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Ovarian cancer

Ovarian cancer is an abnormal and uncontrolled growth of cells that starts in your ovaries. It’s the fifth most common cancer in women in the UK.

In ovarian cancer, cells in your ovaries start to grow abnormally and out of control. The ovaries are two small organs that are part of the female reproductive system. They produce eggs every month in women of childbearing age, and the female hormones oestrogen and progesterone.

Ovarian cancer can sometimes spread more widely in your abdomen (tummy) or more rarely, to other organs through your bloodstream or lymphatic system. Your lymphatic system is made up of the tissues and organs in your body that produce and store cells that fight infection and disease. These include your bone marrow, spleen, thymus and lymph nodes. The channels that carry lymph are also part of this system. If ovarian cancer spreads to other parts of your body, it can form secondary tumours. The spread of cancer through your body is called metastasis.

Over 7,000 women in the UK are diagnosed with ovarian cancer each year, which makes it the fifth most common cancer in women. Worldwide, it’s the eighth most common cancer in women. Ovarian cancer mostly affects women over 50, but younger women can get it too.

Types of ovarian cancer

There are different types of ovarian cancer. The most common is epithelial ovarian cancer, which affects the lining of your ovaries. Nine out of 10 ovarian cancers are epithelial. There are several different types of epithelial ovarian cancer; the most common type is called ‘serous’.

Non-epithelial ovarian cancer is much less common. This type includes cancers that form from the cells in your ovary that make eggs. These usually affect younger women.

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How cancer develops
Cells begin to grow in an uncontrolled way
An image showing the location of the ovaries and surrounding structures

Details

  • Symptoms Symptoms of ovarian cancer

    Many women don’t have any symptoms or only have vague symptoms in the early stages of ovarian cancer. Many of these symptoms can occur in other conditions as well and aren’t necessarily a sign of cancer. If you do have symptoms, they may include:

    • stomach pain or pain in your pelvis
    • a swollen abdomen and persistent bloated feeling
    • feeling full quickly and losing your appetite
    • needing to pass urine more often or more urgently

    Other possible symptoms include:

    • unexplained weight loss
    • changes in your bowel bladder habit, such as constipation, excess wind or diarrhoea
    • back pain
    • extreme tiredness
    • rarely, abnormal bleeding from your vagina

    If you have any of these symptoms, see your GP. The earlier you’re diagnosed, the better your chance of survival so it's important to discuss any concerns with your GP.

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  • Diagnosis Diagnosis of ovarian cancer

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history and whether anyone else in your family has had breast or ovarian cancer.

    Your GP will ask you to have a blood test to check the levels of certain proteins, such as CA125, that can be high if you have ovarian cancer. He or she may also examine you internally to check your womb and ovaries.

    Your GP may organise some further tests, such as an ultrasound scan to view the inside of your abdomen and pelvis. Your GP may do the ultrasound or you may need to go to hospital to have this. You may also have a CT scan at a hospital.

    Your GP may refer you to a gynaecologist (a doctor who specialises in women’s reproductive health).

    If you’re found to have cancer, you will need to have more tests to assess if the cancer has spread outside your ovaries. This process of finding out whether the cancer has spread is called staging. This is important because it can help doctors to estimate how your cancer is likely to progress, and what the best course of treatment will be.

    Further tests may include a gynaecological laparoscopy – this is a procedure used to examine your fallopian tubes, ovaries and womb. You may also have a small sample of tissue taken (a biopsy), which will be sent to a laboratory for testing. If you have a build-up of fluid in your stomach, it can be drawn out through a needle and examined to see whether cancer cells are present. This is known as abdominal fluid aspiration or paracentesis.

  • Treatment Treatment of ovarian cancer

    Your treatment will depend on the type of ovarian cancer you have and how far it has spread. It will also depend on your general state of health, whether you plan to have children and other issues personal to you.

    Most women with ovarian cancer have a combination of surgery and chemotherapy. Your doctor may give you information on clinical trials that are testing new treatments for ovarian cancer.

    Surgery

    Almost all women with ovarian cancer need surgery. If the cancer hasn't spread beyond your ovary, it may be possible to remove just your single affected ovary and fallopian tube.

    If the cancer has already spread beyond your ovary, you may need to have both ovaries and your womb, together with nearby lymph nodes and surrounding tissue removed. This is called a total abdominal hysterectomy and bilateral salpingo-oophrectomy, or a TAH and BSO for short.

    Other types of surgery for more advanced ovarian cancer are used to remove, or 'debulk' as much of the tumour as possible before you have chemotherapy.

