Sadly few women with ovarian cancer are diagnosed in the early stages, due to a widespread lack of awareness of the disease and absence of early screening tests, reports the Cancer Association of South Africa (CANSA). “Ovarian cancer is called the silent whisperer of cancers, because it’s mostly symptomless until advanced stages,” says Dr Elize Wethmar, a Benoni gynaecological oncologist.
Knowing the warning signs and getting treatment early can save not only your life, but in some cases your fertility, too.
If you notice an unexplained increase in abdominal size, persistent bloating, difficulty eating, feeling full quickly, abdominal or pelvic pain and the need to pee more urgently or frequently, and this persists longer than three weeks, get checked out by your health provider, says Professor Michael Herbst, CANSA medical specialist.
Many different types of tumours can begin in the ovaries, and some are treated by removing either part or the ovary or all of it. The standard treatment in most instances involves radical surgery, including a hysterectomy, removal of both ovaries and fallopian tubes, appendectomy and removal of all visible tumour, followed by chemotherapy, says Wethmar.
“Fertility-preserving surgery involves careful planning and is mostly limited to early stages of ovarian cancer. If fertility-preservation options are considered, an infertility specialist will be part of the team.” Three out of four women with ovarian cancer survive a year after diagnosis – “during this time, however, they would have had extensive surgery and six cycles of chemotherapy” – Wethmar says.
“The five-year survival rate is 44%, depending on the stage at the time of diagnosis. Very few women get diagnosed at stage 1 disease, when the disease has not spread outside the ovary.”
If you want children, it’s vital to talk to your team of specialists before your ovarian cancer treatment starts
Much will depend on the type and stage of your cancer, but there have been many advances in fertility. Among the options you may have to preserve your fertility:
Fertility-sparing surgery
If your cancer has been caught early and only one ovary is affected, or if you have a germ cell tumour of the ovary, it may be possible to save your uterus and the healthy ovary; but the chemotherapy needed to effectively treat some cancers may damage that ovary or raise your risk of earlier menopause. Talk to your medical team and fertility specialist. “Medication is often prescribed to try to protect the ovary from the effects of chemotherapy,” Wethmar says.
Egg freezing
If you still have a healthy ovary producing eggs, and your oncologist considers it safe to delay the start of chemotherapy, you may be able to have your eggs retrieved at a specialised fertility centre after having hormone treatment to stimulate them. The eggs can then be frozen, or fertilised by sperm and frozen as embryos, to be implanted at a later stage – “usually one to two years after the completion of treatment for ovarian cancer,” says Wethmar.
Freezing an unaffected ovary or slices of unaffected ovarian tissue: An alternative to egg freezing, this may be possible before cancer treatment. But specialists may not consider it safe to implant tissue that could possibly be harbouring cancer cells back into the womb of a woman who has been cured of cancer.
“The unaffected ovarian tissue gets implanted at a distant site (until needed), such as subcutaneously in the arm of the patient”’ she says. “The risk is that the site harbouring the tissue might form metastatic (cancerous) tissue. The frozen tissue might also harbour cancerous cells, and might not be viable for future use.”
Surrogacy
If the surgical procedure or treatment results in you being unable to conceive or carry a pregnancy to full term, another woman may be able to carry your baby for you, inseminated with either your partner’s or a donor’s sperm. If you have frozen eggs of your own, these can be used, so the baby is biologically yours and your partner’s. For information and support, contact The Surrogacy Advisory Group.
Adoption
You also have the option of fostering or adoption. Agencies may require a letter from a doctor certifying you are in good health. Contact the National Adoption Coalition of South Africa.
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