Over 7,100 women in the UK are diagnosed with ovarian cancer each year. Ovarian cancer mostly affects women over 50, but younger women can get it too.
Types of ovarian cancer
There are several types of ovarian cancer. These affect women of different ages and are treated in different ways.
Epithelial ovarian cancer is the most common type, causing nine out of 10 ovarian cancers. This cancer develops in the cells that line your ovaries and fallopian tubes (the tubes leading from your ovaries to your womb).
Non-epithelial ovarian cancer is much less common and usually affects younger women. It includes cancers that grow from the cells in your ovary that make eggs.
Symptoms of ovarian cancer
In the early stages of ovarian cancer, you don’t usually have any symptoms. If you do have symptoms, they're usually very vague and are similar to symptoms caused by other, less serious conditions. These may include:
- having a swollen abdomen and constantly feeling bloated
- feeling full quickly and losing your appetite
- pain in your stomach or back
- needing to pass urine more often or more urgently
Other symptoms that you may notice if you have ovarian cancer include:
- losing weight for no obvious reason
- unexplained changes in your bowel or bladder habits, such as constipation, excess wind or diarrhoea
- indigestion and acid reflux
- pain during sex
- unexplained extreme tiredness
- rarely, abnormal bleeding from your vagina
Remember that there can be many reasons for these symptoms, other than ovarian cancer. If you do develop any of these symptoms though, and they last for longer than a few weeks, make an appointment to see your GP.
Diagnosis of ovarian cancer
Your GP will ask you about your symptoms and examine you. They may also ask you about your medical history and whether anyone else in your family has had breast or ovarian cancer.
Depending on what symptoms you have and how long you’ve had them, your GP may arrange for you to have a blood test. This is to check for a protein called CA125. Your level of CA125 can be high if you have ovarian cancer, although other conditions can also raise your CA125 level. A high CA125 doesn’t necessarily mean you have ovarian cancer.
Your GP may ask to examine you internally to check your womb and ovaries. Your GP may also organise some further tests, such as an ultrasound or CT scan to view the inside of your abdomen and pelvis. They may refer you to a gynaecologist (a doctor who specialises in women’s reproductive health).
If you’re found to have cancer, you’ll need to have more tests. These tests are to see how large the tumour is and whether it has spread outside your ovaries. This is called staging. Staging can help doctors to estimate how your cancer is likely to progress, and what’s the best course of treatment for you.
Your doctor may also suggest you have a gynaecological laparoscopy. This is a procedure to look at your fallopian tubes, ovaries and uterus, using thin tube with a camera on the end, inserted into your abdomen. Your doctor may use this procedure to remove small samples of tissues (biopsies) from your ovaries to test for cancer.
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 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. You may have surgery first and then chemotherapy, or vice versa, depending on what your doctor thinks will work best for you.
Almost all women with ovarian cancer need surgery. The aim of surgery is to remove as much of the tumour as possible. This is called ‘debulking’ 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, your womb, nearby lymph nodes and surrounding tissue removed. This is a total hysterectomy.
Chemotherapy is a treatment for cancer that uses medicines to destroy cancer cells. The exact chemotherapy treatment you have will depend on your type of ovarian cancer. Carboplatin is a common type of chemotherapy medicine used to treat ovarian cancer. You may be given this on its own or with another medicine, called paclitaxel. However, there many other chemotherapy medicines also available.
Usually, you will have a course of chemotherapy treatment. This involves having several doses of chemotherapy medicines at regular intervals over a period of weeks. Your doctor will give you information on the type and course that’s best for you.
You may be offered chemotherapy before surgery to shrink the tumour in preparation for surgery. Alternatively, you may be offered chemotherapy after surgery to destroy any cancer cells that weren’t removed by the operation. Your doctor may also suggest chemotherapy if there’s a chance that your cancer may return.
If your ovarian cancer comes back (called a relapse), you may be treated with the same chemotherapy medicine or an alternative one. This will depend on when your relapse occurs and whether the cancer stops responding to your previous chemotherapy medicines.
Radiotherapy uses radiation to destroy cancer cells. It's not often used to treat ovarian cancer but you may be offered it after surgery to destroy any remaining cancer cells. 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.
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 of ovarian cancer
It’s not fully understand what causes some women to develop ovarian cancer, although certain factors can make you more likely to develop it. For instance, you’re more likely to develop ovarian cancer if you have a family history of ovarian or breast cancer. You’re also more likely to develop it if you inherit faulty genes called BRCA1 and BRCA2. Ovarian cancer becomes more common as women get older.
