Article contributed by Dr Cindy Pang 
Associate Consultant Department of Obstetrics & Gynaecology 
Singapore General Hospital

Ovarian Cancer is the 5th most common cancer affecting Singapore women today. It is the most common gynaecological cancer, and usually presents at an advanced stage. As a result, it is the most deadly of the gynecological cancers. In Singapore annually, there are about 265 new cases diagnosed and close to 100 women will die from it.*

Is My Ovarian Cyst Cancerous?

We suspect cancer if the cyst is:

• Solid, septated (many little cysts)

• On both ovaries

And if there is

• Ascites – “Water around the cyst”

• Ca125 raised in your blood test

BUT... note that other conditions such as menses, urine infection, liver problems and diarrhea can lead to a raised level of Ca125. In addition, 50% of Stage 1 Cancers have normal Ca125 Level.

Are there symptoms?

• The common symptoms are non-specific and mimic other conditions such as digestive and bladder disorders.

• The key seems to be persistent or worsening symptoms.

See a doctor if you have more than 2-3 weeks of:

• Abdominal Swelling/Bloating/Clothes Too Tight
• Abdominal/Pelvic Pain or Pressure or Feeling “Full”
• Gastrointestinal Symptoms (such as indigestion, nausea, or changes in bowel movements)
• Urinary Problems – frequent urination, difficulty in urinating
• Tiredness and/or Fever
• Pain During Intercourse
• Back Pain
• Difficulty Breathing

In majority of the time, these symptoms will not be due to cancer, but a professional opinion should be sought whenever in doubt.

Protective Factors:

• Having children
• Use of the contraceptive pills
• Breast feeding
• You can be at increased risk if you:
• Are overweight
• Are nullip (Non-childbearing)
• Are aged above 40
• Have a family history of cancer – first-degree relatives (mother, daughter, sister) affected. A family history of breast or colon cancer
• is also associated with an increased risk
• Have a personal history of breast, endometrial or colon cancer

What are the treatments used?

There are two main types of treatment – surgery and chemotherapy

Surgery

How much surgery you have depends on how far your cancer has spread and on your general health.

Two main goals:

• To stage the cancer – find out the spread and the type of disease.

• To remove as much of the cancer as possible – this is called debulking.

The operation involves removal of the uterus, both ovaries and the fallopian tubes. Also, the omentum (an apron of fat covering the abdominal contents), the nearby lymph nodes and surrounding tissue where the cancer might have spread to and part of the intestines may be involved in the operation.

Chemotherapy

This involves drugs that are injected into the bloodstream to reach all areas of the body with the aim of killing cancer cells that may have spread. For ovarian cancers that are aggressive or of a higher stage, this treatment helps control the disease after surgery.

Conclusion

Ovarian cancer is a serious illness. It is disproportionately deadly because it is usually detected at an advanced stage due to the non-specificity of the symptoms.

It is known as a “silent killer” as the symptoms of abdominal pressure, fullness, swelling or bloating, urinary urgency and pelvic discomfort or pain, may mimic those of many other conditions. It is not unusual for women with ovarian cancer to have a delay in diagnosis as they seek treatment for digestive disorders or urinary disorders before eventually being referred to a gynaecologist.

The key difference in benign and cancerous conditions is the persistence of symptoms. If one has a nagging abdominal discomfort or prolonged symptoms as described above, do seek a doctor’s opinion.

*Singapore Cancer Registry Interim Report 2003-2007