Ovarian cancer

What is ovarian cancer?

Ovarian cancer can occur at any age, but is most common after the menopause. Diagnosis at an early stage greatly improves your chances of recovery.

Nearly 5,500 women are diagnosed with cancer of the ovary every year in the UK. As doctors have realised there are often warning symptoms, although these may be vague and wrongly attributed to other problems, methods of screening women for early signs of the disease are being evaluated. When the disease is caught early, survival rates are much higher, with over 95 per cent of women diagnosed in stage one disease being alive five years later, although the particular type and severity of the cancer are also important factors.

There are several different types of ovarian cancer, but by far the most common - accounting for 90 per cent of cases - is epithelial ovarian cancer, or cancer of the surface layers of the ovary.

Symptoms of ovarian cancer

For women with ovarian cancer in its early stages, symptoms are usually vague, especially in the early stages. It was previously said many women had no symptoms and that the disease went overlooked until it was discovered by chance. In fact, when questioned carefully, many women admitted things weren't quite right, particularly with gastrointestinal or urinary symptoms, for three to four months before they were diagnosed.

These early symptoms may include:

• Bloating, pelvic or abdominal pain (especially in the lower abdomen or side)
• Difficulty eating or early satiety (feeling full very quickly)
• Urinary urgency or frequency
• Loss of appetite or weight loss
• Swelling or pain in the abdomen
• Pain during sex
• Constipation
• Irregular periods

In the advanced stages of disease, there may be loss of appetite, nausea, weight loss, tiredness and shortness of breath. It is infrequent that an obvious symptom such as bleeding from the vagina is present.

Women who develop any of these symptoms, especially if they persist, should get them checked by their GP.

Diagnosing ovarian cancer

A doctor examining for the signs of ovarian cancer will carry out a full pelvic examination, feeling for the presence of an abnormal lump. However, it's only as a tumour grows and spreads that the symptoms become clearer and the problem easier to diagnose.

Your GP may request some tests, including:

• Blood tests
• Ultrasound
• Laparoscopy - keyhole surgery to look at the ovaries, fallopian tubes and uterus. A biopsy, which means a small piece of tissue is taken from the ovary, will also be done
• Chest x-ray to check for spread of the cancer into the lungs
• CT or MRI scan, also to look for any possible spread

If any problems are suspected with the digestive system, an endoscopy will be arranged, to look at the stomach, or a colonoscopy, to look at the lower bowel. If there is a lot of fluid within the abdomen due to ovarian cancer, the consultant will do an abdominal tap, which allows some of the fluid to be drawn off under a local anaesthetic and then the fluid examined under a microscope for cancer cells, or drained off to make the patient more comfortable.

Screening is currently only offered to those at high risk, for example because of a family history, although positive preliminary results of a large UK ovarian cancer screening programme trial were published in March 2009.

Ovarian cancer causes

Scientists don't yet know what causes ovarian cancer, but some factors are known to increase the risk.

The most important is family history, because the faulty genes that increase the risk of ovarian and other types of cancer can be inherited. In particular you may be at increased risk and offered screening if you have close relatives (sibling, parent or daughter) who've had one of the following types of cancer - breast, colon, prostate or endometrial (lining of the womb).

Women who have never had a child also run an increased risk of ovarian cancer and the risk increases for women over 50. In addition, women who have previously suffered from breast cancer are twice as likely to get ovarian cancer in the future.

The risk may also be related to how many eggs the ovary releases. Each time an egg is released (ovulation) the surface of the ovary breaks open and the cells on the surface divide to repair the damage, increasing the chances of a tumour developing.

Having children and breastfeeding may reduce the risk, as may taking the contraceptive pill (as it prevents ovulation). Other possible risk factors include fertility treatment, a high-fat diet and being obese.

Ovarian cancer treatments

Surgery is almost always the first treatment a woman with ovarian cancer undergoes. This normally involves removal of the ovaries, the womb and the fallopian tubes, which link the two. Usually both ovaries are removed, unless the patient has only a slow-growing cancer in one and wants her fertility to be preserved. The surgeon cannot always be sure that all the cancerous cells have been removed, so chemotherapy is almost always given as well, to kill any which remain in the body.

However, treatment will depend on your general health, the type of cancer, how far it has spread and the severity or grade of the cancer.

Many cases will continue to respond to multiple courses of chemotherapy. Chemotherapy can be given after surgery, or beforehand in selected cases. Radiotherapy is used occasionally to kill cancer cells in the pelvic area. Ongoing trials are studying hormone treatments and biological therapies.

Many factors increase or reduce the woman's chance of beating ovarian cancer. The main one is the spread of the disease - if caught early, as with many cancers, it's much more treatable, particularly if only one part of one ovary is involved. If the cancer involves a whole ovary, both ovaries, or has spread to involve other tissues, the chances of a cure are reduced.

Also important is the type of ovarian cancer - some affect the cells which line the womb, whereas some affect the cells which produce eggs. Both have different cure rates.

Overall the quality of life of ovarian cancer patients has improved considerably over the last ten years.

You may want to have a look at Macmillan's OPERA tool. This online risk assessment program has been designed to give information about your hereditary risk based on the your personal and family history of breast and ovarian cancer.