What to expect after an ovarian cancer diagnosis
In Australia, over 1,500 women are newly diagnosed with ovarian cancer every year. Here’s what to expect after each stage of investigation and treatment.
There will be several health care professionals involved in your ovarian cancer treatment and follow-up care based on a patients’ needs and preferences. The type of treatment received will depend on the stage and type of cancer and your general health.
Initial investigations and referral
Firstly, a GP will assess your symptoms (which may include persistent abdominal pain, lack of appetite or urinary incontinence), conduct a physical examination, and arrange ultrasound and blood tests. Some women may require a colonoscopy to rule out any bowel conditions that may be causing the symptoms. If ovarian cancer is still suspected after these tests, you will be referred to a gynaecological oncologist for further testing. In my practice, I see patients normally within a few working days from referral.
Diagnosis, staging and treatment
Diagnosis for ovarian cancer can only be confirmed by examining tissue, which sometimes involves surgery. Medical imaging or blood tests cannot confirm or exclude ovarian cancer.
If we suspect “early” ovarian cancer (stage 1 or 2, ovarian cancer without ascites), I typically suggest surgery through an open, abdominal approach (called a laparotomy) and the aim is to firstly confirm the diagnosis. In these circumstances, a frozen section is helpful to analyse tissue under a microscope. If results confirm ovarian cancer the operation is continued to determine if the cancer has spread and if so where it has spread to, and we also remove as much of the tumour as possible. Ideally, after surgery, no residual tumour is left.
Depending on several factors (stage, medical conditions, age of the patient) ovarian cancer surgery will often remove the uterus, fallopian tubes and both the ovaries. In addition, the omentum (fatty tissue that stitches over the intestines, liver and stomach) and lymph nodes may also need to be removed. In some cases, patients will require a part of their bowel removed (bowel resection).
Depending on age and individual circumstances, prior to surgery your team should also discuss the option of fertility preservation and provide clear information about the risk of early menopause and hormonal changes.
If advanced ovarian cancer (stage 3 or 4) is suspected (based on medical imaging), I often recommend upfront chemotherapy to shrink the tumour straight away. In this case, I sometimes suggest a laparoscopy to remove a solid piece of tumour for testing. However, sometimes, patients are too sick to have a surgical procedure. In such circumstances, I will arrange for some fluid to be drained from the pelvis or the chest for cytological analysis only.
Chemotherapy is usually administered through a drip into a vein in the arm and uses a combination of drugs to help attack cancer cells and stop or reduce their growth. Almost all patients will require chemotherapy after or even before surgery to help the cancer shrinking or stop it from returning.
Chemotherapy can have side effects. Ask your doctor to explain what side effects to expect and how best to manage them. How long a patient may need to undertake chemotherapy and where you can have chemotherapy will also be explained.
Targeted therapy drugs are sometimes used to treat advanced epithelial ovarian cancer and can get inside cancer cells and block specific proteins that tell the cells to grow. Bevacizumab and Olaparib are two targeted therapy drugs. They are sometimes more effective than chemotherapy alone but still can cause side effects.
If both ovaries are removed during surgery this will cause surgical menopause and hormonal changes in young women. This may lead to night sweats, hot flushes or reduced libido. There are ways to reduce or manage the side effects of early menopause which can be discussed with your doctor including hormone replacement therapy if required.
After surgery, you should be seen regularly for follow-up for five years. After five years, the risk of the cancer returning becomes much lower. These examinations will include pelvic examinations and blood tests. PET/CT scans are recommended only if needed.