Ovarian cancer begins in one or both ovaries, a pair of solid, oval-shaped organs producing hormones and eggs (ova). Recent research suggests that certain ovarian cancer types might even start in the Fallopian tubes.
Every year in Australia, 1200 women are diagnosed with ovarian cancer, primary peritoneal cancer or fallopian tube cancer. 800 patients will die of their disease. Risk factors include genetic conditions (BRCA1, BRCA2, Lynch/HNPCC). The oral contraceptive pill reduces the risk of ovarian cancer by 50%. Prophylactic, risk-reducing surgery (removal of ovaries and fallopian tubes) protects from ovarian cancer by 80% to 90%.
Due to the lack of early symptoms and inefficiency of screening, two out of three patients are diagnosed at advanced stages (stage three or four). Patients with early stage disease (stage one or two) require surgical removal of the tubes and the ovaries, as well as a staging procedure to determine the extent of cancer spread. Patients with advanced stage ovarian cancer require surgical removal of as much cancer as possible.
This may include removal of uterus, tubes, ovaries, omentum, bowel, spleen, diaphragm and abdominal peritoneum. The size of the tumour left behind after surgery determines the prognosis to a large extent. If large scale surgery is not feasible, patients will have some chemotherapy upfront, followed by delayed surgery and more chemotherapy thereafter. Virtually all patients require chemotherapy, to which 85% of patients respond well. However, the majority of patients with advanced ovarian cancer will relapse.
Current research focuses on the development of new markers indicating the earliest possible stage of ovarian cancer. Diagnosing and commencing treatment of ovarian cancer early might result in better survival outcomes. Other research addresses the selection of patients for advanced surgery as well as measures to improve recovery from treatment.