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.
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.
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:
Other possible symptoms include:
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.
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:
Ovarian cancer is generally less common in women who have:
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.
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.
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.
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 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.
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.
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.
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.
Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, June 2013.
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