Gynaecological Cancers & Conditions
Ovarian Cancer
The incidence of ovarian cancer is rising in Australia – and it is estimated that nearly 1,500 women per year will be diagnosed with this disease by 2015. In general, the risk of getting ovarian cancer is 1 in 70 – however, this could rise to 1 in 2 if you have any significant risk factors or inherited conditions. During your consultation with Dr Tan, he will conduct a thorough medical history to determine your specific risks – and advise on any ‘risk-reduction’ preventative surgeries as necessary.
The majority of ovarian cancers are already at an advanced stage when diagnosed, with significant tumour in the abdomen and surrounding tissue. There is no evidence at present that screening for ovarian cancer helps to prevent the disease or increase survival rates – however, screening may be advisable (though not proven to be effective) for certain “high risk populations” such as those with a strong family history, gene mutation carriers and Ashkenazi Jewish women.
What are the symptoms?
Most patients will have symptoms such as abdominal or pelvic pain, a change in urinary frequency or incontinence, a change in bowel habits, indigestion and unexplained weight gain or loss – as well as more vague symptoms, such as reduced appetite, abdominal bloating & ‘fullness’, fatigue and pressure in the abdomen area.
How it is diagnosed?
Dr Tan will conduct a thorough investigation using a combination of examination, ultrasound, CT scans, blood tests and patient medical history. This enables him to accurately assess your condition and choose the best treatment options.
This is particularly important for patients with the above symptoms that persist for longer than a month, and especially if they are over the age of 40 or have a history of ovarian or breast cancer.
Note: not all lumps and cysts in the ovaries are cancerous – some may be benign. To confirm the nature of any mass in the ovaries, it may be necessary to do a special type of biopsy called a “frozen section”, while you are under anaesthetic – this is immediately assessed by a pathologist and the results sent back to Dr Tan while you are still in theatre, so that any action required can be taken at the same time, while you are still on the operating table (naturally, following what you and Dr Tan have discussed and agreed upon prior to the operation).
How is it treated? What happens during surgery?
There will be different treatment options depending on whether the cancer is only inside the ovaries (in 10 – 15% of cases) or has spread to other areas of the abdomen (in 85% of cases). A decision on whether a surgical approach is best will be made following careful consideration of the patient’s pre-existing medical conditions, as well as discussion at a Multi-Disciplinary Tumour Board Meeting/ Tumour Board Conference between Dr Tan and a panel of expert Gynaecological Pathologists and Medical Oncologists.
If tumour has spread, then the goal will be removing all signs of visible disease, through a procedure known as a debulking operation. In addition to removing the ovaries and uterus, this procedure will also include extensive examination of all the usual places that tumour cells may hide, such as in the lymph nodes, liver, bowel, diaphragm and other abdominal organs.
The gold standard is to achieve “optimal debulking”, which is when no disease is visible and as a Certified Gynaecological Oncologist (CGO), Dr Tan’s significant expertise will ensure that there is a high chance of reaching this goal. He will also discuss any available procedures which can help to preserve fertility, prior to surgery.
Will I need chemotherapy or radiation therapy?
In many cases, chemotherapy is a vital part of treatment in the fight against ovarian cancer.
In certain cases, depending on the distribution of the tumour, it may be considered more effective for the patient to undergo a course of chemotherapy first, to reduce the size of tumour, so that surgery has a better chance of successfully eliminating all visible disease. Thus a patient will be given 3-4 cycles of chemotherapy, followed by a less extensive debulking operation, which is then followed by another 3-4 cycles of chemotherapy. This is known as ‘Neoadjuvant Chemotherapy with Interval Debulking’. This has been shown to achieve similar results and rates of survival compared initial surgery followed by chemotherapy.
Chemotherapy is usually delivered intravenously (into the bloodstream) but in certain cases, the use of Intraperitoneal Chemotherapy may be considered appropriate. This is when chemotherapy is delivered directly into the abdominal cavity via a special catheter (tubing). Note that it must be used in conjunction with an ‘optimal debulking’ procedure in order to be fully effective. While this technique does produce more side effects at the time of treatment, it provides an improved survival advantage when compared to intravenous chemotherapy alone, especially in the case of advanced disease.
What happens after my surgery and treatment?
If you have had a cancer treated, Dr Tan will discuss the best follow-up regime, tailored to suit each individual patient. There are normally reviews every 6 months for the first 2 years, extending to 12 monthly reviews for the next 3 years. For patients living outside the Perth Metropolitan Area, Dr Tan can make arrangements for ongoing follow-up with your local GP or Gynaecologist.
Evidence that regular blood tests and reviews improve outcomes in gynaecological cancers are lacking. However, it may be re-assuring for ongoing follow-up for 5 yrs after the diagnosis. Dr Tan will discuss with each patient the recommendations tailored to suit your specific needs.
