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. A number of rarer types of ovarian cancer make up the other 10 per cent. Some of these are derived from the egg-making cells of the ovary (germ cell cancers, including terato.)
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.
When the disease is caught early, survival rates are high, with over 90 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). But although there are often warning symptoms, these may be vague and wrongly attributed to other problems. Women need to be aware of the signs and symptoms of ovarian cancer. Meanwhile, researchers are trying to find ways to screen women for early signs of the disease.
Types of Ovarian Cancer
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
The symptoms of ovarian cancer 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 say that things weren’t quite right, particularly with gastrointestinal or urinary symptoms, for three to four months before they were diagnosed. But more obviously worrying symptoms such as bleeding from the vagina are rarely present.
Early Symptoms of Ovarian Cancer
- Bloating, or swelling in the abdomen
- 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
- Irregular periods
Advanced Symptoms of Ovarian Cancer
- Loss of appetite,
- 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 doctor.
It is also recommend that any woman of 50 or over who has had symptoms within the last 12 months which suggest a new diagnosis of Irritable Bowel Syndrome (IBS) should have tests for ovarian cancer as IBS rarely presents for the first time in women of this age, and may be confused with ovarian cancer.
Ovarian cancer Diagnosis
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 doctor may request some tests, including:
- Blood tests: these will include a test called CA125. This is a protein made by some (but not all) ovarian cancers and released into the blood. But other conditions such as fibroids and endometriosis can caused a raised CA125 so it is not a definitive diagnostic test for ovarian cancer but an indication that further tests may be needed.
- Ultrasound: this may be done across the abdomen, or as a transvaginal scan (using a device placed inside the vagina, which often produces a clearer picture of the ovaries)
If these tests are suggestive of ovarian cancer (your GP should calculate your “risk of malignancy index 1 or RMI 1 score” using the results of the tests) you should be referred to a specialist team in the hospital. They may carry out further tests such as:
- CT or MRI scan, to check the ovaries and surrounding tissues
- 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.
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 cancer, colon cancer, prostate cancer or endometrial cancer (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.
Ovarian Cancer Prevention
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 Treatment
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.
Ovarian Cancer Survival Rate
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.