The majority of ovarian cancers cause few symptoms until the disease has spread beyond the pelvis. The symptoms associated with the development of the cancer are very non-specific and often vague which causes a delay in diagnosis in most cases.
The symptoms, which are commonly associated with the egression of ovarian cancer, are abdominal swelling and bloating; irregularity of bowel habit, such as constipation or diarrhea; abnormal vaginal bleeding; pelvic pressure, and occasionally the woman will feel a lump herself. It is all too common that a woman will say that she thought her abdominal swelling was due to menopause or ‘getting old’. It is not brought on by what the patient does even if you feel guilty about your lifestyle prior to diagnosis.
The diagnosis is usually made when a lump is felt during a vaginal or abdominal examination. In most cases an ultrasound or CT scan is given. Suspicious findings include the presence of solid areas within the lump; the presence of fluid (ascites’); the presence of a tumour within either ovaries or the presence of cauliflower-like growth on the surface of the ovarian cyst seen on scan.
In most cases, the final diagnosis is made during surgery when the surgeon will make a decision to ‘stage’ or ‘debulk’.
Surgery can take two forms. A ‘staging’ operation means that if the cancer seems to have stayed in the ovary or the pelvis, the surgeon takes samples from areas where it might spread. These, include the surface of the bladder and large bowel, the omentum — which is a pad of fat which hangs off the large bowel – and biopsies of lymph glands along the wall behind the ovary affected and along the major blood vessels up to the kidneys (the ‘para-aortic’ lymph glands).
In ‘debulking’ surgery, the surgeon has to try and remove as much of the cancer as possible to improve a woman’s chance of survival. In advanced cases, up to 30% of women will need part of the bowel removed to achieve this aim.

By ‘optimally’ debulking the tumour, i.e. removing as much of it as possible down to any nodule being 1 cm or less in diameter, then there is a substantial improvement in a woman’s chance of survival. If large amounts of tumour are left behind then the opposite effect occurs and makes survival relatively uncommon.
Following surgery in every case, except when the disease has been found to be confined to the ovary and is considered to be ‘low risk’, chemotherapy is recommended. Radiation therapy is not usually given for ovarian cancer, although it can be useful if cancer recurs at the top of the vagina or in lymph glands or the brain.
Ovarian cancers often recur after the first round of treatment, so that secondary treatment with different or new drugs is usually then recommended. The chances of tumours shrinking in this situation are only between 20 and 25%.
When cancer of the ovary recurs and becomes advanced, then treatment will be given to remove accumulated fluid, bowel obstruction may happen, requiring an operation either to bypass the obstruction or alternatively to divert the bowel contents  out onto  the wall of the abdomen  (an ‘ileostomy or ‘colostomy’).
Likewise,   sometimes   fluid  accumulates   in   the  lungs requiring repeated drainage, usually through a fine needle, j Occasionally the lining of the lung will be surgically ‘glued’ onto j the lung itself, and this prevents fluid accumulating between the lining of the lung and the lung tissue (‘pleurodesis’).
Survival with ovarian cancer is extremely challenging if the tumour is at an advanced stage and spread out of the ovary at time of diagnosis.  If the cancer is determined to be confined to the ovary then cure rates are extremely high.

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