Presenting problem
Usually presents as vague abdominal symptoms such as bloating, fullness, indigestion, decreased appetite, weight gain or loss, change in bowel habits, fatigue, urinary frequency or incontinence, abdominal or pelvic pain, pressure in the abdomen.
Risk
The Background risk for women of having ovarian cancer is 1 in 70 without any family history. This can be as high as 1 in 2 in some inherited conditions (this may necessitate prophylactic laparoscopic surgery in such cases like Angelina Jolie). Dr Land will conduct a thorough history to determine any significant risk factors in your history such as a history of ovarian or breast cancer.
Diagnosis
If any of the above symptoms persist for more then one month particularly over the age of 40 or with a history of breast or ovarian cancer an ultrasound of the pelvis plus or minus tumour markers (CA125, CEA, CA19.9) are recommended to further investigate the problem. CT scanning may also be utilised depending on the situation as this has a more global look at the rest of the abdomen, which can often be involved, with cancer of the ovary. As much information as possible from imaging, blood tests, history and examination will allow Dr Land to give you the most accurate assessment preoperatively and ultimately the correct and complete treatment first time.
All cancers results are reviewed weekly by expert gynaecological pathologists and Dr Land in a multidisciplinary tumour board review meeting to ensure the highest possible standards of care are maintained.
Frozen Section - what is it?
If there is any concern regarding the nature (cancer or benign) of any ovarian lump, cyst or mass Dr Land will arrange a frozen section. This is a special assessment by a pathologist performed while you are asleep during the procedure on the abnormal tissue, cyst etc. and the result is telephoned through to Dr Land in theatre. This enables a tailor made procedure to be performed immediately (all in the one procedure) pending the intraoperative pathology result and your preoperative counselling with Dr Land i.e. what you and Dr Land have agreed upon that you wish to have done depending on results: benign versus cancer.
All treatment decisions will be individualised to suit patient needs and requirements.
Treatment
Treatment depends if the disease is localised to the ovaries (10-15%) or has spread elsewhere in the abdomen (85%). In cases that do not appear to have spread a full Staging procedure is undertaken to check in all the usual places these tumor cells may hide (e.g. lymph nodes). Fertility sparing procedures for appropriate tumours may be possible and will be discussed fully preoperatively. Where disease has spread away from the ovaries the most important goal is to remove all visible disease, which may require quite an extensive procedure called a Debulking operation.
Dr Land as a certified gynaecologic oncologist has the necessary expertise to enable a high probability of achieving this goal of optimal debulking (no visible disease).
Chemotherapy is frequently required as a powerful adjunct to surgery in the treatment of ovarian cancer and Dr Land will arrange all necessary follow up including intraperitoneal chemotherapy where appropriate (Chemotherapy into the abdominal cavity via a specially placed catheter). Chemotherapy can usually be arranged for closer to home for most patients who come from outside of Brisbane.
Follow up
Dr Land will coordinate follow up after treatment is completed with 3 monthly reviews for 2 years then 6 monthly reviews for a further 3 years then usually annually thereafter. If you come from out of town alternate follow up arrangements can be made in conjunction with you local GP or gynaecologist.