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Overview of Hong Kong
Ovarian cancer is one of the major gynecological malignancies among women in Hong Kong. In 2022, ovarian cancer ranked as the sixth most common cancer among women in Hong Kong, accounting for approximately 3.2% of all new cancer cases in females, with around 590 new cases. The crude incidence rate per 100,000 female population was approximately 14.8, while the age-standardized incidence rate per 100,000 standard population was about 9.7.
Ovarian cancer is the sixth most fatal cancer among women in Hong Kong. In 2023, approximately 270 women died from ovarian cancer, accounting for about 4.2% of all female cancer deaths. The crude mortality rate per 100,000 female population was approximately 6.6, while the age-standardized mortality rate per 100,000 standard population was about 3.3. The age-standardized incidence rate of ovarian cancer has shown an upward trend over the past 40 years and the past 10 years.
Symptoms of Ovarian Cancer
Early-stage ovarian cancer often presents no symptoms and can easily be overlooked. Some patients may experience the following symptoms but are usually mild and mistaken for other health issues.
Understanding Cancer Causes
Research indicates that certain risk factors may increase a woman’s chance of developing ovarian cancer. However, most women with these risk factors do not develop ovarian cancer, while some without known risk factors may still develop the disease. Therefore, risk factors alone cannot fully predict the likelihood of developing ovarian cancer. The safest approach is to consult a doctor and undergo appropriate screenings.
Risk factors for ovarian cancer include:
Common Diagnostic Methods
Early Detection of Ovarian Cancer
Currently, there is no effective screening method for ovarian cancer. The commonly used Pap smear test (also known as the Pap test) cannot diagnose ovarian cancer.
The following are the examination and diagnostic methods for ovarian cancer, ideally performed by a gynecologic oncologist:
Although the CA-125 blood test is more accurate for detecting ovarian cancer in postmenopausal women, it is not a reliable method for identifying early-stage ovarian cancer. In approximately 20% of advanced ovarian cancer cases and 50% of early-stage cases, patients do not show elevated CA-125 levels. On the other hand, certain benign gynaecological conditions, such as endometriosis or fibroids, may cause CA-125 levels to rise. Therefore, it must be used with other diagnostic methods for accurate assessment.
Pathologists examine cells from tissue and fluid samples under a microscope to classify ovarian cancer tumours into three grades: Grade 1, Grade 2, or Grade 3.
Grade 1: Well-differentiated tumour
Grade 2: Moderately differentiated tumour
Grade 3: Poorly differentiated tumour
Generally, higher-grade tumours indicate faster-growing cancer cells with a greater likelihood of spreading.
Based on the extent of cancer spread, ovarian cancer is divided into four stages, with Stages I to III further categorised into substages A, B, and C.
Stage I
| Stage | Definition | 5-Year Relative Survival Rate |
| IA | Cancer is found in only one ovary. | 94％ |
| IB | Cancer is found in both ovaries. | 92％ |
| IC | Cancer is found in one or both ovaries, along with one of the following: · Cancer cells on the surface of one or both ovaries. · Ruptured ovarian surface. · Cancer cells detected in abdominal fluid or peritoneal washings. | 85％ |
Stage II
Cancer is found in one or both ovaries and has spread to pelvic tissues.
| Stage | Definition | 5-Year Relative Survival Rate |
| IIA | Cancer has spread to the uterus and/or fallopian tubes. | 78％ |
| IIB | Cancer has spread to other pelvic tissues. | 73％ |
| IIC | Cancer is found in one or both ovaries and has spread to the uterus/fallopian tubes or other pelvic tissues, along with one of the following: · Cancer cells on the ovarian surface. · Ruptured ovarian surface. · Cancer cells detected in abdominal fluid or peritoneal washings. | 57％ |
| Stage | Definition | 5-Year Relative Survival Rate |
| IIIA | Cancer is limited to the pelvis, but microscopic spread is seen on the peritoneal surface, small intestine, or tissues connecting the intestine to the abdominal wall. | 59％ |
| IIIB | Cancer has spread to the peritoneum, with tumours ≤2 cm. | 52％ |
| IIIC | · Cancer has spread to the peritoneum with tumours>2 cm; and/or · Cancer has spread to the abdominal lymph nodes. | 39％ |
Stage IV
Cancer has spread beyond the abdomen to distant organs, such as the lungs, liver, or lymph nodes outside the abdominal region.
