Ovarian cancer: risk factors, symptoms and treatments

Published February 2024 | 6 min read
Expert contributor Dr Kristina Warton, Gynaecological Cancer Research Group, University of New South Wales
Words by Trudie McConnochie

Ovarian cancer can often go undetected and has lower survival rates than other cancers – yet there's no ovarian cancer test. Researchers are working to find a solution for early diagnosis.

When researcher Dr Kristina Warton tells people she’s working on developing an ovarian cancer test, they often say something like, "Oh yes, I had one of those at my GP last week". The mistaken belief that a test for cervical cancer – commonly known as a pap smear or pap test – will also detect ovarian cancer is frustratingly common, she says.

"I think a lot of that [misconception] is coming from how people talk about female reproductive anatomy," says Dr Warton. "Everything gets kind of lumped into one and there’s not the awareness that the reproductive system is a few different organs that work together but have different jobs."

In fact, there’s no screening test for ovarian cancer, which is one reason it has lower survival rates than other cancers that affect women. Knowing more about ovarian cancer may improve your chances of getting diagnosed early, which means a better prognosis.

What is ovarian cancer?

Ovarian cancer starts when cells in one or both ovaries or in the fallopian tubes grow abnormally and form a malignant tumour. Early-stage ovarian cancer is often asymptomatic – and when symptoms do present, they can be mistaken for other conditions.

According to the Ovarian Cancer Research Foundation, around 1,815 Australian women are diagnosed with ovarian cancer each year and up to 70% of those diagnoses will be at an advanced stage, meaning the cancer has already spread to other parts of the body. "If a tumour can be caught early while it's still in the one place, you can cure the person by surgery, because you simply cut the tumour out and it's gone," says Dr Warton. "Once the cancer has spread, it’s very hard to remove it all."

Ovarian cancer risk factors

While the specific cause of ovarian is unknown to experts, they know that getting older, a family history of ovarian cancer and certain lifestyle factors can increase your risk. Being post-menopausal is a high risk factor, while carrying a certain genetic mutation (especially in the BRCA1 or BRCA2 genes) may also elevate your risk by around 20%.

Other factors that may increase the risk of ovarian cancer include having a history of breast cancer or endometriosis, being overweight, having diabetes, smoking, using hormone replacement therapy and not having had children.

Ovarian cancer symptoms

The most common symptoms for ovarian cancer are pain, swelling or persistent bloating in the abdomen, as well as changes to urination habits and a feeling of fullness after small amounts of food. Women with ovarian cancer can also experience:

• digestive issues, including indigestion, nausea and constipation
• unexplained weight changes
• excessive fatigue
• pain in the lower back or pelvis
• pain or bleeding during or after sex
• changes to your periods or bleeding after menopause.

Melbourne lawyer and mother of two Christine Crupi, 42, assumed she had a urinary tract infection (UTI) when she experienced an increased need to urinate in July 2022. But when the UTI test came back negative, her GP recommended further tests, including an ultrasound.

"When I saw the look on the sonographer's face, I knew something was wrong," she says. "Of course, they’re not able to disclose the results without a doctor, but I did say to him: ‘I know something’s wrong. Can you just tell me what part of the body that you’re looking at that is of concern?’ And he said, 'the ovaries' and I immediately went: OK, this is ovarian cancer."

Even so, having a doctor confirm her suspicion was like "being hit by a truck".

"It's not like anything else you can imagine," she says. "Aside from utter shock, it was just the fear, the anger, the frustration – all of those sorts of emotions then followed."

Christine's mother had passed away from breast cancer at the age of 48, so she had been diligently having breast checks every year from her mid-20s. But she wasn't aware of a link between breast and ovarian cancers, so ovarian cancer was "not on my radar at all".

Her message to women is to be aware of the symptoms – and trust your intuition. "I had the bloating, I had a bit of lower back pain… all of these types of things are so easy to ignore, because you could put it down to typical female symptoms that we get with our menstrual cycle," says Christine.

"For about a month before I presented to the doctor, I just didn’t feel quite right. I put it down to just being stressed with work and a lot going on in life with a young family."

But a little voice in her head was telling her something wasn’t quite right.

"If you do have these persistent symptoms, and you're getting that little voice inside that something isn’t quite right, go to the doctor and insist on getting some tests," she says.

Ovarian cancer treatments

Treatment options for ovarian cancer depend on your age, health, stage of cancer and whether you plan to have children.

Surgery – which may involve removing the ovaries, uterus, fallopian tubes, cervix and parts of your bladder and bowel – is the most common treatment. Other recommended treatments include chemotherapy, radiotherapy and targeted drug therapy, including poly adenosine diphosphate-ribose polymerase (PARP) inhibitor treatment.

Christine’s treatment was a combination of surgery, chemotherapy and PARP. Fortunately, she responded well and is now in “complete clinical remission”, which means regular ongoing surveillance to check for cancer recurrence.

How to test for ovarian cancer

Blood tests, pelvic ultrasounds, CT scans and MRI scans can be used to look for signs of ovarian cancer, but a biopsy taken during surgery is the only way to make a definitive diagnosis. One of the blood tests involves measuring levels of CA 125, a protein that can be produced by ovarian cancer cells. But since CA 125 can also be elevated by menstruation, endometriosis or non-malignant ovarian cysts, Ovarian Cancer Australia says it isn’t a reliable indicator of the disease.

Australian research to develop a screening test is well underway. Dr Warton and the Gynacological Cancer Research Group at the University of New South Wales are developing a blood test to detect traces of dead cancer cells.

"If somebody has a tumour, as it's growing, the cells have some amount of turnover and cell death, and some of that DNA from the cells that have died ends up in the blood," she explains. "If you know what DNA changes you're looking for, then you may be able to pick it up. This has been successfully done for colorectal cancer, and also gets used for colorectal cancer monitoring, and we’re looking to extend that to ovarian cancer."

The main aim of the blood test will be to allow early diagnosis, but it may also help doctors treat the disease more effectively by giving accurate information on whether or not the tumours are decreasing.

"Sometimes it takes a while to tailor someone's cancer therapy to their tumour, so a few different things have to be tried," says Dr Warton. "The therapy can be toxic, and if a patient is receiving something that’s not working for their tumour, the sooner oncologists have that information, the better, because they can change to a more effective treatment."

For more information and support, contact the Ovarian Cancer Australia helpline on 1300 660 334.

Do you have questions?

If you're concerned about any risk factors or possible symptoms, it's important to chat to your GP as soon as possible. Through our partnership with GP2U, all HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50.