Ovarian Cancer

Cancer of the ovaries affects more than seven thousand women in the UK annually [1] and sadly eleven women die from the disease every day. If we catch it in the early stages, we can often cure the condition.  But, unfortunately, awareness of ovarian cancer is low and too often early signs are missed by both women and their GPs. In two-thirds of women with ovarian cancer, the disease has already spread at the time of diagnosis.

The statistics sound frightening, but by being aware of the symptoms of ovarian cancer you can seek help at an early stage. This, together with expert support and surgery can help improve your chances of fighting the disease.

Mr Thomas Ind is an accredited gynaecological surgeon with extensive experience in women’s cancer care. He works with a team of health professionals who will provide information to prepare you for surgery, assist your recovery and support you throughout your ovarian cancer journey.


What are the ovaries?

The ovaries have a vital role in reproduction. They are the organs that are responsible for producing and storing eggs and releasing the hormones that control your monthly menstrual cycle.

You have two ovaries located on either side of the womb, in the pelvis.

When cancer develops in the ovaries, abnormal cells multiply causing a tumour to grow. The most common type of cancer is called ‘epithelial’ cancer and is an overgrowth of abnormal cells from the ovary lining, this makes up 85 to 95% of tumours. Other types can develop including an overgrowth of abnormal cells from the tissues that produce hormones or eggs. You can find out more about cancer types at Target Ovarian Cancer.


Who is at risk of ovarian cancer?

Ovarian cancer occurs in about 1 in 80 women and every woman is potentially vulnerable. Your risk of developing cancer can be affected by your age, your genetics and the way you live your life.

Faulty genes are believed to cause most ovarian cancers. Usually these develop during your lifetime, however in between 5 and 15% of cases they can be passed down through the family. Inherited genes include BRCA1 and BRCA2, which can also increase the risk of breast cancer.

Because of this potential link between breast and ovarian cancer, women with breast cancer have as much as double the risk of developing ovarian cancer, with the chance increasing further for women under 40.

Other factors that may increase risk include smoking, endometriosis, the use of hormone replacement therapy and the practise of using talcum powder in the vulval area.


Does age affect the chance of developing ovarian cancer?

The risk of developing ovarian cancer increases as you grow older, the same as with most types of cancer. Ovarian cancer is thankfully rare before the age of 40, and over half of all women diagnosed with disease are over 65 years-old.

However, ovarian cancer can occur in younger women and can kill them. So, it’s vital to get expert medical assessment and advice if you’re concerned. It’s particularly important to seek help if a tendency to develop the cancer runs in the family. Consider further consultation if two or more relatives, under fifty years of age, from one side of your family have had ovarian cancer. It is also worth checking, if more than one close female relative has had ovarian or breast cancer.


What are the symptoms of ovarian cancer?

There’s a reason that ovarian cancer if often called the silent killer, the symptoms can be frustratingly vague and non-specific. This is especially true in the early stages of the disease. Sometimes it can be found coincidentally on an ultrasound scan. However, there are some symptoms that should be investigated:

  • Persistent abdominal pain.
  • Bloating and discomfort that doesn’t go away.
  • Feeling full more quickly when eating.
  • Changes to your normal bowel habit.
  • Needing to pass water more frequently.
  • Abdominal swelling, a lump or a feeling of fullness in the lower abdomen.
  • Feeling tired, weak and unwell.

All of these symptoms can also be caused by other, much less serious conditions, like cysts or irritable bowel syndrome. However, it’s important not to dismiss them. Picking the cancer up at an early stage could make a real difference to your chances of curing the disease [2].


What causes ovarian cancer?

We don’t fully understand what causes many ovarian cancers. It is thought that faulty genes are linked to many cases, however only a small proportion of these are passed directly down through families. Studies suggest that somewhere between 5-15% of cases are due to inherited genes like BRCA1 and BRCA2.

A woman with one of these BRCA genes may have up to a 40% lifetime risk of developing ovarian cancer. If you have two first degree relatives (that’s a mother, sister or daughter) with ovarian cancer you have a 15% risk of developing cervical cancer during your life. In contrast, if only one first degree relative has the disease, you risk is only upped by 1%.

Other factors have been associated with ovarian cancer, including endometriosis and the use of talcum powder. However, the link between these factors and the development of cancer has not been definitively proven and needs further investigation. Research suggests that prolonged use of hormone replacement therapy probably does increase a woman’s risk of developing ovarian cancer, although this increase is very small.

Studies show that ovarian cancer is most common in women whose periods start early, end late, and who have fewer children. This has led some scientists to believe that the number of times a woman produces an egg is related to the development of the disease.


Prevention of ovarian cancer

By moderating your lifestyle and being aware of any cancer risk that runs in your family, you may be able to protect yourself from ovarian cancer or identify the disease early, so that it can be successfully treated:

The pill: Women who take the combined oral contraceptive pill for more than five years reduce their risk of ovarian cancer by half.

