IN Jamaica, ovarian cancer is not as common as other cancers such as breast, cervical or endometrial cancer, and it is mostly a disease seen in older, post-menopausal women, with 80 per cent of cases occurring over age 50.
But obstetrician-gynaecologist (ObGyn) Dr Anna-Kay Taylor Christmas said despite Jamaica having one of the lowest incidence rates, ovarian cancer is significant as it accounts for more deaths than the other gynaecological cancers combined in developed countries, and overall long-term survival rates are still low.
“The chances of survival increase the earlier the stage it is at diagnosis, and the chances are very good if it has not spread outside of the ovary at the time of surgery. Signs and symptoms of ovarian cancer are usually initially vague and non-specific. This therefore means that management is currently geared towards picking up early-stage disease and treating it as quickly and effectively as possible to afford patients the best survival rates,” she said.
Unfortunately, however, Dr Taylor Christmas said only 30 per cent of all patients are actually diagnosed at the earliest disease stage, because there is currently no effective, affordable, standardised screening protocol available for ovarian cancer.
So what are some of the symptoms of ovarian cancer?
Dr Taylor Christmas said early stages tend to have vague, non-specific symptoms, or no symptoms at all, but patients may experience:
1. Abdominal bloating
2. Difficulty eating or feeling full quickly
3. Frequent or urgent urination
4. Back, abdominal or pelvic pain
6. Menstrual irregularities
9. Pain during sexual intercourse
10. Unexplained weight loss.
Unfortunately, the ObGyn said these are all common symptoms which can occur for a variety of reasons, which are often not serious. However, if these symptoms are persistent or severe, she said medical attention should be sought.
“Unlike cancer of the cervix, there is no good screening test that can pick up early abnormal changes in the ovary. However, some women are at an increased risk of cancer because of their family or personal history. If several close blood relatives (for example mother, aunt, sister) have had breast or ovarian cancer, that is considered a strong family history, especially if this was diagnosed at an early age,” she said.
“In women with this kind of family history we can screen for the associated abnormal genes called BRCA1 and BRCA2. If a woman has inherited a fault in one of these genes, she has a high chance of developing ovarian cancer or breast cancer, although it does not mean that she is certain to develop cancer. Around five per cent of all breast cancers and up to 15 per cent of invasive ovarian cancers can be explained by an inherited gene fault in BRCA1 or BRCA2.”
With regards to diagnosis, the ObGyn said ovarian cancer is usually diagnosed after a woman comes in complaining of symptoms, and is sometimes picked up incidentally when doing physical exams or tests for other reasons.
“Abnormal changes can be seen on ultrasound, CT scan or MRI, which may show a mass or cyst in or beside the ovary. We often do additional blood tests to determine the chances of the cyst being cancerous before surgery,” she said.
Dr Taylor Christmas said treatment mainly involves surgery to remove the mass, as that is really the primary way to confirm the diagnosis.
“The extent of the surgery depends on the patient's age and desire to have children in the future. For young patients, we try to be as conservative as possible, and leave behind the uterus and the other ovary if feasible. If the tests are very suspicious for cancer and it looks abnormal at the time of surgery, then often we have to remove both ovaries as well as the uterus to offer the best chance of survival. For younger patients with cancer who need to have their ovaries removed, there is the possibility of harvesting their eggs and storing them for future use, once treatment has been completed (once the delay to surgery can be facilitated),” she said.
“If the cancer has spread beyond the ovaries, then chemotherapy is often used as well, to kill any remaining cancer cells. There are lots of options for chemotherapy, and many new and experimental drugs as well, which unfortunately tend to be very expensive and may require enrolment in a clinical trial in a developed country,” Dr Taylor Christmas said.
To complement the treatment, Dr Taylor Christmas said a healthy lifestyle of a well-balanced diet and exercise is encouraged, pointing out that bad habits such as smoking and excess alcohol negatively affect healing and recovery. As such, these habits are discouraged.