Ovarian cancer, often referred to as a “silent killer” because of its lack of specific symptoms, is striking more women in Singapore, with its incidence doubling in the past 30 years.
The age-standardised rate of ovarian cancer in Singapore has increased from six per 100,000 women per year in 1975 to 12 per 100,000 women per year in 2005.
However, the treatment options for this deadly cancer have also increased. Now a new post-surgery method, known as targeted therapy, can be used in combination with conventional chemotherapy to block the growth of cancer cells.
“On average, more than 290 cases are diagnosed annually and there are about 100 deaths per year. The high mortality is attributed to the fact that ovarian cancer is usually diagnosed in advanced stages,” says Dr Timothy Lim Yong Kuei, Consultant and Head, Pre-invasive Disease and Screening Unit, Department of Gynaecological Oncology, KK Women’s and Children’s Hospital.
KK Women’s and Children’s Hospital sees about 100 to 150 new cases per year. “One of the reasons for an increase over the last three decades is because more women are living longer and having less children,” adds Dr Lim.
Risk factors and symptoms
Post-menopausal women over the age of 55 are at higher risk of developing this cancer, the fifth most common women’s cancer in Singapore. Other risk factors include:
- A strong family history of breast and ovarian cancer (affecting a close relative such as the mother, sister or daughter)
- Having never delivered a baby
Though ovarian cancer does not present with specific symptoms, patients commonly complain of the following:
- Swelling of the abdomen
- Early satiety
- Urinary frequency or constipation
- Abdominal or pelvic discomfort/pain
- Lump in the abdomen
The first step of treatment for ovarian cancer is surgery to remove the ovaries, womb and cervix as well as the lymph nodes. If the patient is young and at an early stage of the disease, the womb may be saved for future childbearing.
The second step of treatment is chemotherapy for patients who are at an advanced stage of the cancer to reduce the risk of relapse. The current international standard for chemotherapy is a combination of a platinum containing chemotherapy agent as well as paclitaxel (a compound derived from the Pacific Yew tree). A new treatment method called targeted therapy is used to inhibit a protein that stimulates new blood vessel formation. This method is usually used in combination with conventional chemotherapy.
“Targeted therapy is a type of medication that blocks the growth of cancer cells rather than simply interfering with rapidly dividing cells,” says Dr Lim. Treatment to shrink a tumour before surgery (neoadjuvant chemotherapy), is also an option in patients who are not surgically fit at the time of diagnosis, he adds.
Ovarian cancer can be cured if it is diagnosed at an early stage, with the five-year survival at stage 1 being 76 to 93 per cent. If the cancer is diagnosed at stage 3 or 4, the five-year survival rate drops to less than 30 per cent. About 40 per cent of women are diagnosed at stage 1 or 2 in Singapore.
While the prevention of ovarian cancer is difficult, Dr Lim says, research has shown that women who have been taking contraceptive pills for five years or more, have a 50 per cent lower risk of getting the disease. Other factors associated with a reduced risk of this cancer include pregnancy (the earlier the better), breastfeeding, hysterectomy and tubal ligation in which the fallopian tubes are blocked to prevent pregnancy.
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