Ovarian cancer
Updated: 03.08.2023
Approved by: General Practitioner, Alice Pan
Ovarian cancer is a condition that affects the two small organs called ovaries, which store the eggs needed for reproduction. While anyone with ovaries can develop ovarian cancer, it typically affects individuals over the age of 50. Additionally, there may be a familial predisposition to ovarian cancer in some cases. Unfortunately, the symptoms of ovarian cancer are not always obvious, making early diagnosis challenging. However, detecting ovarian cancer early significantly improves the chances of successful treatment. It is crucial to get any symptoms checked promptly.
Symptoms
The main symptoms of ovarian cancer include:
- swollen tummy or feeling bloated, occurring frequently (roughly 12 or more times a month)
- tummy pain or tenderness, including the area between the hips (pelvis)
- loss of appetite or feeling full quickly after eating
- urgent need to urinate or increased frequency of urination
Other symptoms may include:
- indigestion
- constipation or diarrhoea
- back pain
- persistent fatigue
- unexplained weight loss
- vaginal bleeding after menopause
If you experience any of these symptoms, it's important to see a GP. While these symptoms can be caused by various conditions, including benign ones, it's essential to rule out ovarian cancer. Early detection significantly improves the chances of successful treatment.
What to expect at your GP appointment
During your appointment, the GP will inquire about your health and symptoms. It is crucial to inform them if anyone in your family has had ovarian or breast cancer. The GP or practice nurse may also conduct a physical examination. The examination might involve:
- the use of a smooth, tube-shaped tool called a speculum to examine the vagina
- palpation of the abdomen and internal examination to check for lumps or tender areas
The examination should not be painful, but you may experience some discomfort. Feel free to communicate any discomfort to the GP or nurse. If you wish, you can have a friend, family member, or staff member present during the exam. Remember, you are in control, and you can ask the doctor to stop at any time.
Referral to a specialist
If the GP or practice nurse suspects a condition that requires further investigation, they may refer you for more tests or to see a specialist. In some cases, an urgent referral may be made, typically within two weeks, if specific symptoms are present. However, it's important to note that an urgent referral does not definitively mean you have cancer. Further tests will be conducted to determine the cause of your symptoms accurately.
Understanding the causes and risk factors
The risk of developing ovarian cancer increases with age, with more than half of all cases occurring in individuals aged 65 and over. Ovarian cancer can affect anyone with ovaries, including women, trans men, non-binary people, and intersex people. It is important to note that if you have had surgery to remove your ovaries, you cannot develop ovarian cancer.
Certain factors may increase the likelihood of developing ovarian cancer:
- inherited faulty genes, such as BRCA genes or those associated with Lynch syndrome
- history of breast or bowel cancer
- previous radiotherapy treatment for another type of cancer
- conditions like endometriosis or diabetes
- early onset of menstruation or late onset of menopause (over 55 years old), or never having given birth
- no use of hormonal contraception (e.g., the pill or an implant)
- hormone replacement therapy (HRT) use
- being overweight
- smoking
While these factors may increase the risk, they do not guarantee the development of ovarian cancer.
Lowering the risk of ovarian cancer
While ovarian cancer cannot always be prevented, there are measures you can take to reduce your chances of developing it. Here are some recommendations:
- quit smoking
- maintain a healthy weight or lose weight if overweight
- discuss with a GP the possibility of tests or treatment (such as hormonal contraception or ovary removal) if ovarian cancer runs in your family
Diagnostic tests
Diagnosing ovarian cancer usually involves a blood test and a scan, although further tests may be necessary. An ultrasound scan is commonly performed to identify any changes in the ovaries. This can be done through a transvaginal scan, using a scanning device inserted into the vagina, or an abdominal scan over the tummy area.
If the scan results appear normal but your symptoms persist for a month or more, it is advisable to revisit your GP. Sometimes, ovaries may be too small to show up on a scan, particularly after menopause. Additional tests that you may undergo include:
- CT scan
- removal of a small sample of cells or fluid from the ovaries (needle biopsy)
- examination of the ovaries using a camera on the end of a tube inserted through a small incision in the abdomen (laparoscopy)
- surgery to remove tissue or potentially the ovaries (laparotomy)
Receiving your test results
You should receive the results of your tests within a few weeks. If you are concerned, do not hesitate to contact the hospital or GP for an update. A specialist will explain the results to you and discuss the next steps. It may be helpful to bring a support person along with you to these appointments.
Treatment
The appropriate treatment for ovarian cancer depends on various factors, including the size and type of cancer, its location, the extent of spread, and your overall health. The primary treatments for ovarian cancer are surgery and chemotherapy, although targeted medicines and hormone therapies may also be utilized.
The specialist care team will provide a comprehensive explanation of the treatments, their benefits, and potential side effects. Together, you will create a treatment plan tailored to your specific needs. It's important to communicate any concerns or side effects to your specialists promptly. Regular check-ups, tests, and scans will be scheduled during and after treatment.
- Surgery: The type of operation you undergo depends on the stage of cancer and whether it has spread. Ovarian cancer is more treatable when detected early. In the early stages, surgery may involve the removal of both ovaries and fallopian tubes or the cervix and womb. If the cancer has spread, more extensive surgery may be necessary, including the removal of parts of the bowel.
- Chemotherapy: Chemotherapy involves the use of medications to kill cancer cells. It may be administered before and after surgery or as a standalone treatment. Chemotherapy can also be used to treat recurrent ovarian cancer.
- Radiotherapy: High-energy radiation is utilized in radiotherapy to destroy cancer cells. In some cases, radiotherapy may be recommended to manage symptoms or treat advanced ovarian cancer when other treatments are not suitable.
- Targeted therapies: Targeted therapies are medications that specifically target the factors promoting cancer cell growth and survival. They may be considered for advanced ovarian cancer that has recurred.
- Hormone therapy: Certain types of ovarian cancer depend on the hormone estrogen to grow. Hormone treatments can block the production of estrogen, effectively stopping the growth of these cancers. However, hormone therapy is rarely used, and your doctor will assess if it's appropriate for your specific case.
Ovarian cancer and fertility
Treatment for ovarian cancer, particularly in younger women, can have an impact on fertility and menstrual cycles, potentially affecting the ability to conceive. It is essential to discuss fertility preservation options with your healthcare team before initiating treatment.
Living with advanced ovarian cancer
If you have been diagnosed with advanced ovarian cancer that may not be curable, the focus of your treatment will shift towards managing symptoms and improving quality of life. You will be referred to a specialized team of doctors and nurses known as the palliative care or symptom control team. They will work closely with you to provide comprehensive support, manage symptoms, and ensure your comfort. The clinical nurse specialist or palliative care team can also help you and your loved ones access additional support as needed.
