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Ovarian Cancer

What is Ovarian Cancer


The ovaries, located in the pelvis, are part of the female reproductive system. The size of each ovary is equivalent to that of an almond. The main functions of the ovaries include producing oestrogen and progesterone, together with releasing eggs. An egg  travels from the ovary through a fallopian tube to the womb, or uterus. When a woman goes through menopause, the ovaries stop releasing eggs, resulting in markedly lower levels of hormones being produced.

The ovaries contain primitive cells, which will go on to become eggs and epithelial cells. When primitive cells become cancerous, they are referred to as germ cell tumours. Notably, epithelial cell cancer of the ovary is more common than germ cell cancer. In Singapore, ovarian cancer is the fifth most prevalent cancer, with a rising incidence. Ovarian cancer is known to be the deadliest gynaecological cancer because it is usually detected in the later stages, due to the ovaries being located deep in the body cavity. Hence, pre-cancerous and early cancerous changes difficult to detect.

It is important to note that CA125 blood test and other tumour marker blood tests are ineffective for screening ovarian cancer. Furthermore, even regular ultrasounds of the ovaries in normal healthy women with no obvious family history of ovarian, breast or colon cancers have proven to be ineffective. While these tests are often offered as a part of routine health screening packages, they are only helpful in detecting other non-cancerous conditions in the general population. If you are in good health generally and you sisters, your mother and her sisters have no history of ovarian, breast or colon cancer, do let your healthcare provider know that you do not need a CA125 blood test.

It is worthwhile to remember the most effective early detection tool for ovarian cancer is knowing your body, equipping yourself with knowledge of early symptoms and having regular pelvic examination by a gynaecologist.


Who is at risk?

  • Family history of ovarian cancer;
  • Personal history of cancer of the breast, uterus, colon, or rectum;
  • Late pregnancy or have never been pregnant;
  • Early onset of menstruation and/or late menopause, and
  • Menopausal hormone therapy (such as taking oestrogen without progesterone) for ten or more years).
*People who think they may be at risk should discuss this with their doctor.
What are the signs and symptoms?

Early ovarian cancer often does not exhibit obvious symptoms. Hence, it has been dubbed a "silent killer". Nonetheless, as the cancer grows, common symptoms include:

  • Pressure or pain in the abdomen, pelvis, back or legs;
  • Swollen or bloated abdomen caused by fluid build-up or tumour;
  • Nausea, indigestion, gas, constipation or diarrhoea;
  • Having trouble eating or feeling full quickly ; and
  • Feeling extremely most of the time.

Less prevalent symptoms include:

  • Shortness of breath;
  • Feeling the need to urinate often; and
  • Unusual vaginal bleeding (heavy periods or bleeding after menopause).

It is important to know that these symptoms may be caused by ither conditions other than cancer. Hence, it is important for individuals with these symptoms to promptly consult a doctor.

How is Ovarian Cancer diagnosed?

The doctor may ask about personal and family medical history, and order one or more of the following tests.

Physical Examination

The doctor will may press on the abdomen to check for the potential tumours or abnormal build-up of fluid. A sample of the fluid may be taken for further investigation of the presence of ovarian cancer cells.

Pelvic Examination

The doctor feels the ovaries and nearby organs for any lumps or changes in their shape or size.

Blood Tests

The doctor may order blood tests for laboratory investigation of CA-125, a protein found on the surface of ovarian cancer cells and of other normal tissues. This test is approved by the Food and Drug Administration for monitoring an individual's response to ovarian cancer treatment and for any recurrence post-treatment. It is noteworthy that while high CA-125 levels may be indicative of ovarian cancer or other conditions, they are not definitive in the diagnosis of ovarian cancer.


Ultrasound devices use sound waves to penetrate organs that are inside the pelvis. As sound waves bounce off organs, an attached computing system generates an image based on the resulting echoes. The image may reveal the presence of ovarian tumour. For better visualisation of the ovaries, the device may be inserted into the vagina, a procedure known as transvaginal ultrasound.


Biopsy is the removal of tissue or fluid for investigation of the presence of cancer cells. Based on the results of the blood tests and ultrasound, the doctor may recommend surgical intervention, such as a laparotomy, to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer.


A thin, lighted tube, known as a laparoscope, is inserted through a small incision in the abdomen. Laparoscopy may be used to remove small, benign cysts or early ovarian tumour. It may also be used to determine if the cancer has spread to other sites.

What are the treatment options?

Treatment options include surgery and chemotherapy.


A laparotomy will be performed, which involves a long cut being made in the wall of the abdomen. If ovarian cancer is observed, the surgeon may remove:

  • both the ovaries and fallopian tubes (salpingo-oophorectomy);
  • the uterus (hysterectomy);
  • the omentum (thin, fatty pad of tissue that covers the intestines);
  • the nearby lymph nodes; or
  • tissue samples from the pelvis and abdomen.

If the cancer has spread, the surgeon perform a "debulking" procedure to remove as much of the tumour as possible. In cases of early stage I ovarian cancer, the extent of surgery will depend on whether the patient wishes to get pregnant eventually. If so, the doctor will only remove one ovary and one fallopian tube, together with the omentum.


Chemotherapy involves the use of anticancer drugs to eradicate cancer cells. Most patients undergo chemotherapy for ovarian cancer post-surgery, while some may receive it before surgery. Chemotherapy is administered in cycles and each treatment period is followed by a rest period. The length of the rest period and the number of cycles will depend on the anticancer drugs used. The treatment procedure may be undertaken at a clinic or the doctor's office. Some patients may need to be hospitalised during treatment. 

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