Questions on ovarian cancer
Question: I have just been diagnosed with ovarian cancer. What exactly does this mean?
Answer: Ovarian cancer occurs when there is uncontrolled growth of cells in one or both of the two ovaries. As a result of this a small swelling or tumour arises from this clump of cells and may spread into the surrounding tissues.
Question: What are the early symptoms of ovarian cancer?
Answer: Unfortunately, there may be no symptoms in the early stages and that is why the tumour is often found to be spread outside the ovary at the time of diagnosis. Some women suffer from symptoms of feeling bloated or non specific pain in the abdomen. Other symptoms include vaginal bleeding due to production of the hormone oestrogen, urinary symptoms due to pressure or irritation of the bladder and bowel upset for the same reason.
Question: Why do some women have an operation for their tumour while others are just given chemotherapy?
Answer: When you are first diagnosed with ovarian cancer, you undergo what is called staging. This literally means at what stage your disease has progressed to and will determine what treatment you are offered.
Question: Can you explain to me how this staging is done?
Answer: Most women will undergo a CT scan and this will suggest if the tumour appears to be localised within the ovary (Stage I disease), spread into the surrounding tissues (Stage II disease), further spread into the lining of the intestines (Stage III disease) and finally spread to other parts of the body (Stage IV disease). These stages are then subdivided to explain the degree of spread more accurately.
However, the CT scan is not as good as the surgeons' eyes and an exploratory operation to look at how much tumour there is and where it has spread to, will often be carried out.
Question: Does the treatment depend on the stage of the disease?
Answer: Yes. If there is no evidence that the tumour has spread, then surgery alone is adequate. However, in the majority of cases the tumour has spread and despite the skills of the surgeon, all the tumour cells may not be removed. In this case treatment is given to try to kill any remaining tumour cells – known as adjuvant therapy.
Sometimes the tumour is so widespread at diagnosis that the surgeon feels it would not be possible to remove the whole of the tumour. In this case an attempt is made to reduce the size of the tumour using chemotherapy before contemplating surgery. This is known as neo adjuvant treatment.
Question: If after a number of cycles of chemotherapy to try to reduce the size of the tumour, there is no effect, is there anything else that can be tried?
Answer: Other chemotherapy agents can be tried. These are called second line drugs because overall they are not as effective as the first line drugs. However, every tumour is different and everyone's immune response also differs so they may well work.
Question: I feel very bloated and my abdomen looks like I am pregnant. The doctor says that I have collected a lot of fluid which has been produced by the tumour. Is there anything I can do to remove it?
Answer: If you feel very uncomfortable with the excess fluid then it can be drained off. It involves coming into hospital and a small tube is placed into the cavity where the fluid has collected and it is then drained off. The whole procedure should be painless and only a small amount of local anaesthetic is required.
Question: If the fluid keeps coming back, is there anything else that can be done?
Answer: It may be possible to put in a permanent tube that drains the fluid back into the normal circulation.