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FOR HEALTH PROFESSIONALS

Ovarian cancer in New Zealand

Ovarian cancer is the fifth most common cause of female cancer death in New Zealand.

Prior to 2000, ovarian cancer was considered a ‘silent cancer’, which is a harmful myth. In actual fact, the opposite is true.

Research has shown the majority of women experience symptoms before they are diagnosed, sometimes when ovarian cancer is at an early stage. However, the significance of these symptoms can be easily missed by women and health professionals alike, reducing survival.

Some New Zealand practitioners are doing an excellent job diagnosing ovarian cancer, but there is room for improvement. A survey of women in the New Zealand Ovarian Cancer Facebook Support Group, undertaken by OCFNZ (previously called Cure Our Ovarian Cancer) in 2019, found that 40% of women got tested on their first or second visit to a medical professional, and one quarter were diagnosed within a month of presentation; this is less than half the rate of Australia.

Improving diagnosis rates

Due to the non specific nature of symptoms, people with ovarian cancer may present to a variety of health professionals in the search for a diagnosis. As a health professional, you play a crucial role in the education and detection of ovarian cancer.

Top ten tips for diagnosing ovarian cancer

1.

Testing is symptom-triggered. There is no benefit to regular testing of the general population in the absence of symptoms.

2.

Symptoms of ovarian cancer are often vague and generalised and not gynaecological in nature. Women may have one symptom, or many.

3.

Ovarian cancer symptoms can be mistaken for irritable bowel syndrome (IBS) or constipation, gastritis, stress, depression and urinary tract infections (UTIs). Younger age is a risk factor for delayed diagnosis.

4.

Family history – about 10-15% of ovarian cancer is hereditary (BRCA/Lynch Syndrome) – a history of breast, ovarian, prostate, pancreatic or bowel cancer can increase the risk of ovarian cancer.

5.

A pelvic exam should include abdominal palpation, vaginal/rectal examination looking for firm resistance on abdominal palpation, unexpected fullness, fullness with shifting dullness on percussion, a hard or irregular mass in the Pouch of Douglas, or adnexal masses. A normal pelvic exam does not exclude ovarian cancer.

6.

CA-125 is often raised in ovarian cancer (80% sensitivity in >50 year olds) – but can also be elevated by other cancers and non-cancerous conditions. The CA-125 blood test misses half of all early cancer and is less sensitive at finding cancer in younger women than an ultrasound. If normal, encourage patients to return if symptoms persist.

7.

Trans-vaginal ultrasound has 98% sensitivity, but it’s more expensive than CA-125. It can miss diffuse ovarian cancer; if the pelvic exam or CA-125 are abnormal or symptoms persist – consider an ultrasound. If women wish to go private, the cost is approximately $400.

8.

If all three tests are normal you might repeat the CA-125 in four months. If any tests are borderline, repeating in four to eight weeks may increase detection (as per The Detecting Ovarian Cancer Early (DoVE) Pilot study (2012, The Lancet))

9.

Only a small proportion of women presenting with symptoms will have ovarian cancer (the rate is similar to breast cancer detection with a routine mammogram) – but it is important to consider because delays to diagnosis are often life-threatening.

10.

Practice nurses are ideally placed to give information on ovarian cancer. Many women mistakenly believe that a cervical smear test will detect ovarian cancer.

Remember!

Any bloating, abdominal or pelvic pain, early satiety, urinary frequency or urgency, or bowel habit changes lasting for four weeks or longer - particularly if they are frequent, unusual (for your patient) or worsening - think about ovarian cancer.

Additional resources

Australian diagnosis guidelines differ to BPAC, NICE and SIGN in the management of patients with a normal pelvic exam.

Assessment of symptoms that may be ovarian cancer by Cancer Australia contains a helpful summary of conditions that can affect CA125

Optimal Care Pathway For Ovarian Cancer endorsed by Cancer Australia and the Australian Cancer Council covers diagnosis through to end of life care

Practitioners can consult Health Pathways for individual regional management. Access to ultrasounds varies greatly across the country. As an organisation we encourage individual practitioners to offer patients with persistent symptoms the option of a private ultrasound, regardless of their CA125 result.

Approximately one in ten ovarian cancers are due to hereditary genetic conditions. If a genetic condition is identified prior to the development of ovarian cancer, there may be actions people can take to significantly reduce their risk. The Genetic Health Services New Zealand (Ratonga Hauora Iranga Aotearoa) criteria for genetic testing for ovarian cancer is found on Health New Zealand Te Whatu Ora’s Genetic Health Services New Zealand

Patient support

Learn more about the support services we provide for people living with ovarian cancer

Get in touch with OCFNZ

If you have any questions or would like to know more, contact us at office@ocfnz.org.nz.

Last reviewed: 16 January 2024