The low survival rate in the Republic for women with ovarian cancer – the worst in Europe – is attributed mainly to a lack of awareness and late detection. Just 29 per cent of women diagnosed here live beyond five years, compared with a European average of 36 per cent and a US rate of 44 per cent.
“I think there is sometimes reluctance on the part of some women to seek advice and sometimes there are a lot of misconceptions in relation to what cancer represents and that cancer can actually be treated,” says consultant obstetrician/gynaecologist Dr Tom D’Arcy of the Coombe Women and Infants University Hospital.
He also believes the way our primary care system is structured is a factor. “I think a lot of people use and sometimes misuse primary care. Some people may come in and complain and complain and complain – and after a while it’s like crying wolf and they may actually have a problem.”
The people who most need it are sometimes the ones who don’t actually end up getting managed in perhaps the way they should, he suggests. “That would be a very controversial issue – but there is an element of that undoubtedly.”
He welcomes the first World Ovarian Cancer Day tomorrow. “If you make people aware of it, they are going to be more proactive in seeking help and seeking advice.”
Unfortunately at present most people don’t seek appropriate advice early enough. “With the result that 80 per cent of women with ovarian cancer will present at a late stage, where it’s not so much palliative but what you are trying to do is to increase their disease-free interval rather than cure.”
The pelvis allows expansion of the ovary, so cysts can develop with few if any symptoms, he explains. And those symptoms may be put down to menstrual dysfunction, irritable bowel syndrome, pressure and anxiety, among other things.
The vast majority of ovarian cancers occur by chance, with hereditary patterns seen in only about 5 per cent. At least that is our understanding at the moment, says D’Arcy, pointing out that 10 or 15 years ago nobody would have thought that most cervical cancers were caused by a viral infection. He is sure potential risk factors for ovarian cancer will be identified in the future.
“Already pre-cancerous changes can be recognised in the Fallopian tube and in the future, just as smears are taken for the cervix, it may be possible to look for cellular change that may reflect change in the Fallopian tube.”
Screening the general population has not been shown to reduce mortality from ovarian cancer, he says, but if an at-risk group – people who have a tenuous family history of female cancer – is targeted, it does. Using a combination of ultra sound and a blood test “can have some predictive value in determining risk”.
The majority of ovarian cysts are nothing to do with cancer. A simple cyst is like a water-filled balloon, he says, and within a certain size range all of them are benign.
However if they are complex, the extent of that complexity will determine the risk of potential underlying malignancy.
All complex cysts need to be examined, so if a woman presents with pelvic symptoms outside the norm, she needs to be referred for a pelvic scan and specialist opinion, he advises.
There is no question but that the treatment here for ovarian cancer is second to none in Europe, says D’Arcy, consolidated as it has been since the establishment of the National Cancer Control Programme in 2007. Before that some cases were being handled by people who didn’t have the experience of dealing with the problem they should have.
“The standard of care here is as good as anywhere in the world,” he adds. “I think our figures within the next 10 years will probably reflect that.”
Ovarian cancer symptoms
Symptoms of ovarian cancer are often similar to those of other less serious conditions, such as gastrointestinal disorders and menstrual problems. However experts now believe it is the frequency and combination of symptoms that can help doctors distinguish between ovarian cancer and other conditions.
If a woman has one or more of the following almost daily within a three- week period, she should tell her GP:
Increased abdominal size or persistent bloating
Abdominal or pelvic pain
Difficulty eating and/or feeling full quickly
Needing to pass urine more urgently or more frequently
