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Ovarian Cancer

  • What is ovarian cancer?

    ovarian cancer

    Ovarian cancer refers to harmful growth appearing in different parts of the ovaries. The ovaries are part of a woman’s reproductive system where the eggs are developed. Most ovarian cancers are a type of cancer called ‘epithelial’ – cancer starting from the surface of the ovary. Other types start from the egg cells (germ cell tumour) or supporting cells (sex cord-stromal tumour).

    Risk factors and causes of ovarian cancer

    The risk factors of ovarian cancer include:

    • Late pregnancy
    • Early start of menstruation
    • Late menopause
    • Never had children
    • History of breast cancer
    • Family history of the cancer
    • Endometriosis, where tissue that normally lines the inside of the uterus grows outside instead

    Ovarian cancer is the 5th most common cancer among women in Singapore and is the second most common female genital tract cancer. According to the Singapore Cancer Registry Annual Report 2018, it also has the 3rd lowest age-standardised relative survival rate (ASRS) among the common cancers diagnosed in females at 42.7%.

    Ovarian cancer onset age

    Epithelial ovarian cancer usually affects older women than younger women. However, younger women have a higher risk of contracting germ cell cancers of the ovary than older women.

    Ovarian cancer is known to run in some families with BRCA gene defects or Lynch syndrome. Families with BRCA gene defects may have a higher risk of getting ovarian, breast and uterine cancer. Families with Lynch syndrome may have a higher risk of getting ovarian, uterine and colorectal cancer. For example, a woman with a sister or mother with Lynch syndrome is 20 times more likely to develop ovarian cancer. Ovarian cancer also runs in certain families with a history of breast and colon cancers. There is now evidence to suggest that certain genes are involved in causing these diseases.

  • What are the signs and symptoms of ovarian cancer?

    Early ovarian cancer

    Women with early-stage ovarian cancer often do not experience any symptoms. Some women may experience mild symptoms such as bloating, abdominal pain, or a frequent need to urinate. These early signs of ovarian cancer are often overlooked since they come and go, or are mistaken for more common conditions such as dyspepsia or ovarian cysts.

    Advanced ovarian cancer

    Ovarian cancer symptoms are more prominent in women with advanced stages of the disease. Symptoms of advanced ovarian cancer include:

    infographic of ovarian cancer symptoms
    • Abdominal swelling and discomfort
    • Back pain
    • Bloating
    • Changes in bowel habits, such as constipation
    • Loss of appetite
    • Pain in the pelvic area
    • Persistent indigestion, gas or nausea
    • Weight loss
  • Diagnosing ovarian cancer

    ovarian cancer diagnosis using ultrasound

    CA 125 blood test

    CA 125 is a protein found on the surface of ovarian cancer cells and certain healthy tissue. The level of CA 125 is higher in about 80% of patients with epithelial ovarian cancers. However, higher levels of CA 125 are not always a sure sign of ovarian cancer as other conditions such as endometriosis and appendicitis can also result in increased CA 125 proteins. Thus, a CA 125 blood test is not enough for a diagnosis alone.


    Ultrasound scan

    You may have an internal ultrasound (known as a transvaginal ultrasound), where the ultrasound probe is inserted into the vagina. Another type of scan is an external ultrasound, where the probe is put next to your stomach. The ultrasound image shows the size and texture of the ovaries, as well as any cysts that may be present.

    Pelvic examination

    The doctor can inspect the genitals (vulva), vagina, uterus and ovaries for unusual changes.

    CT scan / MRI scan

    A computed tomography (CT) or a magnetic resonance imaging (MRI) scan takes images of the abdomen, chest and pelvis and combines them to form a 3-dimensional (3D) picture to help doctors look for signs of cancer in the body.

    Chest X-ray

    X-rays uses a type of radiation to take images of the insides of the body. Chest X-rays are useful in find out if the ovarian cancer has spread to other parts of the body like the lungs.

    Surgery / Biopsy

    An operation or biopsy is needed to prove if affected cells are cancerous or not.

  • What are the options for ovarian cancer treatment?

    Ovarian cancer treatment

    To judge how far the cancer has spread, surgical exploration or 'staging' of the cancer is needed. To do so, the doctor does surgery to study the peritoneum, which is the inner lining of the abdomen. Fluid within the lower stomach area is sent for review which involves study under a microscope. Besides determining the stage of the cancer, the aim of the surgery is to remove as much of the cancer as possible. Often this includes removing the ovaries, the uterus and its surrounding lymphatics. Additional treatment following surgery will depend on the stage of the disease, the grade of the disease and the type of cancer.


    For very early stage or non-aggressive cancer, further treatment may not be needed. For more advanced and aggressive cancer, chemotherapy may be the treatment of choice.

    Prognosis of ovarian cancer

    Treatment tends to be highly effective for ovarian cancer in the early stage, though less effective if the cancer is in its late stage. However, survival rates have improved in the last 10 – 20 years due to better chemotherapy treatments.


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