Ung thư tử cung

Ung thư tử cung
Pamela Wilson

Ung thư tử cung có thể nói là giết người trong im lặng. Nhưng hầu hết những người đàn bà mắc phải đều có triệu chứng;  vấn đề là họ không nghĩ nó lính líu đến ung thư tử cung thôi.

Ovarian cancer
by Pamela Wilson

Ovarian cancer has been called a silent killer. But most women diagnosed with the disease do experience symptoms; it's just they don't link them to cancer.

Published 25/02/2010

While a woman's likelihood of developing ovarian cancer is much lower than for many other cancers, there's no cause for complacency. (Only one in 77 Australian women will develop ovarian cancer in their lifetime, compared to one in nine women for breast cancer.)

Ovarian cancer is deadly, and ranks as the leading cause of death from gynaecological cancers amongst women. It is the sixth most common cancer that Australian women typically die from.

This is because, unlike with breast or skin cancer, it is impossible for a woman to check her ovaries for early signs of cancer. And unlike with cervical cancer, there is no early detection test.

This absence of screening means about two thirds of women with ovarian cancer are not diagnosed until their cancer is advanced.

But it's not all bad news. When ovarian cancer is detected early, women have a 95 per cent chance of survival, making it important for women to be able to identify the symptoms of the disease. And research has found most women with ovarian cancer do have symptoms in the year before their diagnosis.

Also new data suggests that a woman's risk of dying of ovarian cancer is declining, from a 1 in 89 in 1982 to a 1 in 108 risk in 2006.

Any disease that hides itself deep inside your body is hard to detect and identify.

Most women with ovarian cancer do have symptoms of the disease before diagnosis. Unfortunately many of these women were unable to identify these symptoms, which can seem non-specific. Women often add these symptoms to the list of common physical ailments that plague them and don't bother to seek medical attention. Because of this, ovarian cancer is often missed until it has spread to other parts of the body such as the abdomen lining and other organs in the pelvis.

However, research has shown there are a number of symptoms reported by women diagnosed with ovarian cancer. Common symptoms reported by women with ovarian cancer include:

Persistent pelvic or abdominal pain
Abdominal swelling and/or bloating
Increased urgency and frequency of urination, or incontinence
Difficulty eating or feeling full quickly
Other symptoms reported by women with ovarian cancer include:

Vague but persistent stomach upsets, such as wind nausea, heart burn and indigestion
Pelvic or back pain
Changes in bowel habits
Pain during sex or vaginal bleeding
Excessive weight loss or weight gain
If you have any of these symptoms then it is a good idea to see your GP. These symptoms might be a result of a more common condition, such as Irritable Bowel Syndrome. However, if the symptoms persist or do not improve with treatment then you should go back to your GP, and ask them to consider the possibility of ovarian cancer.

Ovarian Cancer Australia has a symptom dairy you can download, to help you keep track of your symptoms and record any information that might be useful for your GP.


Types of ovarian cancer
There are three types of ovarian cancer and each one affects a different part of the ovaries.

Epithelial type: this is the most common form, representing 90 per cent of all ovarian cancers, and it occurs in the cells on the outside of the ovaries.

Germ Cell type: this form occurs in the cells that produce eggs in the ovaries. If a younger woman or teenage girl is diagnosed with ovarian cancer, it is more likely to be this type.

Stromal type: the rarest form of ovarian cancer, this occurs in the supporting tissues that produce female hormones.

The good news is that when the cancer is confined only to the ovaries, the prognosis is good. However, once it spreads to other parts of the body, it becomes known as advanced ovarian cancer or metastatic ovarian cancer. With advanced ovarian cancer, the five-year survival rate drops to 40 per cent.


Risk factors and causes
As with many cancers, there is no single cause or predictive factor linked to ovarian cancer. However, there are certain risk factors that can increase your chance of developing it. Established risk factors are:

Age – The risk of ovarian cancer increases with age. Although it can occur at any age, the average age of diagnosis is 63. Also older women are more likely to die from the disease.
Family history or faulty genes. (See below)
Childlessness – Ovarian cancer is more common among women who have never had children, who are infertile or who have their first child after the age of 30.
Hormonal medication use – Women who have never taken oral contraceptives or who have taken oestrogen-only hormone replacement therapy (HRT) for a long time (10 years) or who have undergone fertility treatment may also be at a higher risk. Research released by Oxford University last year found that for every five years a woman is on the contraceptive pill her risk of developing ovarian cancer is reduced by 20 per cent.
A history of endometriosis.
Other factors that may increase risk of ovarian cancer, but which require further research, include:

Menstruation – Women who have early onset of menstruation (i.e. who began their periods before age 12) or who experience late menopause may be at an increased risk.
Lifestyle – Women are more at risk if they eat a high-fat diet.

Genetics and family history
If you have a family history of breast or ovarian cancer then you may be at increased risk of ovarian cancer, but this does not mean you will develop the disease.

The risk increases with the number of family members affected by breast or ovarian cancer, the age of diagnosis (it's higher if it's for younger people) and the closer the relation. Both the mother's and father's side of the family are important. Being of Ashkenazi Jewish descent is also a key factor. These families are more likely to have gene mutations linked to ovarian cancer.

If a woman is found to be at high or potentially high risk of ovarian cancer, based on her family history, she may be referred to family cancer clinic for further assessment and possible genetic testing. Meanwhile, having a family history or ovarian cancer and/or a BRCA1 or 2 gene mutation are not the sole inherited links to the disease. For example, if you have a strong family history of other cancers such as colorectal cancer, endometrial cancer or prostate cancer, you may also be at an increased risk of ovarian cancer. Also, not every gene mutation leading to an increased risk of ovarian cancer is currently detectable.

People with a fault in their BRCA1 or BRCA2 gene have a 50 per cent chance of passing on that faulty gene to both their female and male children. For more information on genetic testing read our genetic testing feature.


Protective strategies
Research shows that screening for ovarian cancer using a blood test (known as the CA125), ultrasound or a combination of these tests, is not effective for women at high or potentially high risk of ovarian cancer due to family history or a gene fault. The most effective strategy for these women is surgery, which involves having both ovaries and fallopian tubes removed. And even if a woman has this surgery, there is still a small chance that she may get ovarian cancer.

While there is no way to prevent ovarian cancer, factors which may be protective against ovarian cancer include:

Taking the contraceptive pill
Having children
Eating a low-fat diet and avoiding too much red meat
Getting regular exercise
Maintaining a healthy weight.
Although further research is needed to clarify the role of dietary and lifestyle factors in reducing risk for ovarian cancer.


Testing and diagnosis
Unfortunately, there is no early detection test for ovarian cancer. Pap smears detect cervical cancer, but not ovarian cancer.

Self-awareness is the best form of detection, which is why it is important that women know the possible symptoms. If you notice unusual, persistent changes, such as the ones listed above, see your doctor.

Doctors will recommend blood tests and ultrasounds if they suspect a woman has ovarian cancer. But the disease can only be confirmed through a surgical procedure, called a laparotomy. This involves taking a biopsy of the tumour.


Depending on the stage and type of ovarian cancer, treatments will vary. Surgery can include the removal of:

the uterus
the fallopian tubes and ovaries on both sides
the fatty tissue that covers the bowels
one or more lymph nodes.
After surgery, most women may need to undergo chemotherapy to kill any remaining cancer cells and to prevent the cancer reoccurring.

Reviewed by Professor Michael Quinn from the Department of Obstetrics and Gynaecology at the University of Melbourne and the Oncology/Dysplasia Unit, Royal Women's Hospital, Melbourne.


Additional information