Ovarian Cancer

Ovarian cancer ranks the 6th among the top 10 female cancers in Hong Kong. There are about 400 new cases every year with most of the patients over 50 years of age.

Although ovarian cancer does not have a very high incidence rate, it is the 8th most common cause of cancer deaths due to its location deep inside the pelvic cavity and the undifferentiated early symptoms. Abdominal discomfort is the major complaint during the early stage of the disease, which many patients mistake it as stomachache or indigestion. As a result, diagnosis and treatment are often delayed. The presence of a palpable abdominal mass usually shows that the disease is already at a later stage and thus results in the high death rate.

Post-menopausal women should undergo regular gynaecological examination to enable early detection of ovarian cancer. Women with a family history of ovarian cancer or breast cancer should pay special attention to abdominal discomfort of an unknown reason and consult the doctor as soon as possible.

(Special thanks to Prof. Hextan Y S NGAN, Chief of Service, Department of Obstetrics and Gynaecology, Queen Mary Hospital for reviewing the information of this page.)


Ovaries are female reproductive organs in the pelvic cavity. There is one ovary with the size of a walnut on each side of the womb to which is connected by the fallopian tubes. Ovaries produce eggs and secrete female hormones. Every month, the ovaries release one egg. If not fertilized, the egg would be discharged along with the shedding of the inner lining of the womb, causing a woman to menstruate.

When a malignant tumor is found in the ovaries, it is called ovarian cancer.


The causes of ovarian cancer are still uncertain, but the following women are more susceptible to this disease:

  • Menopause occurs at a comparatively later age
  • Has never given birth
  • Family history of ovarian cancer (especially mother, sisters and aunts)
  • Overweight, high fat diet
  • Spontaneous abortion or infertility
  • History of breast cancer
  • Hormone replacement therapy for more than 5 years after manupause

The following methods can effectively prevent ovarian cancer:

  • Balanced diet, avoid high fat diet
  • Regular exercise
  • Emotionally stable and effective stress management
  • Women who have long-term ovarian dysfunction should undergo active treatment

In addition, studies showed that women who have taken oral contraceptives for more than 5 years are at a lower risk of ovarian cancer. Being pregnant for at least once, breast-feeding, tubal ligation (surgery to close the fallopian tubes) or removal of the cervix also reduce the risk of ovarian cancer.

Women aged over 50 years of age may consider taking a blood test for the CA125 index and ultrasound examination to detect the disease at its early stage.

The cause of ovarian cancer remains uncertain. It has been postulated that the tiny damages and recoveries of ovarian tissues as a result of ovulation (egg production) or the hormonal fluctuations during ovulation may induce abnormal cell growth.

相片    Since ovaries are hidden deep inside the pelvic cavity, early symptoms are not obvious. Attention should be paid to the following symptoms:

  • Persistent and worsening stomachache and indigestion
  • Abdominal discomfort, bloating
  • Frequent need to urinate
  • Constipation
  • Pain during sexual intercourse
  • Back pain

If ovarian cancer is suspected after history taking, the doctor may order some or all of the following tests in addition to clinical examination to confirm the diagnosis: 

  • Vaginal examination: examine the womb, rectum and pelvic cavity through vagina to detect any mass or hyperplasia (abnormal proliferation of cells) inside the ovaries
  • Ultrasound: to detect where the tumor is
  • Blood test: women with ovarian cancer or benign ovarian lesions may have increased CA125 level. However, it is also possible for the CA125 level to remain normal at the early stage of ovarian cancer
  • Computerized tomography scan (CT scan) and magnetic resonance imaging (MRI scan) can help detect the location of the tumor
  • Laparoscopy (a procedure to visually inspect the inside of the abdomen) and diagnosis: a small cut is made near the navel (belly button) while the patient is under general anaesthesia. A laparoscope (a thin, bendy microscope with light on the end) is used to examine the tissues inside the abdominal cavity and a sample of the tumor is taken for pathological diagnosis
  • Exploratory laparotomy (incision of the abdomen): a surgery to examine, diagnose and treat the patient when needed
  • Biopsy: to classify the cell type

If ovarian cancer is highly suspected, other examinations may be needed to determine the area affected by the tumor:

  • Chest X-ray
  • CT scan
  • MRI scan
  • Upper endoscopy (an examination of the inside of the gullet, stomach and duodenum with an endoscope) or colonoscopy (an examination of the lining of the bowel with an endoscope)

Ovarian cancer can be classified into the following 4 stages:

Stage I - Cancer tumor is confined to the ovaries

Stage II - Cancer tumor has spread to tissues surrounding the ovaries but is still confined to the pelvic cavity

Stage III - Cancer tumor has spread to peritoneum (the lining on the inside of the abdomen) or lymph system. Most of the patients with confirmed diagnosis are in Stage III

Stage IV - Cancer cells have spread to other main organs in the body, such as liver and lungs


相片    Ovarian cancer requires prompt treatment including surgery and chemotherapy. Regular follow-up of the disease is vital to increase the survival rate.

Surgical resection:
Remove the areas including ovaries on both sides, egg tubes, womb, greater omentum (a large fold of membrane that hangs down from the stomach), lymph nodes nearby and tissues which has signs of spreading.

For young patient with cancer of early stage (tumor being confined to one ovary), the doctor may consider removing only the affected ovary and fallopian tube but keep the other ovary after staging operation so that hormone secretion is maintained and the patient can get pregnant if she wants to.

After surgery, doctor will use anti-cancer drugs as an adjuvant therapy to destroy and interfere with the growth of cancer cells to lower the chance of recurrence.

The anti-cancer drugs are usually injected into the body through the vein. A complete treatment consists of 6 injections, given once every 3 or 4 weeks. Common side effects of chemotherapy are nausea, vomiting, hair loss, loss of appetite and fatigue. Anemia, low platelet count and risk of infection are also common as the bone marrow is affected.


The common complications of ovarian cancer are as follows:

  • Rupture of tumor: causing symptoms of severe abdominal pain, nausea and vomiting
  • Tumor torsion (twist): venous drainage is obstructed by tumor causing congestion. Patient is attacked by sudden severe pain in the lower abdomen accompanied with nausea, vomiting and even shock when the situation becomes serious
  • Infection: fever, abdominal pain, abdominal distention, increased white blood count and increased body temperature which would lead to different degrees of peritonitis (inflammation of the inner lining of abdomen that coats the organs)
  • Malignant changes of benign tumor: tumor grows quickly in a short period of time. Patient feels bloated in the abdomen or stomach, loss of appetite;
  • Symptoms of anemia: patient in advanced stage has symptoms of bleeding, loss of appetite, intestinal obstruction, weight loss, loss of energy, stomach discomfort

There are a lot of things to care about during the recovery process. Better understanding will help patients face the disease positively.

  • Regular follow-up: inform the doctor immediately if you have persistent abdominal pain or distention or shortness of breath
  • Regulating life style: lots of rest, avoid over-exertion and maintain body strength
  • Diet: balanced nutrition, eat more fresh fruits and vegetables and appropriate supplement of protein
  • Mental health: stay optimistic enhances the effect of treatment
  • Sex life: avoid sex during chemotherapy, after surgery and in the advanced stage of cancer
Back To Top
Local and Overseas Supporting Organisations
Back To Top
Related Documents
Back To Top
Related Audio
Back To Top
Related Video
Back To Top
Back To Top