    Non-surgical treatments

    Chemotherapy

    Chemotherapy uses medicines to destroy cancer cells. The type of chemotherapy treatment you have will vary depending on your type of ovarian cancer. A common type of chemotherapy medicine is carboplatin, which you can have alone or in combination with another medicine, called paclitaxel. However, there are lots of other chemotherapy medicines available. Usually you have a course of treatment, which will involve having several doses at regular intervals over a period of weeks. Your doctor will give you information on the type and course that is best for you.

    You will probably be offered chemotherapy after surgery to destroy any remaining cancer cells that weren’t removed by surgery or if there is a risk the cancer may return. However, you may also have chemotherapy before surgery to shrink your tumour.

    If ovarian cancer comes back (a relapse), you may be treated with the same chemotherapy medicine or an alternative one. This will depend on the timing of your relapse and whether the cancer has developed resistance to previous chemotherapy medicines.

    Radiotherapy

    Radiotherapy uses radiation to destroy cancer cells. It's not often used to treat ovarian cancer but is very occasionally used after surgery to destroy any remaining cancer cells.

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  • Recovery After your treatment

    You will need to attend hospital appointments and have regular check-ups after your treatment to see if any of the cancer remains. If further cancer is found, you may be able to have more treatment to remove it.

  • Causes Causes of ovarian cancer

    The exact reasons why you may develop ovarian cancer aren't fully understood at present. However, there are some things that can make it more likely. It's more common in women who live in developed countries for example, and in those who have gone through the menopause. It’s also known that inheriting faulty genes called BRCA1 and BRCA2 increase the risk of ovarian cancer.

    Other factors that may increase your risk of getting ovarian cancer include:

    • certain types of hormone replacement therapy (HRT) – especially if you take them for longer than five years
    • being overweight or obese
    • having endometriosis or ovarian cysts
    • smoking
    • starting the menopause late

    Ovarian cancer is generally less common in women who have:

    • used the contraceptive pill
    • had children – the more children, the lower the risk
    • breastfed their children
    • had a hysterectomy or been sterilised
  • Prevention Prevention of ovarian cancer

    You may be able to reduce your risk of developing some types of ovarian cancer by making changes to your lifestyle, such as stopping smoking and eating a healthy, balanced diet. If you take an oral contraceptive, it can also reduce your risk.

    If you have a strong family history of breast or ovarian cancer, for example if your mother or aunt had cancer when she was under 50, let your GP know. He or she may refer you to a genetic service. This service can assess your own risk and if it's high, your GP can monitor you and diagnose and treat any cancer early.

  • Help and support Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need. If you have more advanced cancer, further support is available to you in hospices or at home – this is called palliative care.

  • FAQs FAQs

    Are there any ovarian cancer screening programmes I can attend?

    Answer

    No, there isn't a national ovarian cancer screening programme because tests to spot early ovarian cancer cells aren't effective enough yet. But your GP can refer you to a local genetics service (also known as a family cancer clinic) for screening if you're at a high risk.

    Explanation

    Research is being carried out in a 10-year study called the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) to find reliable tests that may lead to a screening programme. Some 200,000 women are taking part in the trial to see if routine blood tests and ultrasound scans can detect early ovarian cancer. Initial results are encouraging and suggest that these tests could be used on a large scale to identify ovarian cancer. Final results from the study are expected in 2015.

    If you have two relatives from the same side of your family who were diagnosed with ovarian cancer or breast cancer under the age of 50, you may be considered high-risk. Your GP can refer you to a local genetics service where your risk will be assessed and you will be given information and advice.

    How can ovarian cancer come back after I have had surgery?

    Answer

    The aim of surgery is to remove as much of the cancer as possible. It may be possible to remove all of the cancer but sometimes some of the cancer may be left behind.

    Explanation

    It’s still possible for ovarian cancer to come back even if you have had an operation to remove your ovary. Ovarian cancer may have spread beyond your ovary by the time it’s diagnosed so even if you had it removed, some cancer cells may already have spread into other parts of your body.

    The aim of surgery is to remove as much cancer as possible. However, residual ‘seedlings’ of cancer cells can often be unavoidably left behind after surgery. The amount of cancer left after surgery varies between women. It may be only a few cells but can be larger amounts.

    You may have chemotherapy after your operation as this can help to destroy any remaining cancer cells. Chemotherapy is often able to kill off the majority of cancer cells and the cancer is then in ‘remission’. If all the detectable cancer disappears, it’s called ‘complete remission’. If most of the cancer disappears but a small amount remains, it’s known as ‘partial remission’. Sometimes the cancer cells resist the effects of chemotherapy and the disease doesn’t improve. Your doctor will then discuss alternative treatments with you.