Primary Treatment Methods
Before making any treatment decisions, patients should consult with healthcare professionals to fully understand each treatment option’s effectiveness, potential side effects, and risks. Ovarian cancer treatment methods include:
1.Surgery
Surgery is the primary treatment for ovarian cancer. During the procedure, the surgeon aims to remove all visible tumours. Patients operated on by gynecologic oncologists typically have better outcomes, including higher survival rates and longer progression-free survival, than those treated by non-specialised surgeons.
For early-stage ovarian cancer, laparoscopic or minimally invasive surgery may be suitable. However, most patients require laparotomy, where the surgeon removes tissues based on the extent of tumour spread, including:
Abdominal fluid is also collected for cytological analysis. If the tumour shows significant spread, the surgeon performs tumour debulking surgery to remove as much cancerous tissue as possible, which positively impacts treatment outcomes and survival rates.
Younger patients with early-stage ovarian cancer who wish to preserve fertility may opt, under medical guidance, to remove only one ovary, the fallopian tube, and the omentum.
For elderly patients, those in poor physical condition, or individuals with comorbidities, doctors may recommend neoadjuvant chemotherapy (chemotherapy before surgery) to shrink the tumour. If the cancer responds well, surgery is then performed to excise visible tumours, followed by additional chemotherapy.
Post-surgery pain can be managed with medication. Recovery time varies but typically requires several days of hospitalisation. Full recovery to normal activities and readiness for chemotherapy may take weeks.
Ovarian removal in premenopausal women induces early menopause, with symptoms such as hot flashes, vaginal dryness, and night sweats. Medications and lifestyle adjustments can help alleviate these effects.
2. Radiation Therapy
Radiation therapy uses high-energy radiation to destroy cancer cells and is divided into two types: external beam radiation therapy and internal radiation therapy.
External Beam Radiation Therapy
Radiation is delivered from outside the body and focused on the area affected by cancer. The treatment itself is painless. Typically, patients undergo treatment five days a week for several weeks. Common side effects include:
These side effects usually improve after treatment ends. If they become bothersome, inform your healthcare team, who can provide ways to manage them.
Internal Radiation Therapy (Brachytherapy)
Radioactive material is placed inside the body near the tumour. However, this method is rarely used for ovarian cancer.
1. Chemotherapy
Chemotherapy for ovarian cancer is primarily divided into two categories: intravenous chemotherapy and intraperitoneal chemotherapy.
Intravenous Chemotherapy
Intravenous chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. The drugs are administered through a vein, entering the bloodstream to reach tumours throughout the body.
Intraperitoneal Chemotherapy
Chemotherapy drugs are delivered directly into the abdominal cavity through an implanted catheter. Since the drugs are offered in a more concentrated form near the tumour site, they effectively eliminate tumours in the abdomen or pelvis.
The most commonly used chemotherapy drugs for ovarian cancer are platinum-based (e.g. Carboplatin, cisplatin) and taxane-based (e.g. Paclitaxel) combinations.
Chemotherapy is administered in cycles, typically every 3 to 4 weeks via intravenous infusion. For the most common type, epithelial ovarian cancer, the standard course consists of about 6 cycles, though the exact number depends on the cancer stage and type. Doctors regularly monitor CA-125 levels during treatment—a decline indicates a positive response.
Neoadjuvant Chemotherapy
Some patients, particularly older individuals, those in poor physical condition, or those with symptoms like ascites (abdominal fluid buildup), may receive chemotherapy before surgery to shrink tumours and alleviate symptoms. If the tumour responds well, surgery is performed to remove as much of the tumour as possible, followed by additional chemotherapy.
For advanced ovarian cancer, doctors may recommend combining chemotherapy with targeted drugs.
2.Targeted Therapy
Targeted therapy focuses on specific genes, proteins, or tissue environments that support cancer cell growth and survival. These drugs are more precise, causing less harm to normal cells. After completing chemotherapy, targeted drugs may be used for maintenance therapy to control the disease further.
Goals of Maintenance Therapy:
Currently Approved Targeted Drugs for Ovarian Cancer:
*Sources:
Cancer Online Resource Hub
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
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