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Ovarian cancer

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Ovarian cancer



Introduction 

In the UK, around 7,100 women are diagnosed with ovarian cancer each year.

It's the fifth most common cancer among women after breast cancer, bowel cancer, lung cancer and cancer of the uterus (womb).

Ovarian cancer is most common in women who have been through the menopause (usually over the age of 50), although it can affect women of any age.

As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such as persistent bloating, pain in the pelvis and lower stomach, and difficulty eating.

It's important to see your GP if you experience these symptoms, particularly over a long period of time.

The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month. This is known as ovulation.

Different types of ovarian cancer affect different parts of the ovaries. Epithelial ovarian cancer, which affects the surface layers of the ovary, is the most common type. This topic focuses on epithelial ovarian cancer.

What causes ovarian cancer?

The exact cause of ovarian cancer is unknown, but certain things are thought to increase a woman's risk of developing the condition, such as age, the number of eggs the ovaries release and whether someone in your family has had ovarian or breast cancer in the past. However, only 1 in 10 cases of ovarian cancer has a genetic link.

 

Treating ovarian cancer 

The treatment you receive for ovarian cancer will depend on several things, including the stage of your cancer and your general health. Chemotherapy is the main treatment for ovarian cancer, but your treatment will usually involve a combination of surgery and chemotherapy.

Overall, 72 out of every 100 women (72%) will live for at least one year after being diagnosed with ovarian cancer. Around 46 out of 100 (46%) women will live for at least five years, and about 35 out of 100 (35%) will live for at least 10 years. However, women with advanced ovarian cancer have a poorer survival rate.

As with most types of cancer, the outlook for ovarian cancer will depend on the stage it's at when diagnosed – that is, how far the cancer has advanced. The Cancer Research UK website has more information about the outlook for ovarian cancer.

Being diagnosed with ovarian cancer can affect daily life in many ways. However, support is available for many aspects of living with ovarian cancer, including emotional, financial and long-term health issues.

 

Ovarian cancer screening

There are methods of screening for ovarian cancer but, currently, they haven't been fully tested. Screening is only available for women who are at high risk of developing the condition due to a strong family history or inheritance of a particular faulty gene. Clinical trials in the UK are currently being carried out to assess the effectiveness of screening in high-risk women and in the general population. A cervical screening test, which used to be called a smear test, can't detect ovarian cancer.

 

Symptoms of ovarian cancer 

The symptoms of ovarian cancer can be difficult to recognise, particularly in its early stages.

This is because they are often the same as symptoms of other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS).

However, three main symptoms are more frequent in women diagnosed with ovarian cancer. They are:



increased abdominal size and persistent bloating (not bloating that comes and goes)



persistent pelvic and abdominal pain



difficulty eating and feeling full quickly, or feeling nauseous



Other symptoms, such as back pain, needing to pass urine more frequently than usual, and pain during sex may be the result of other conditions in the pelvic area. However, they may be present in some women with ovarian cancer.

If you have these types of symptoms, try keeping a diary to record how many of these symptoms you have over a longer period. Bear in mind that ovarian cancer is rare in women under 40 years of age.

See your GP if you have these symptoms regularly (on most days for three weeks or more). Although it's unlikely they're being caused by a serious problem, it's best to check.

If you've already seen your GP and the symptoms continue or get worse, you should go back and explain this. You know your body better than anyone.

Want to know more?



Ovarian Cancer Action: video about the symptoms of ovarian cancer



Target Ovarian Cancer: ovarian cancer symptoms



Ovarian Cancer Action: symptoms diary (PDF, 61kb)



 

Causes of ovarian cancer 

Several possible causes of ovarian cancer have been identified, along with risks that may make developing the condition more likely.

Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.

In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer isn't identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system.

Increased risk

The exact cause of epithelial ovarian cancer (the main type) isn't known, but certain things may increase your risk of developing it.

 

Age

Your risk of ovarian cancer increases with age, with most cases occurring after the menopause. More than 8 out of 10 cases of ovarian cancer occur in women who are over 50 years of age.

Family history

If you have two or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer, your risk of also developing the condition may be increased.

If your relatives developed cancer before the age of 50, it's more likely it was the result of an inherited faulty gene. BRCA1 and BRCA2 are faulty genes that are linked to ovarian cancer. They're also known to increase the risk of breast cancer.

Having relatives with ovarian cancer doesn't mean you definitely have a faulty gene in the family – the cancer could have happened by chance. Only 1 in 10 (10%) of ovarian cancers are thought to be caused by a faulty gene.

You may be at a high risk of having a faulty gene if you have:



one relative diagnosed with ovarian cancer at any age and at least two close relatives with breast cancer whose average age is under 60; all of these relatives should be on the same side of your family (either your mother's OR father's side)



one relative diagnosed with ovarian cancer at any age and at least one close relative diagnosed with breast cancer under the age of 50; both of these relatives should come from the same side of your family



two relatives from the same side of the family diagnosed with ovarian cancer at any age 



If you're at a higher risk of having a faulty gene, your GP can refer you for tests to check for faulty BRCA1 and BRCA2 genes.