    It’s important to attend hospital appointments after your operation and have regular tests to see if any of the cancer remains. If further cancer is found, you may be able to have more treatment to remove it.

    If you have any questions about your surgery and what results you can expect from it, ask your surgeon or doctor for advice. 

    I've heard that using talcum powder causes ovarian cancer, is this true?

    Answer

    It’s possible that talcum powder may increase your risk of getting ovarian cancer but at present the research is inconclusive. More research is needed to prove if talc can cause ovarian cancer.

    Explanation

    There is a theory that talc may be able to travel up your vagina through your cervix to your womb, fallopian tubes and ovaries. This could potentially cause your ovaries to become irritated and inflamed, which may lead to cancerous changes in the cells.

    Some studies found that women who used talcum powder on their genitals were at a slightly higher risk of getting ovarian cancer than those who didn't. However, the studies and the results are not considered to be very reliable and the slight increase could have been a chance result.

    Other research found an increased risk of ovarian cancer in women who regularly use talc – and the risk increased with heavier use of talc. However, further research is needed to get a decisive answer. If you have any questions about the latest research, ask your doctor.

    Why are women who take the contraceptive pill or have children less likely to develop ovarian cancer?

    Answer

    Doctors believe that ovarian cancer is related to the number of times you ovulate (release one or more eggs from one of your ovaries) in your life. So the fewer ovulation cycles you have, the lower your risk of ovarian cancer. You ovulate during each menstrual cycle, several days before your period.

    Explanation

    Research has shown that taking the contraceptive pill at some point in your life reduces your chances of getting ovarian cancer. The longer you take it for, the lower your risk becomes. Once you stop taking the contraceptive pill, it carries on protecting you from ovarian cancer for at least 20 years.

    Having been pregnant – even if you had a miscarriage or an abortion – reduces your risk of developing ovarian cancer. The more children you have, the lower your risk of developing ovarian cancer. Some research suggests that this is also related to the age you are when you have your last child. For example if you have your last child after the age of 35, you're more protected than if you have your last child before the age of 25.

  • Resources Resources

    Further information

    Sources

    • Cancer incidence for common cancers. Cancer Research UK. www.cancerresearchuk.org, published 26 July 2012
    • Ovarian cancer. eMedicine. www.emedicine.medscape.com, published 26 September 2012
    • Lawrie TA, Medeiros LRF, Rosa DD, et al. Laparoscopy versus laparotomy for FIGO stage I ovarian cancer. Cochrane Database of Systematic Reviews 2013, Issue 2. doi: 10.1002/14651858.CD005344.pub2
    • Quality standard for ovarian cancer. National Institute for Health and Care Excellence. www.nice.org.uk, published May 2012
    • Types of ovarian cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 February 2011
    • Ovarian cancer: The recognition and initial management of ovarian cancer. National Institute for Health and Care Excellence, April 2011. www.nice.org.uk
    • Ovarian cancer symptoms. Cancer Research UK. www.cancerresearchuk.org, published 14 March 2012
    • Ovarian cancer risks and causes. Cancer Research UK. www.cancerresearchuk.org, published 1 June 2012
    • Ovarian cancer – presentation. Map of Medicine. www.mapofmedicine.com, published 10 January 2013
    • Further tests for ovarian cancer. Cancer Research UK. www.cancerresearchuk.org, published 20 March 2012
    • Ovarian cancer. American Cancer Society. www.cancer.org, published 21 March 2013
    • Ovarian cancer treatment and management. eMedicine. www.emedicine.medscape.com, published 26 September 2012
    • Surgery for ovarian cancer. Cancer Research UK. www.cancerresearchuk.org, published 21 March 2012
    • Treating advanced ovarian cancer. Cancer Research UK. www.cancerresearchuk.org, published 22 March 2012
    • Drugs used for ovarian cancer. Cancer Research UK. www.cancerresearchuk.org, published 22 March 2012
    • Radiotherapy for ovarian cancer. Cancer Research UK. www.cancerresearchuk.org, published 3 April 2012
    • Ovarian cancer screening. Cancer Research UK. www.cancerresearchuk.org, published 29 January 2013
    • UK collaborative trial of ovarian cancer screening (UKCTOCS). UCL Institute for Women's Health. www.instituteforwomenshealth.ucl.ac.uk, published 5 January 2012
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    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, June 2013.

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