Ovarian cancer - rare, but insidious

Ovarian cancer represents only 3% of malignant tumours in women but the resulting mortality rate for all cancers is very high.

There have recently been reports that ovarian cancer can be detected early using a blood test, similar to the early detection of prostate cancer in men (PSA determination). Like the PSA test, this blood test is controversial and it is not yet certain that it is effective.

Symptoms usually only occur in advanced ovarian cancer

Ovarian cancer does not usually present symptoms. The disease spreads tumour cells into the entire abdominal cavity, which results in an extensive disease pattern at an early stage. The tumour and its secondaries then cannot be completely removed surgically. Although this disease most often occurs in women in their 60s, younger women are also affected. The youngest of my ovarian cancer patients was only 15 years old!

Even young women can be affected by ovarian cancer

Early detection is unfortunately the exception. In most cases, the doctor is led to the correct diagnosis by diffuse symptoms in the stomach area caused by accumulation of fluid, or unexplained pain caused by the tumour growing into the pelvic wall. By this time, the disease is already at an advanced stage.

How can ovarian cancer be detected early?

Any ovary enlargement must, depending on the age of the patient, be investigated via laparoscopy and tissue samples. An experienced gynaecologist will notice this enlargement during the annual examination, either by palpation or by ultrasound.

Women of child-bearing age often have cycle-related cysts. Follicular cysts happen before ovulation, and corpus luteum cysts before periods. This is why cysts should not be investigated immediately, but checked again later. These types of ovary enlargement are known as functional cysts, and usually disappear when the period starts. A check-up (palpation/ultrasound) must therefore be carried out after menstruation to see whether the cysts have disappeared. This happens in about 90% of cases. If it does not, further investigation is essential.

Non-cystic ovary enlargements that show abnormal content (containing solid and fluid components) must also be investigated in younger women.

Any ovary enlargement in the menopause (after menstruation has stopped) must be investigated!

Insidious: when the cancer originates from the Fallopian tubes

Worryingly, even ovaries that are normal in size and shape can be malignant. In this case, the cancer starts from the Fallopian tubes rather than the ovaries. Malignant cells are flushed into the ovaries and deposited there – just like local metastases! This imitates the clinical picture of ovarian cancer. This form of ovarian cancer is viewed as an offshoot of Fallopian tube cancer and is always detected too late. In my practice, I detected the disease early in two patients when I found a small irregularity of the Fallopian tubes by chance. However, these were highly exceptional cases.

If a woman is having surgery on her lower abdomen and does not want any more children, both Fallopian tubes can be removed as a precautionary measure. This recommendation is becoming increasingly established. According to the Journal of Cancer Research and Clinical Oncology, 2014, Runnebaum et al, ‘it can be assumed “that this small operation can prevent a significant number of ovarian cancers.” After the Fallopian tubes have been removed, hormone production occurs normally. The patient does not experience early menopause, which is what happens when the ovaries are removed due to a tumour. As cancer that begins in the Fallopian tubes is so insidious, I inform all of my patients undergoing abdominal surgery that they can have this operation at the same time.

Article from Dr. med. Reto Stoffel, specialist in gynaecology and obstetrics.