 

Ovulation and fertility

Every time an egg is released into the reproductive system, the surface of the ovary breaks to let it out. The surface of the ovary is damaged during this process and needs to be repaired. Each time this happens, there's a greater chance of abnormal cell growth during the repair. 

This may be why the risk of ovarian cancer decreases if you take the contraceptive pill, or have multiple pregnancies or periods of breastfeeding. At these times, eggs aren't released.

There's no strong evidence to show that women who have infertility treatment have an increased risk of developing ovarian cancer. However, it's thought that infertility itself may increase ovarian cancer risk and research into this area is being carried out. 

 

Hormone replacement therapy (HRT)

Women who take hormone replacement therapy (HRT) have been shown to have a small increased risk of developing ovarian cancer. However, if HRT is stopped, after five years the risk is reduced to the same level as women who've never taken HRT.

 

Endometriosis

Endometriosis may also increase your risk of ovarian cancer. In endometriosis, the cells that usually line the womb grow elsewhere in the body.

These endometrial cells behave as if they were in the womb, so thickening and bleeding that usually occurs during menstruation occurs in other parts of the body. There's no way for this endometrial tissue to leave the body so it becomes trapped, leading to pain, swelling and bleeding in that area.

More information 



Target Ovarian Cancer: When ovarian cancer runs in families



Cancer Research UK: Ovarian cancer risks and causes



 

Diagnosing ovarian cancer 

See your GP as soon as possible if you have any symptoms of ovarian cancer.

Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether there's a history of ovarian or breast cancer in your family.

They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan.

If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital.

 

Blood test (CA125)

You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer.

However, CA125 isn't specific to ovarian cancer and it can be raised in conditions including endometriosis, fibroids, pelvic inflammatory disease and pregnancy, so a raised CA125 level doesn't definitely mean you have ovarian cancer.

The Lab Tests Online UK website has more information on the CA125 test.

The National Institute for Health and Care Excellence (NICE) has produced guidance that recommends testing for CA125 if you frequently experience: 



bloating



feeling full quickly and/or loss of appetite 



pelvic or abdominal pain 



needing to urinate urgently and/or frequently  



Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb).

If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation, you may also be tested for CA125.

If you're 50 or over and you've experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

Around half of all women with early stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised, you'll be referred for an ultrasound scan.

 

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of your ovaries. You may have an internal ultrasound where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach.

The image produced can show the size and texture of your ovaries, plus any cysts or other swellings that are present.

 

Further tests

If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and if it's spread. This is called staging.

Other tests you may have include:



a chest X-ray



a CT scan or MRI scan



abdominal fluid aspiration – a thin needle is passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells 



laparoscopy– a thin tube with a camera on the end is inserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy)



Staging helps your doctors to decide on the best kind of treatment for your condition. However, it's important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

The Cancer Research UK website has more information on further tests for ovarian cancer.

Stages and grades of ovarian cancer

 

 

Staging

If your test results indicate that you have ovarian cancer, it will be given a stage. The stage describes the size of the cancer and how far it has spread. The four commonly used stages of ovarian cancer are:



stage 1 – where the cancer only affects one or both of the ovaries



stage 2 – where the cancer has spread from the ovary and into the pelvis or womb



stage 3 – where the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis



stage 4 – where the cancer has spread to other parts of the body, such as the liver, spleen or lungs 



This is a simplified guide. Each stage is further divided into categories A, B and C. Ask your doctor if you're not sure what stage you have.

 

Grading

The grade of cancer refers to the appearance of cells under a microscope. The grades are as follows:



low grade – although abnormal, cells appear to be slow-growing



moderate grade – cells look more abnormal than low-grade cells



high grade – cells look very abnormal and are likely to be fast-growing



The Cancer Research UK website has more information on the stages and grading of ovarian cancer.

 

Treating ovarian cancer 

If you have cancer, a team of specialists will work together to provide you with the best possible treatment and care.

This is known as a multidisciplinary team. It will often consist of specialist cancer surgeons (gynaecological oncologists), a medical oncologist (chemotherapy specialist) and a specialist cancer nurse. Other members may include a radiologist, pathologist, physiotherapist, dietitian and an occupational therapist.

When deciding which treatment is best for you, your doctors will consider:



the stage of your cancer (its size and how far it's spread)



your general health



whether fertility is an issue



You can discuss treatment with your care team and ask questions at any time.

Surgery and chemotherapy are the two main treatments for ovarian cancer.

Advanced ovarian cancer

Ovarian cancer is often diagnosed at an advanced stage (3 or 4) when it has spread to other parts of the abdomen (tummy). Advanced cancer may not be curable. The goal of treatment will be to put the tumour into remission, so it shrinks or disappears.

Surgery hide


Most women with ovarian cancer will be considered for surgery. It sometimes isn't possible to confirm the stage of the cancer until surgery is carried out.

