Ovarian cancer

Friday 1 April, 2016

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On this page: The ovaries | What is ovarian cancer? | How common is it? | What are the symptoms? | What types are there? | What are the risks? 

The ovaries

The ovaries are part of the female reproductive system. The female reproductive system also includes the fallopian tubes, uterus (womb), cervix (the neck of the womb) and vagina (birth canal).

The ovaries are two small, oval-shaped organs, each about 3 cm long and 1 cm thick in size. They are found in the lower part of the abdomen (the pelvic cavity). There is one ovary on each side of the uterus, close to the end of the fallopian tubes.

Each ovary is covered by a layer of cells called the epithelium. Inside the ovaries are cells called germ cells, which will eventually mature into eggs (ova).

An egg, called an ovum, is released from one of the ovaries each month (ovulation). The egg travels down the fallopian tube to the uterus. If the egg is fertilised by sperm, it can grow into a baby. If an egg is not fertilised by sperm, it disintegrates and – with the lining of the uterus – passes out of the vagina in the monthly period (menstruation).

The ovaries also release the female hormones oestrogen and progesterone from cells called stromal cells.

As a woman gets older, the ovaries gradually produce less of the hormones oestrogen and progesterone. The production of mature eggs also decreases and the woman’s periods become irregular and finally stop. This is known as menopause, which usually happens between the ages of 45 and 55. After menopause, it is no longer possible to conceive a child naturally.

The female reproductive system

What is ovarian cancer?

Ovarian cancer is a malignant tumour in one or both ovaries. Recent research suggests that many ovarian cancers start in the fallopian tubes. This is different to fallopian tube cancer, which is rare.

How common is it?

Each year, about 1400 Australian women are diagnosed with ovarian cancer. The average age at diagnosis is 64. It is the ninth most common cancer in women in Australia. Ovarian cancer is usually diagnosed in women over 501.

What are the symptoms?

In its early stages, ovarian cancer usually has no symptoms or only vague ones. If symptoms occur, they may include: pressure, discomfort or pain in the abdomen or pelvis; swollen or bloated abdomen; appetite loss or feeling full quickly; changes in toilet habits (e.g. constipation, diarrhoea, passing urine often due to pressure, increased flatulence); heartburn and nausea; tiredness; unexplained weight loss or weight gain; changes in menstrual pattern or bleeding after menopause; or pain during sex.

If these symptoms are new for you or continue for a few weeks, make an appointment with your general practitioner (GP). Having these symptoms does not necessarily mean you have cancer, but it is best to have a check-up.

What types are there?

There are many types of ovarian cancer. The table below lists the three most common types.

Types of ovarian cancer
  • starts in the surface of the ovary (epithelium)
  • most common type (about 9 out of 10 cases)
  • subtypes include serous, mucinous, endometrioid and clear cell cancers
Germ cell
  • starts in the egg-producing cells
  • rare type of ovarian cancer (about 4% of cases)
  • usually develops in women under 30
Stromal cell
  • rare cancer that starts in the cells that produce the female hormones oestrogen and progesterone
  • can occur at any age
  • may produce extra hormones, such as oestrogen

Some women (usually younger women) are diagnosed with a borderline tumour. This is not considered to be cancer because, although it can spread, it does not invade other organs. For this reason, borderline tumours are also known as low malignant potential tumours.

Ovarian Cancer Australia has produced a symptom diary to help women record any symptoms and talk about their health concerns with their doctor. 

What are the risks?

The causes of ovarian cancer are unknown, but the risk factors include:

  • age
    ovarian cancer is most common in women over 50 and in women who have stopped menstruating (have been through menopause), and the risk increases with age
  • reproductive history
    women who have not had children, were unable to have children, or had children over the age of 30 may be slightly more at risk
  • having endometriosis
    a benign (non-cancerous) condition in which the tissue that lines the uterus (endometrium) is also found in other areas of the body
  • lifestyle factors
    such as being overweight or eating a high-fat diet
  • hormonal factors
    including early puberty or late menopause, or using oestrogen-only hormone replacement therapy (HRT) for five years or more.

Some factors may reduce the risk of developing ovarian cancer. These include having children, breastfeeding, using the combined oral contraceptive pill for several years, and having your fallopian tubes tied (tubal ligation).

How important is family history?

Most women diagnosed with ovarian cancer do not have a family history of the disease.

About one in 10 women have an inherited faulty gene that increases the risk of developing ovarian cancer. However, not all women who inherit a faulty gene develop ovarian cancer.

The two main genetic conditions known to increase the risk of ovarian cancer include hereditary breast/ ovarian cancer (fault in the BRCA1 and BRCA2 genes) and, less commonly, Lynch syndrome (formerly known as hereditary non-polyposis colorectal cancer or HNPCC).

Certain factors may increase the chance of ovarian cancer being hereditary, including if:

  • family members were diagnosed with ovarian cancer
  • you or a family member were diagnosed with breast cancer
  • you or a family member were diagnosed with bowel or uterine cancer
  • you have Ashkenazi Jewish ancestry.

If you are concerned about your family history of cancer, visit a familial cancer centre to discuss the possibility of genetic testing. Often, these centres are located in major public hospitals. 

Cancer Australia has developed an online tool called the Familial Risk Assessment – Breast and Ovarian Cancer (FRA-BOC) to help health professionals assess your risk.

1. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Ovarian cancer, AIHW, Canberra, 2016.

Reviewed by: Prof Martin K Oehler, Director Gynaecological Oncology, Royal Adelaide Hospital, SA; Dr Serene Foo, Medical Oncologist, Mercy Hospital for Women, Austin Health and Epworth Eastern Hospitals, VIC; Maira Kentwell, Senior Genetic Counsellor and Manager, Department of Genetic Medicine and Familial Cancer Centre, The Royal Melbourne Hospital, VIC; Jane Lucas, Consumer; Cindy Morgan, Consumer; Shannon Philp, Nurse Practitioner – Gynaecological Oncology, Chris O’Brien Lifehouse, NSW; Lea Rawlings, Perth Support Coordinator, Ovarian Cancer Australia; Deb Roffe, 13 11 20 Consultant, Cancer Council SA, SA; and Merran Williams, Clinical Nurse, Bloomhill Cancer Care, QLD.

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