If you have had chemotherapy or radiation after your surgery your follow-up may be shared between Dr Tan, the Medical Oncologist or Radiation Oncologist.
In addition to planned follow-ups, it is more important that should there be new symptoms or problems, please contact us so that a review by Dr Tan may be arranged.
The majority of ovarian cancers are already at an advanced stage when diagnosed, with significant tumour in the abdomen and surrounding tissue. There is no evidence at present that screening for ovarian cancer helps to prevent the disease or increase survival rates – however, screening may be advisable (though not proven to be effective) for certain “high risk populations” such as those with a strong family history, gene mutation carriers and Ashkenazi Jewish women.
What are the symptoms?
Most patients will have symptoms such as abdominal or pelvic pain, a change in urinary frequency or incontinence, a change in bowel habits, indigestion and unexplained weight gain or loss – as well as more vague symptoms, such as reduced appetite, abdominal bloating & ‘fullness’, fatigue and pressure in the abdomen area.
How it is diagnosed?
Dr Tan will conduct a thorough investigation using a combination of examination, ultrasound, CT scans, blood tests and patient medical history. This enables him to accurately assess your condition and choose the best treatment options.
This is particularly important for patients with the above symptoms that persist for longer than a month, and especially if they are over the age of 40 or have a history of ovarian or breast cancer.
Note: not all lumps and cysts in the ovaries are cancerous – some may be benign. To confirm the nature of any mass in the ovaries, it may be necessary to do a special type of biopsy called a “frozen section”, while you are under anaesthetic – this is immediately assessed by a pathologist and the results sent back to Dr Tan while you are still in theatre, so that any action required can be taken at the same time, while you are still on the operating table (naturally, following what you and Dr Tan have discussed and agreed upon prior to the operation).
How is it treated? What happens during surgery?
There will be different treatment options depending on whether the cancer is only inside the ovaries (in 10 – 15% of cases) or has spread to other areas of the abdomen (in 85% of cases). A decision on whether a surgical approach is best will be made following careful consideration of the patient’s pre-existing medical conditions, as well as discussion at a Multi-Disciplinary Tumour Board Meeting/ Tumour Board Conference between Dr Tan and a panel of expert Gynaecological Pathologists and Medical Oncologists.
If tumour has spread, then the goal will be removing all signs of visible disease, through a procedure known as a debulking operation. In addition to removing the ovaries and uterus, this procedure will also include extensive examination of all the usual places that tumour cells may hide, such as in the lymph nodes, liver, bowel, diaphragm and other abdominal organs.
The gold standard is to achieve “optimal debulking”, which is when no disease is visible and as a Certified Gynaecological Oncologist (CGO), Dr Tan’s significant expertise will ensure that there is a high chance of reaching this goal. He will also discuss any available procedures which can help to preserve fertility, prior to surgery.
Will I need chemotherapy or radiation therapy?
In many cases, chemotherapy is a vital part of treatment in the fight against ovarian cancer.
In certain cases, depending on the distribution of the tumour, it may be considered more effective for the patient to undergo a course of chemotherapy first, to reduce the size of tumour, so that surgery has a better chance of successfully eliminating all visible disease. Thus a patient will be given 3-4 cycles of chemotherapy, followed by a less extensive debulking operation, which is then followed by another 3-4 cycles of chemotherapy. This is known as ‘Neoadjuvant Chemotherapy with Interval Debulking’. This has been shown to achieve similar results and rates of survival compared initial surgery followed by chemotherapy.
Chemotherapy is usually delivered intravenously (into the bloodstream) but in certain cases, the use of Intraperitoneal Chemotherapy may be considered appropriate. This is when chemotherapy is delivered directly into the abdominal cavity via a special catheter (tubing). Note that it must be used in conjunction with an ‘optimal debulking’ procedure in order to be fully effective. While this technique does produce more side effects at the time of treatment, it provides an improved survival advantage when compared to intravenous chemotherapy alone, especially in the case of advanced disease.
What happens after my surgery and treatment?
If you have had a cancer treated, Dr Tan will discuss the best follow-up regime, tailored to suit each individual patient. There are normally reviews every 6 months for the first 2 years, extending to 12 monthly reviews for the next 3 years. For patients living outside the Perth Metropolitan Area, Dr Tan can make arrangements for ongoing follow-up with your local GP or Gynaecologist.
Evidence that regular blood tests and reviews improve outcomes in gynaecological cancers are lacking. However, it may be re-assuring for ongoing follow-up for 5 yrs after the diagnosis. Dr Tan will discuss with each patient the recommendations tailored to suit your specific needs.
If you have had chemotherapy or radiation after your surgery your follow-up may be shared between Dr Tan, the Medical Oncologist or Radiation Oncologist.
In addition to planned follow-ups, it is more important that should there be new symptoms or problems, please contact us so that a review by Dr Tan may be arranged.