Your doctor will discuss what will happen during surgery. It will probably involve removing:



both ovaries and the fallopian tubes (a bilateral salpingo-oophorectomy)



the womb (a total abdominal hysterectomy)



the omentum – a fatty layer of tissue within the abdomen (an omentectomy)



The surgeon may also remove the lymph nodes from your pelvis and abdomen, and samples of nearby tissue, to find out whether the cancer has spread.

If it has spread, the surgeon will try to remove as much of it as possible. This is known as "debulking surgery".

If the cancer is confined to one or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to carry a pregnancy.

You will probably be ready to go home three to seven days after your operation, but it can take many weeks to fully recover.

When you go home, you'll need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss the types of exercise that are suitable for you with your doctor or physiotherapist.

Want to know more?



Cancer Research UK: surgery for ovarian cancer



Macmillan: surgery for ovarian cancer



Target Ovarian Cancer: ovarian cancer treatments



 

Living with ovarian cancer 

How ovarian cancer will affect your daily life depends on the stage your condition is at and what treatment you're having.

How women cope with the diagnosis and treatment varies from person to person. There are several forms of support, if you need it. Not all types of support work for everybody, but one or more should prove helpful:



Talk to your friends and family, as they can be a powerful support system.



Communicate with other women in the same situation.



Find out about your condition.



Set reasonable goals.



Take time out for yourself.



 

Want to know more?



Cancer Research UK: living with ovarian cancer



healthtalkonline: experiences of people with ovarian cancer



Recovery and follow-up hide


Many women with ovarian cancer have a hysterectomy. This is a major operation, and takes around 6-12 weeks to recover from.

During this time, you'll have to avoid lifting things, such as children and heavy shopping bags, and doing heavy housework. You won't be able to drive for 3-8 weeks after the operation. Most women need 4-12 weeks off work after a hysterectomy.

If your ovaries have been removed and you haven't already been through the menopause, you'll experience the menopause after your treatment. You may decide to take hormone replacement therapy (HRT) to control your symptoms. Your GP will help you decide what's best for you.

Some treatments for ovarian cancer, particularly chemotherapy, can make you feel very tired. You may need a break from your normal activities for a while. Don't be afraid to ask for practical help from family and friends if you need it.

Practical help may also be available from your local authority. Ask your doctor or nurse who to contact.

After your treatment has finished, you'll be invited for regular check-ups to see how well you are responding to treatments. These are usually every 2-3 months to begin with.

 

Want to know more?



Target Ovarian Cancer: sources of support for women with ovarian cancer



Macmillan: follow-up after treatment for ovarian cancer



 

Preventing ovarian cancer 

There's currently no reliable screening test for ovarian cancer. However, there are a number of things that may help to prevent ovarian cancer.

Stopping ovulation and the contraceptive pill

Each time you ovulate, your ovaries are damaged by the egg as it breaks through the surface of the ovary and is released into your reproductive system.

The cells that make up the surface of your ovaries divide and multiply rapidly to repair the damage caused by the egg. It's this rapid cell growth that can occasionally go wrong and result in ovarian cancer.

Anything that stops the process of ovulation can help to minimise your chances of developing ovarian cancer. This includes:



pregnancy and breastfeeding



the contraceptive pill



hysterectomy surgery (removal of the ovaries)



 

Diet and lifestyle

Research into ovarian cancer has found that the condition may be linked to being overweight or obese. Losing weight through regular exercise and a healthy, balanced diet may to help lower your risk of getting ovarian cancer. Aside from this, regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can help to prevent all forms of cancer and heart disease.

 

Screening for ovarian cancer

At present, there's no screening method for ovarian cancer that is reliable enough to be used by all women in the UK. Clinical trials into this are continuing.

You may be eligible for screening if you're at high risk of developing the condition due to a strong family history, or if you've inherited a specific abnormal gene.

If you're at high risk, your GP can refer you to your local genetics service or family cancer clinic. You may be screened for ovarian cancer when you're over the age of 35, or when you're five years away from the age at which your youngest relative was diagnosed with the condition. From this point, you'll be screened again once a year.

The screening tests for ovarian cancer are the same as those routinely used to diagnose it. The tests are:



a blood test for higher-than-normal levels of CA125 (a protein produced by cancer cells)



a transvaginal ultrasound – where an ultrasound probe is inserted into your vagina so that the size and texture of your ovaries can be seen, as well as any ovarian cysts that may be present



The tests are used together to produce results that are as accurate as possible. However, as these screening methods are still in the process of being tested, there's no guarantee they'll identify every case of ovarian cancer.

A cervical screening test, previously known as a smear test, can't detect ovarian cancer.

 

Online personal education and risk assessment (OPERA)

If you're concerned about your risk of developing inherited ovarian cancer, you can use Macmillan's online interactive assessment tool, OPERA.

It's designed to be used by patients and healthcare professionals to assess a person's risk of developing the condition based on their family history of breast cancer and ovarian cancer. This is because the genes that are mainly responsible for ovarian cancer are also linked to breast cancer.

 

Want to know more?

Cancer Research UK: ovarian cancer screening

 





Ovarian cancer