It is highly variable the effect this has from one person to another.

General questions:
Everybody’s treatment plan will be different, with varying outcomes. However, here are some general questions you may want to ask

Q: Will I need to bring my medical records?
Your doctor or medical team will have shared your medical history with your specialist prior to your appointment, so it’s not necessary for you to bring along copies. If you have had imaging performed, the surgeon would like to have these scans available for review at your first appointment.

Q: Can I bring someone with me to my appointment?
It’s a good idea to bring a trusted family member or friend with you. They may be able to ask the questions during the appointment (if you’re not able to) and find out how they can support you during your treatment.

Q: Do I need to bring my medication with me?
It’s a good idea to bring along any medication you have been prescribed or that you may take regularly (such as pain medication). If you do take any supplements bring these with you too.

Thank you to Lifehouse and Chris O’Brien and Dr Michelle Harris for their input and guidance