Pregnancy: Having children can reduce the risk of ovarian cancer and the more full-term pregnancies you have, the greater the protection.

Breastfeeding. The longer you breastfeed your babies, the lower the risk of developing ovarian cancer.

Genetic testing and screening: Anyone who is concerned about a family history of ovarian cancer or breast cancer should speak to their doctor. They can assess your risk and may refer you on to a genetics expert for counselling.  Screening for ovarian cancer is in the early stages. An ultrasound scan and a blood test called to check for a tumour marker called CA125 may identify cancers in those who are vulnerable.  The value of the screening on a larger scale, or the introduction of a national programme is controversial and scientific studies are still underway to examine its potential [3][4].

Preventative surgery: Women who have a BRCA gene or a strong family history of ovarian cancer may choose to have their ovaries removed at forty, or after completion of their family. The operation results in an early menopause and does not completely eliminate the risk of ovarian cancer, as some cells are inevitably left behind. However, it does prevent 95% of all cancers. Alternatively, a hysterectomy or ligation of the fallopian tubes can also reduce ovarian cancer risk.


Treatment of ovarian cancer

The best treatment for your ovarian cancer will depend on the size of the tumour, the type of cancer you have and whether the disease has spread beyond the ovaries.  Mr Ind will talk you through the options and recommend a treatment plan, taking into account your opinions and your general health.

The mainstays of treatment for ovarian cancer are surgery and chemotherapy, these are usually combined to maximise the chance of success. The surgery required depends on the extent of the disease. You will usually have scans to assess this prior to your operation, so that you know what to expect.

Hysterectomy and clearance surgery: Surgery for ovarian cancer usually involves removal of both ovaries, the fallopian tubes, the womb, the associated lymph nodes and a piece of fatty tissue attached to the bowel called the omentum. Sometimes it is necessary to remove a piece of bowel too. This means you will need a stoma and a bag to drain your bowel contents. Investigations before the operation will give some idea as to how likely this is, so that you can be prepared and counselled about the implications for your recovery and your life after surgery [5].

Oophrectomy: For women with very early disease, it is sometimes possible to remove just the ovary to preserve fertility. During the surgery it is important that the surgeon thoroughly examines the abdomen and pelvis, so that any other areas of disease are not missed.

Chemotherapy: Depending on the type of tumour and the severity of your cancer, different combinations of chemotherapeutic drugs will be given to kill any remaining cancer cells, prevent spread and reduce the risk of the disease recurring.

Chemotherapy usually follows surgery and consists of cycles of treatment, followed by periods of rest and recovery. Therapeutic regimes vary but a typical course will involve a treatment every 2-4 weeks for six cycles. The drugs are given intravenously or by mouth and they will usually be administered in a specialist unit on an outpatient basis.

Different types of chemotherapy exist but the most common type does result in hair loss, there can also be serious side effects in the long and short-term. Find out more at Macmillan.org.uk.


Recovery from ovarian cancer

If ovarian cancer presents early it is often treatable, with an excellent cure rate of over 90% for this stage of tumour. However, frustratingly most cancers present at a much later stage, which is more challenging to treat.

For advanced ovarian cancer, the average survival is about three-and-a-half years for women who have treatment and less than a year for women who don’t have any therapy.

Your age, your overall wellbeing and your physical fitness can also affect recovery, with younger, healthy women often having better outcomes [6].


Recurrence

Finding out that your cancer has come back can be overwhelming and it can be difficult to know how to cope or where to turn.  You are not alone. There will be a team of experts on hand to support you and your family at this difficult time.

Unfortunately, ovarian cancer that recurs after treatment has a poor prognosis and usually it proves to be fatal. However, your healthcare team will manage your symptoms, decide on any further treatments that can improve your chances of survival and work hard to maintain your quality of life.

Mr Ind and his team will work with you to decide on the best treatment strategy. Sometimes more chemotherapy can help and very occasionally when the recurrence has occurred in an isolated location, it can be removed by surgery. If recurrent ovarian cancer blocks the bowel, it may be necessary to bypass the blockage surgically to provide symptomatic relief.


[1] http://www.cancerresearchuk.org/about-cancer/ovarian-cancer/about

[2] http://ovarian.org.uk/ovarian-cancer/what-are-the-symptoms/

[3] http://www.cancerresearchuk.org/about-cancer/ovarian-cancer/getting-diagnosed/screening

[4] http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-looking-at-screening-the-general-population-for-ovarian-cancer#undefined

[5] http://ovarian.org.uk/ovarian-cancer/ive-been-diagnosed-ovarian-cancer/

[6] http://www.cancerresearchuk.org/about-cancer/ovarian-cancer/survival