You’re at greater risk of getting ovarian cancer, if you:
- are overweight or obese
- have endometriosis
- start the menopause late – the average age of the menopause in the UK is 51
There’s some evidence that taking certain types of hormone replacement therapy (HRT) may increase your risk of ovarian cancer. If you use HRT, or have used it in the past, and are worried about your ovarian cancer risk, ask your GP for advice.
Your risk of ovarian cancer is reduced if you:
- have taken the contraceptive pill for five years or more
- have had children – the more children you have, the lower your risk
- breastfed your children
- have had a hysterectomy or been sterilized
Prevention of ovarian cancer
Stopping smoking and eating a healthy, balanced diet may help to reduce your risk of ovarian cancer, as well as a number of other cancers. These factors are also important for your general health. It’s not possible to completely prevent ovarian cancer just by making changes to your lifestyle.
If a close family member (such as your mother or aunt) has, or has had, breast or ovarian cancer before the age of 50, let your GP know. They may refer you to a genetic counselling clinic. Specialists at the clinic will be able to assess your risk and carry out tests for the BRCA1 and BRCA2 faulty genes. If you test positive for these genes, you can be referred to a gynaecologist to talk about treatments you can be offered to reduce your risk of ovarian cancer. These include taking oral contraceptives and surgery to remove your ovaries and fallopian tubes (risk-reducing surgery).
FAQ: Are there any ovarian cancer screening programmes I can attend?
No, there isn't a national ovarian cancer screening programme at the moment. This is because tests to spot early ovarian cancer cells aren't yet effective enough. But your GP can refer you to a local genetics service for screening if you're at a high risk.
Your GP can check your blood for the CA125 protein, which can be high if you have ovarian cancer. But your levels of CA125 can also be high for many other reasons – for example, if you have fibroids, endometriosis or infection. It also doesn’t always pick up on cancer if you have it. Because of this, the test isn’t used on its own to screen for ovarian cancer.
The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) is a 10-year study researching into reliable tests that may lead to an effective screening programme. Over 200,000 women are taking part in the trial to see if routine blood tests and ultrasound scans can detect early ovarian cancer.
UKCTOCS has looked at whether there may be a more effective way of using CA125 levels to identify which women have ovarian cancer. The initial results are encouraging, but more results are needed to see if it will help to save women’s lives before it can be used in a screening programme.
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 to be high risk. Your risk is also high if you are a known carrier of the BRCA1 and BRCA2 faulty genes. Your GP can refer you to a local genetics service to have your risk assessed. You will be given information and advice.
FAQ: How can ovarian cancer come back after I’ve had surgery?
The aim of surgery is to remove as much of your cancer as possible. It may be possible to remove all of your cancer but sometimes some of the cancer cells are left behind. The amount of cancer left behind varies between women.
It’s still possible for ovarian cancer to come back even if you have had an operation to remove your ovary. This is because the cancer may have spread beyond your ovary by the time it’s diagnosed. Even if you had your ovary removed, some cancer cells may already have spread into other parts of your body.
You may have chemotherapy after your operation to destroy any remaining cancer cells. If your chemotherapy kills off all of the detectable cancer cells, your cancer is said to be in ‘complete remission’. Sometimes, the cancer cells resist the effects of chemotherapy and the disease doesn’t improve. If this happens, 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. It’s important to go back to your GP if you develop any symptoms that could indicate that the ovarian cancer has returned. These symptoms include a change in bowel habits, feeling sick, losing your appetite or constantly feeling bloated.
If you have any questions about your surgery and what results you can expect from it, ask your gynaecologist/gynaecological oncologist for advice.
FAQ: I've heard that using talcum powder causes ovarian cancer. Is this true?
There’s no consistent evidence that using talcum powder increases your risk of getting ovarian cancer. If there is a link, the risk is likely to be very small.
Some early studies found a very weak link between using talcum powder and getting ovarian cancer. These studies are no longer considered to be very accurate. Many of them relied on women with ovarian cancer remembering whether or not they had used talc in the past. More recent studies haven’t found a definite link. Even if talc could increase the risk of ovarian cancer, the risk would be very small. Other factors such as age and smoking are more important.
FAQ: How does the contraceptive pill affect my risk of ovarian cancer?
Taking the contraceptive pill at any point in your life reduces your chance of getting ovarian cancer. Your risk is also lower if you’ve been pregnant before.
The contraceptive pill works by stopping you from ovulating every month. It’s known to reduce your risk of ovarian cancer – your risk is halved if you take the contraceptive pill for five years or more. Once you stop taking the contraceptive pill, it carries on protecting you from ovarian cancer for at least 20 years.
Having been pregnant also reduces your risk of developing ovarian cancer. The more children you have, the lower your risk. Having a late menopause (when you stop ovulating) may increase your risk of ovarian cancer. The average age of the menopause in the UK is 51.
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