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Ovarian Cancer Q&A with Dr Greg Gard

31 Jan 2018 by Krystal Barter
Ovarian Cancer Q&A with Dr Greg Gard

Who is at risk for ovarian cancer?  

All women are at risk for ovarian cancer. There is an increased risk for women with a genetic mutation such as BRCA1 or BRCA2.  It is estimated that 80% of ovarian cancer occurs in women with no family history or genetic mutation – these are termed sporadic cases. 20% of women will have a genetic risk that has contributing to the development of the cancer.

What are the symptoms of ovarian cancer? Most common symptoms?   

Unfortunately, most symptoms of ovarian cancer are common, vague and nonspecific. These include bloating, ovarian distention, bowel upset and nonspecific pain or a lump which may be felt. It should be stressed that most people who have these symptoms do not have ovarian cancer.

How do healthcare providers diagnose ovarian cancer? 

Ovarian cancer is ultimately diagnosed by a tissue sample whether it is at surgery or by extracting some fluid from the abdomen. Prior to this time, it is usual to have had imaging performed either a pelvic ultrasound, CT scan or both.

Do any factors make you more/less likely to be diagnosed?   

Delays sometimes occur in diagnosis mainly because the symptoms are so vague and nonspecific. It is at this time unavoidable because not all patients with symptoms need to have comprehensive imaging. The decision will be at the discretion of the general practitioner who will use their clinical acumen based on their history and examination. In general GP’s get it right in the vast majority of cases.

Should women get a second opinion for an ovarian cancer diagnosis?   

Ovarian cancer in Australia is generally managed by a multidisciplinary group and all new patients are discussed with a wide range of expert clinicians. Patients should be aware that this is an excellent quality assurance mechanism with built 2nd opinions from an expert group.

Patients will usually be referred to a gynaecological oncologist when a diagnosis of ovarian cancer is considered. These are specially trained gynaecologists with an interest and special training in oncology. If a patient is presented with a possible diagnosis of ovarian cancer and a referral to a gynaecological oncologist has not been made then it would be worthwhile to ask your GP to see one.

How important is it for women to know their risk of ovarian cancer? Advice for how women can learn more about their risk factors? 

Once a diagnosis of ovarian cancer has been made unfortunately the disease is usually at an advanced stage. This is probably because the cancer will spread well before it gives you any symptoms. The best strategy we will have is to prevent the cancer before it occurs. The only proven strategy is risk reducing surgery with removal of ovaries and tubes. Removal of the ovaries however will induce premature menopause and can also have effects after a natural menopause. Hence this decision must be carefully considered with discussion with expert clinicians.

What are the benefits of preventative surgery and when should women consider it? 

The major benefit of risk reducing surgery is marked reduction in incidence of ovarian cancer. Though there may also be an additional benefit of reducing the risk of breast cancer. Unfortunately, even with removal of the ovaries and tubes it does not reduce the risk to zero. There is a very small risk of peritoneal cancer which is identical in every way to ovarian cancer but it does not arise in the ovaries or tubes. It is thought to arise in the peritoneum which is the membrane lining the abdomen and pelvis and cannot be fully removed.

Women should consider the surgery based on their risk factors after discussion with their doctors. As fertility will be prevented this should always occur after the women has completed her family. BRCA1 mutations can cause ovarian cancer in women even in their early 30’s so should be considered as soon as child bearing has been completed. An ovarian cancer associated with BRCA2 mutation is rare below the age of 50, hence surgery may be contemplated at 45. Women with a strong family history of ovarian cancer but with no proven mutation may consider also consider risk reducing surgery. The timing of this surgery will be an individual decision and will depend on many factors such as the time of cancer diagnosis in her family members as well as their level of anxiety regarding their risk.

Thoughts on genetic testing? How important is it/is it necessary? Who needs it?   

Genetic testing is crucial in reducing the rates of ovarian cancer in order to reduce the harm and distress caused to women and their families and friends. People are often scared of the implications of testing, but I believe that knowledge is power and knowledge of one’s risk will allow women to make decisions that will improve their health and longevity.

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