How doctors determine if you have ovarian cancer

19 Aug 2021

Each day in Australia four women are diagnosed with ovarian cancer and the majority of them are over 40. With survival rates of only 46% and a recurrence rate of 75%, the key is to catch it early. But that’s easier said than done, says gynae-oncologist Dr Rhonda Farrell, from the Chris O’Brien Lifehouse.

“Well, unfortunately, we don't have a good screening tool yet,” she explains. “Hopefully we'll have a test at some point, that's the holy grail of ovarian cancer research.”

That’s why, Dr Farrell stresses, oncologists are relying on women going to the doctors early enough.

“Women need to be aware of their bodies and symptoms,” she explains. “If they experience unexplained bloating or discomfort, changes in bowel habits, frequency of urine, or abnormal bleeding that doesn't settle in two weeks, they should go to their GP.”

Dr Farrell admits that the symptoms are often vague but if they persist and do not settle over one-two weeks, this should prompt a visit to the GP and request for a pelvic ultrasound.

The hereditary link
Being aware of symptoms is especially important for women who have a primary or secondary relative with ovarian cancer, multiple family members with breast cancer at a young age, or if they're of Ashkenazi Jewish descent because they have a higher risk of carrying a BRCA mutation.

Dr Farrell also points out that women are considered high-risk for ovarian cancer if they’ve had breast cancer themselves at a young age.

“With about 15% of women who get ovarian cancer, it's due to a hereditary mutation,” she advises, “which could have been prevented if it was identified early enough.”

So, she says, it’s really important for women who are at risk based on their family history to go to their GP and request a referral towards a hereditary cancer clinic. These are available in all major centres and also in regional outreach clinics. Risk-reducing surgery for these women is offered at around the age of 40 years or once they have completed their family.

Diagnosing the symptoms
To assess any persistent symptoms, GPs have a number of options to determine if there is evidence of ovarian cancer depending on the age of the patient. However, as the latest research now shows that ovarian cancer can start in the fallopian tubes, Dr Farrell says ultrasounds are not a good screening test if there are no symptoms, but are useful if a woman does have persistent symptoms as outlined above.

“A transvaginal ultrasound is minimally invasive. You don't have to have radiation. You don't have to have a cannula put in. So, as a basic first-line action, it's a reasonable test. And if the ovary looks unusual, then there are other assessments which can be made,” she explains.

In women who are menopausal, Dr Farrell says a CA 125 test can be useful to measure the amount of cancer antigen 125 protein in the blood, which can indicate ovarian cancer. In younger women, however, the CA 125 test is not as reliable as other factors, such as having a period, can put that blood test marker up.

The next steps
As ovarian cancer can be challenging to diagnose, Dr. Farrell says there is an algorithm called the risk of malignancy index, (RMI) which is used to help plan a patient’s next steps.

“If there's an abnormality seen on the ultrasound on the ovary, and the CA 125 marker is high, or the woman has a family history of breast or ovarian cancer or a suspicion of cancer, then they should be referred to a gynae-oncologist,” she explains.

Apart from seeing a specialist oncologist, Dr Farrell says it’s really important that any surgery be done in a specialist unit that has the right expertise.

“At Chris O’Brien Lifehouse we can send the ovary or any tissue that's removed to a pathologist during the surgery to tell us whether there's a cancer, so we can do the appropriate staging surgery at the same time,” she explains.

Working with a specialised team means avoiding preliminary surgery and the subsequent wait for results, followed by booking in a second procedure and waiting again. Dr Farrell says that while this process is happening sometimes the cancer can spread. The evidence supports that women with ovarian cancer have a better outcome if their surgery is performed by a gynaecological oncologist in a specialised centre rather than by a general gynaecologist or general surgeon.

The good news
Despite the lack of concrete testing, Dr Farrell is confident in the future ovarian cancer treatments and diagnostics.

“Look, things are improving for women with ovarian cancer,” she explains. “There are more targeted treatments, more effective chemotherapy-type treatments for women who have a BRCA mutation, and there’s also the use of PARP inhibitors (for example, Olaparib), which has just been approved for PBS funding as treatment for many women with primary ovarian, fallopian tube or peritoneal cancer. These are all targeted treatments that are showing improved survival in many women with ovarian cancer.”

However, Dr Farrell points out that while these treatments are having some success, it is very important to be aware of your own personal risk so that you can discuss the options for prevention with your GP.