Ovarian cancer

The ovaries are part of the female reproductive system. These oval-shaped glands sit inside the pelvis and release an egg (ovum) each month. They also produce female sex hormones. Cancer can develop in one or both ovaries.

About 90% of ovarian cancers occur in women over the age of 40, and like most cancers the risk increases with age.

Risk factors#

The exact causes of ovarian cancer are not known, but risk factors include:

• a family history of ovarian cancer — the risk is higher if a blood relative, such as your mother, sister or daughter, has had it
• a family history of breast or colon cancer
• inheriting a changed gene (also called a faulty gene or gene mutation), such as the BRCA1 or BRCA2 gene
• increasing age
• some medical conditions, such as endometriosis
• smoking tobacco
• obesity

Around 20% of all cases of invasive ovarian cancer involve an inherited faulty gene. Some factors appear to reduce the risk, including having had a full-term pregnancy, using the oral contraceptive pill, and tubal ligation (having your tubes tied).

Symptoms#

Ovarian cancer can be difficult to diagnose at an early stage, largely because symptoms can be vague and similar to those of other common illnesses. The symptoms vary depending on the stage of the cancer.

Many women with early-stage ovarian cancer have no symptoms. If they do, it may be some pain in the lower abdomen or side, and a bloated or full feeling in the tummy. Symptoms that may occur, particularly at a later stage, include:

• a swollen abdomen as the cancer grows; very advanced cancer can cause more extensive swelling that may need draining
• urinary changes, such as needing to pass urine frequently or urgently
• discomfort in the abdomen, such as bloating or a feeling of pressure
• a change in bowel habits, or constipation
• appetite loss, feeling full quickly, or indigestion
• pain, especially during sex
• nausea and vomiting
• tiredness and breathlessness

Symptoms can be vague, so it is important to see your doctor about anything that is unusual or persistent.

Types of ovarian cancer#

The four main types are:

• Epithelial — cancer of the outer cells covering the ovary. This is the most common type; about 9 in 10 ovarian cancers are epithelial.
• Germ cell — cancer of the cells inside the ovary that mature into eggs. This uncommon form usually affects women under 30.
• Sex-cord stromal cell — cancer of the cells that release female hormones. This uncommon form can affect women of any age.
• Borderline tumors — types of epithelial tumor that are not as aggressive as other forms.

Diagnosis#

There are a range of tests used to diagnose ovarian cancer:

• a physical examination, in which the doctor checks for lumps in the lower abdomen or pelvis
• imaging tests, such as a trans-vaginal or abdominal ultrasound, CT scan, MRI or PET scan
• blood tests to look for tumor markers, such as CA 125
• colonoscopy, to make sure symptoms are not caused by a bowel problem
• surgery — the only definitive way to confirm ovarian cancer, as a tissue sample is needed

A blood test for the protein CA 125 can help diagnose or rule out ovarian cancer, but it is not a definitive test for all women. CA 125 can be raised by other causes too, such as endometriosis and ovarian cysts, and the test is most reliable in postmenopausal women. It is not recommended as a screening test for women without symptoms, because around half of all women with early-stage ovarian cancer do not have raised CA 125 levels. Other blood tests may be done to help with diagnosis and to check the effects of treatment.

Note that cervical screening (which has replaced the Pap test) only helps detect cancer of the cervix, not ovarian cancer.

Test results can take a few days to come back, and it is natural to feel anxious while you wait. It can help to talk to a close friend or relative about how you are feeling.

Treatment#

Ovarian cancer is often diagnosed during surgery, and the affected ovary or ovaries are removed at the same time. In some cases only one ovary is affected, and it may still be possible to conceive a child after surgery. In other cases, parts of the reproductive system such as a fallopian tube and the uterus (womb) may also be removed. Sometimes it is necessary to remove the appendix and part of the bowel.

• Chemotherapy (anti-cancer medications) is often given alongside surgery, to shrink a tumor before it is removed or to kill any cancer cells remaining afterwards.
• Radiotherapy (using x-rays to kill cancer cells) is also occasionally used.

It is common for people with cancer to seek out complementary or alternative treatments. Used alongside conventional treatment, some therapies can help you feel better and improve your quality of life. Others may be unhelpful, and in some cases harmful, so discuss any complementary therapy with your medical team. All treatments have side effects, which your medical team will discuss with you before treatment begins.

Early detection and better treatment have improved survival for people with ovarian cancer, and research is ongoing. Clinical trials can test the effectiveness of promising new treatments or new ways of combining them. Always discuss your treatment options with your doctor.

Sexuality and relationships#

Having ovarian cancer and its treatment can affect the way you feel about your body, who you are, your relationships, and the way you express yourself sexually. These changes can be very upsetting. Your medical team should discuss these issues with you before and during treatment. If you would like to talk things through further, you can ask your doctor for a referral to a counselor. If you have a partner, it helps to be as open as possible with them about how you are feeling.

Caring for someone, and advanced cancer#

Caring for someone with cancer can be a difficult and emotional time, and support is available for carers.

If ovarian cancer is diagnosed at a later stage, it may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving symptoms — this is called palliative treatment. Medications can be used to relieve pain, nausea and vomiting.

Key points#

• Like most cancers, the risk of ovarian cancer increases with age.
• The symptoms of ovarian cancer vary depending on the stage of the cancer.
• Many women with early-stage ovarian cancer may not have any symptoms.
• Later-stage symptoms can include a swollen abdomen as the cancer grows.
• The four main types are epithelial, germ cell, sex-cord stromal cell and borderline tumors, with epithelial being the most common.

Where to get help#