Ovarian cancer is the 10th most common cancer type for Australian women, with survival beyond five years after diagnosis at only 46%, it’s a disease that constantly requires improved education of the public. Specifically, to ensure we as women understand the early signs and symptoms, in order to ensure an earlier diagnosis and therefore better survival outcomes.
A recent poll by Pink Hope found that awareness of ovarian cancer signs and symptoms are low (around 50% of women admitted to not knowing the symptoms), and this lack of awareness can lead to confusion and fear, and all kinds of misconceptions.
To sort fact from fiction, we spoke to a medical oncologist, Dr Jeffrey Goh, from Brisbane’s Icon Cancer Centre to find out about some of the biggest myths surrounding ovarian cancer.
MYTH: The symptoms are so subtle, by the time you notice them, it’ll be too late
The symptoms of ovarian cancer can feel like other sensations, such as bloating or general discomfort, says Dr Goh.
“Ovarian cancer can indeed sneak up on women and it’s very non-specific in terms of symptoms at diagnosis; patients do not always present with a lump on the abdomen but instead they feel very non-specifically unwell,” he explains.
Dr Goh says some of the symptoms can include feeling bloating, loss of appetite, and tummy swelling, however, women may not pay attention to them.
“These are the kinds of symptoms that can also arise if women are going through menopause or if they’re younger, the changes that happen during your menstrual cycle,” he says, “So sometimes it’s not easily picked up.”
Whether you’re feeling bloated, have a loss of appetite due to feeling as though you are ‘full’, or an unusual cramp and sense of heaviness, any of these small things can add up to something more serious. As well, any changes to your bowel habits, such as being more constipated than usual, more frequent heartburn, pain during intercourse or an ache in your back or abdomen, or both, are symptoms worth discussion with your doctor.
MYTH: Your pap-smear will catch ovarian cancer
One of the biggest misconceptions is that a pap smear screens for ovarian cancer, however, Dr Goh points out that a pap smear only screens for cervical-related cancer, and at the moment in Australia there is no comparable test for ovarian cancer.
With these limitations, it’s incredibly important to speak with your doctor about any consistent physical discomfort or changes you are noticing. Dr Goh says to listen to your body and speak to your health professional if something feels new or wrong.
Following a discussion around your symptoms, family history and other risk factors, your doctor might start by doing a pelvic exam and may order a blood test (including tumour markers) and ultrasound to look for suspicious growths. Your doctor may also consult a Gynaecological Oncologist to take a closer look at the findings to keep you well monitored.
MYTH: Ovarian cysts are a type of ovarian cancer
Having ovarian cysts does not mean you have ovarian cancer. Cysts on your ovaries are common, and in most situations normal.
Most ovulating women form cysts, which are small sacs filled with fluid, on their ovaries each month. Known as functional cysts these are benign and usually disappear on their own. Other types of benign cysts can form around the ovaries too, and often go away without further treatment required.
When ovarian cancer develops, however, it is often on the outside surface cells of the ovaries, known as the epithelial cells, where most malignancies are found. It can also develop in the cells that form the eggs, the cells that release estrogen and progesterone or in the fallopian tubes.
“What the gynaecologist would look for is not a simple cyst but cysts that are complex on ultrasound, that has multiple septations, meaning it’s got different parts to it,” explains Dr Goh. “So, a complex cyst is more likely to be malignant, whereas a simple cyst is less likely.”
The malignant ovarian cysts that characterise ovarian cancer are rare, and only 13 to 21 per cent of ovarian cysts that are removed are cancerous, according to the Office on Women’s Health.
MYTH: No family history means you’re in the clear
Regardless of whether you carry a strong family history or genetic predisposition to an increased risk of developing ovarian cancer, all women need to be vigilant about their ovarian health.
“You don’t have to have a family history to develop ovarian cancer and in fact, we now routinely test for BRCA mutations, which is the gene that is inherited (germline) or acquired (somatic mutation) that predisposes patients to develop ovarian and/or breast cancer,” Dr Goh explains. “That particular mutation can be found in 30% of patients without a family history. So, family history may not predict a gene carrier.”
While on average, a woman’s risk of developing ovarian cancer is 1 in 85 by her 80th birthday, according to Cancer Australia, scientists really don’t know the main cause. While age is one risk factor, nulliparity (not having children) and endometriosis can also influence a woman’s risk of developing ovarian cancer.
“However, don’t forget that ovarian cancer is still relatively uncommon,” Dr Goh advises. “It’s only 1% prevalence, meaning one in a hundred women will get it in their lifetime.”
MYTH: Ovarian cancer is incurable
Ovarian cancer can be cured, especially when detected early, however, Dr Goh says it depends on the stage the cancer is at when you’re diagnosed.
“The chance of a long-term remission is very good with stage one disease, and usually it’s picked up at that stage because a person is having a procedure, having an ultrasound for something like abnormal bleeding or pain in the tummy, and it gets picked up early, then the cure rate or the five-year remission rate is quite good actually for stage one disease,” he says.
And while more difficult to treat, certain late-stage ovarian cancers also have good outcomes, depending on a variety of factors. New targeted therapies, particularly for BRCA-related ovarian cancers are helping women with late-stage ovarian cancer to live longer, and patients who don’t respond to one therapy are often tried on subsequent lines of therapies. Participating in clinical trials is a good way to access the latest treatments as well.
Because early detection plays such a key role in the survival of ovarian cancer patients, it’s so important to be empowered to know what the signs and symptoms are and ask your doctor if you feel as though something is wrong.
