Ovarian Cancer

In the UK nearly 7,500 people are diagnosed with ovarian cancer every year- making it the sixth most common cancer in women in the UK after breast, bowel, lung, womb cancer and melanoma (a type of skin cancer).

What is ovarian cancer?

Cancer of the ovary is most common post-menopause, although it can affect anyone with ovaries at any age.

There are many types of ovarian cancer, with epithelial ovarian cancer being by far the most common form:

  • Epithelial ovarian cancer (epithelial ovarian tumours) – develops from cells on the surface of the ovary. It include the sub-types:
  • Fallopian Tube cancer; we now know that many ovarian cancers begin in the Fallopian Tubes. They are treated in the same way as ovarian cancer
  • Primary peritoneal cancer (PPC). Primary peritoneal cancer is rare. It is similar to epithelial ovarian cancer. The peritoneum is a thin lining inside of the abdomen, covering the abdominal organs. It is treated in the same way as ovarian cancer
  • Germ cell ovarian cancer– derived from the egg-producing cells in the ovary. This rare type of cancer more commonly affects teenagers. Some of these tumours are benign (non-cancerous)
  • Stromal ovarian cancer (sex cord stromal tumours [SCSTs]) – develops within the cells that hold the ovaries together. Granulosa cell tumours are the most common type. Some of these tumours are benign (non-cancerous)
  • Small cell ovarian cancer-the least common sub-type, that usually affects younger women and people with ovaries
  • Cancers from other organs in the body can spread to the ovaries – called metastatic cancers

How does it develop?

Cells in the ovary start to change and grow abnormally. If the cancer isn’t identified at an early stage, it can breach the ovary skin and spread to the abdomen and pelvis (peritoneal cavity).

Ovarian cancer symptoms-

If ovarian cancer symptoms are identified and the cancer is diagnosed at an early stage, more treatment options are available and the prognosis is more optimistic. However, because some of the symptoms of ovarian cancer are often the same as for other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS), it can be difficult to recognise the symptoms in the early stages.

There are five main ovarian cancer symptoms:

  • Increased abdominal size and persistent bloating (not bloating that comes and goes)
  • Persistent pelvic and abdominal pain
  • Unexplained change in bowel habits
  • Difficulty eating and feeling full quickly, or feeling nauseous
  • Needing to urinate (wee) more regularly

Other symptoms, such as back pain, fatigue, weight loss and pain during sex may also be present. However, it is possible that these are not symptoms of ovarian cancer but may be the result of other conditions.

Risk Factors

We don’t know exactly what causes ovarian cancer, but some factors may increase the risk of it developing, including:

Age
Your risk of getting 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 and people who are over 50 years of age.

Family history
If you have two or more close relatives (parents, siblings or children) who developed ovarian, breast, prostate or pancreatic cancers, your risk of these cancers may be increased from an inherited gene alteration (a BRCA1 or BRCA2 alteration). You may be at a high risk of having a BRCA gene alteration if you have:

  • A close family member (parent, child or sibling) who has a known BRCA1 or BRCA2 gene alteration
  • One relative diagnosed with ovarian cancer at any age and at least two close relatives with breast cancer whose average age is under 60, or one close relative with breast cancer under the age of 50. All of these relatives should be on the same side of your family (either your mother’s OR father’s side)
  • 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 BRCA gene alteration, your GP can refer you for genetic testing. You can find out more about BRCA alterations and genetic testing here.

Ovulation and fertility
Every time an egg is released, 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 you’ve had multiple pregnancies or periods of breastfeeding, as eggs aren’t released during this time.

Endometriosis
This condition may increase your risk of a rare sub-type of peritoneal cancer (a rare form of ovarian cancer). In endometriosis, the cells that usually line the womb grow elsewhere in the body.

Other Risk Factors

There are a number of other risk factors which may increase your chance of developing ovarian cancer. These include being overweight, smoking, exposure to asbestos, radiation exposure, being diabetic and use of hormone replacement therapy (HRT).

How is ovarian cancer diagnosed?

In 2011, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the symptoms of ovarian cancer and refer people for the right tests faster.

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.

Blood test (CA125)
You may have a blood test to look for a protein called CA125. A very high level of CA125 may indicate that you have ovarian cancer.

CA125 isn’t specific to ovarian cancer and it can be raised in other conditions including endometriosis and pelvic inflammatory disease- so a raised CA125 level doesn’t necessarily mean you have cancer. Approximately half of women and people with early stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised you are likely to be referred for imaging; this is mostly likely to include 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 (called a transvaginal ultrasound), where the ultrasound probe is inserted into your vagina, and an external ultrasound, where the probe touches and is rolled over your abdomen.

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

Further tests
If you’ve been diagnosed with ovarian cancer, you will 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 CT scan- which will help your doctors decide on the best kind of treatment for you. However, it’s important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress
  • A biopsy – a small tissue sample. This may be undertaken either by CT or ultrasound guidance. This biopsy may also be sent off to test for alterations on the BRCA genes.
  • Your treatment will be planned at specialist meeting of cancer doctors: this is called a multi-disciplinary team (MDT) meeting

Ovarian cancer treatment

Most women and people with ovarian cancer will be treated by a combination of chemotherapy and surgery.

Treatment plans are discussed at a multi-disciplinary team meeting. The team includes gynaecologists, oncologists, radiologists, histopathologists and clinical nurse specialists. They will work out the best treatment option(s) based on distribution of disease, symptoms and well-being.

Sometimes, the cancer is treated with a type of surgery called primary debulking surgery before or after several cycles of chemotherapy; this is known as interval debulking surgery.

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

  • both ovaries and the Fallopian Tubes (a bilateral salpingo-oophorectomy)
  • the womb and cervix (a total hysterectomy)
  • and part of the vagina (the vaginal cuff)

The surgeon may also remove the omentum (a fatty layer of tissue that covers the intestines and lower abdominal organs). In some cases, part of the bowel may need to be removed, resulting in a stoma (colostomy). In some patients, this can be reversed at a later date.

Chemotherapy is usually given either before surgery (known as neo-adjuvant) for three or four cycles, or afterwards (adjuvant) for a further two or three cycles. For women and people who do not undergo surgery, six cycles of chemotherapy will usually be given. Your oncologist will explain what to expect from your treatment plan and answer any of your questions.

If you would like anymore information on ovarian cancer, or if you would like some advice about you or a loved one, you can contact our Ask Eve information service for free and confidential advice and information, on nurse@eveappeal.org.uk or 0808 802 0019.

We have tailored information on ovarian cancer for trans men, non-binary and intersex people with ovaries, which you can read here.