Ovarian Cancer

Many women don’t have any symptoms or only vague symptoms in the early stages of ovarian cancer. Many of these symptoms can occur in other conditions as well and are not necessarily a sign of cancer. If you do have symptoms, they may include:

• Stomach pain or pain in your pelvis
• A persistent bloated feeling

Other possible symptoms include:

• Unexplained weight loss
• Swelling of your abdomen
• Changes in bowel or bladder habits – constipation, excess wind, diarrhoea or needing to pass urine more often
• Back pain
• Extreme tiredness
• Rarely, abnormal vaginal bleeding

These symptoms aren't always caused by ovarian cancer but if you have them, or you’re in any doubt, see your GP. The earlier you are diagnosed, the better your chance of survival.

The exact reasons why you may develop ovarian cancer aren't fully understood at present. However, there are some things that can make it more likely. It's more common in women who live in developed countries for example, and in those who have gone through the menopause. It’s also known that inheriting faulty genes called BRCA1 and BRCA2 increase the risk of ovarian cancer as well as breast cancer.

Other factors that may increase your risk of getting ovarian cancer include:

• certain types of hormone replacement therapy (HRT) – especially if you take them for longer than five years
• being overweight or obese
• having endometriosis or ovarian cysts
• smoking
• starting the menopause late

A possible link to using talcum powder has been suggested but this needs to be confirmed by more research (see our common questions for more information).

Ovarian cancer is generally less common in women who have:

• used the contraceptive pill
• had children – the more children, the lower the risk
• breastfed their children
• had a hysterectomy or been sterilised

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history and whether anyone else in your family has had breast or ovarian cancer.

Your GP will ask you to have a blood test to check the levels of certain proteins, such as CA125, that can be high if you have ovarian cancer. He or she may also examine you internally to check your womb and ovaries.

Your GP may refer you to a specialist for further tests, such as an ultrasound scan or a CT scan to view the inside of your abdomen and pelvis.

If the results of your tests show you have cancer, you may need to have more tests to assess if the cancer has spread. The process of finding out the stage of a cancer is called staging.

Further tests may include a gynaecological laparoscopy – this is a procedure used to examine your fallopian tubes, ovaries and womb. You may also have a small sample of tissue taken (a biopsy), which will be sent to a laboratory for testing.

If you have a build-up of fluid in your stomach, it can be drawn out through a needle and examined to see whether cancer cells are present. This is known as abdominal fluid aspiration or paracentesis.

Almost all women with ovarian cancer will need surgery. If the cancer hasn't spread beyond your ovary, it may be possible to remove just the single affected ovary and fallopian tube.

If the cancer has already spread beyond your ovary, both ovaries and your womb, together with nearby lymph nodes and surrounding tissue, may need to be removed. This is called a total hysterectomy and oophrectomy.

Other types of surgery for more advanced ovarian cancer are used to remove, or 'debulk' as much of the tumour as possible.

• Chemotherapy Chemotherapy uses medicines to destroy cancer cells. The type of chemotherapy treatment you have will vary depending on your type of ovarian cancer. Usually you have a course of treatment, which is given as several doses at intervals over a period of weeks. Your doctor will give you information on the type and course that is best for you. You will probably be offered chemotherapy after surgery to destroy any remaining cancer cells that were not removed by surgery or if there is a risk the cancer may return. However, you may have it before surgery to shrink the tumour. If ovarian cancer comes back (a relapse), you may be treated with the same chemotherapy medicine or an alternative, depending on the timing of your relapse and whether the cancer has developed resistance to previous chemotherapy medicines.

• Radiotherapy Radiotherapy uses radiation to destroy cancer cells. It's not often used to treat ovarian cancer but is very occasionally used after surgery to destroy any remaining cancer cells. Your doctor may give you information on clinical trials that are testing new treatments for ovarian cancer. You may wish to take part in a trial as it may involve a new treatment and benefit other patients in the future.

• Prevention of ovarian cancer You may be able to reduce your risk of developing ovarian cancer by making changes to your lifestyle, such as stopping smoking and eating a healthy, balanced diet. Getting enough vitamin D may reduce your risk of developing a number of cancers, including ovarian cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during the winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough. Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Question: I've heard that using talcum powder causes ovarian cancer, is this true?

Answer: It’s possible that talcum powder may increase your risk of getting ovarian cancer but at present the research is inconclusive. More research is needed to prove if talc can cause ovarian cancer.

Explanation: There is a theory that talc may be able to travel up your vagina through your cervix to your womb, fallopian tubes and ovaries. This could potentially cause your ovaries to become irritated and inflamed, which may lead to cancerous changes in the cells.

Some studies found that women who used talcum powder on their genitals were at a slightly higher risk of getting ovarian cancer than those who didn't. However, the studies and the results were not felt to be reliable and the slight increase was most likely a chance result.

Other research found an increased risk of ovarian cancer in women who regularly use talc – and the risk increased with heavier use of talc.

However, further research is needed to get a decisive answer.

Question: Why are women who take the contraceptive pill or have children less likely to develop ovarian cancer?

Answer: Doctors believe that ovarian cancer is related to the number of times you ovulate (release one or more eggs from one of your ovaries) in your life. So the fewer ovulation cycles you have, the lower your risk of ovarian cancer. You ovulate during each menstrual cycle, several days before your period.

Explanation: Research has shown that taking the contraceptive pill at some point in your life reduces your chances of getting ovarian cancer. The longer you take it for, the lower your risk becomes. Once you stop taking the contraceptive pill, it carries on protecting you from ovarian cancer for at least 20 years.

If you have children, you're less likely to develop ovarian cancer, and the more children you have the lower your risk. Some research suggests that this is also related to the birth of your last child, for example if you have your last child after the age of 35, you're more protected than if you have your last child before the age of 25. Miscarriages and abortions can also reduce your risk of ovarian cancer.

Question: Are there any ovarian cancer screening programmes I can attend?

Answer: No, there isn't a national ovarian cancer screening programme because tests to spot early ovarian cancer cells aren't effective enough yet.

If you have two relatives from the same side of your family who were diagnosed with ovarian cancer or breast cancer under the age of 50, you may be considered high-risk. Your GP can refer you to a local genetics service where your risk will be assessed and you will be given information and advice.

Question: How can ovarian cancer come back after I have had surgery?

Answer: The aim of surgery is to remove as much of the cancer as possible. It may be possible to remove all of the cancer but sometimes some of the cancer may be left behind.

Explanation: It’s still possible for ovarian cancer to come back even if you have had an operation to remove your ovary. Ovarian cancer may have spread beyond your ovary by the time it’s diagnosed so even if you had it removed, some cancer cells may already have spread into other parts of your body.

The aim of surgery is to remove as much cancer as possible. However, residual ‘seedlings’ of cancer cells can often be unavoidably left behind after surgery. The amount of cancer left after surgery varies between women. It may be only a few cells but can be larger amounts.

You may have been given chemotherapy after your operation as this can help to destroy any remaining cancer cells. Chemotherapy is often able to kill off the majority of cancer cells and the cancer is then in ‘remission’. If all the detectable cancer disappears, it’s called ‘complete remission’. If most of the cancer disappears but a small amount remains, it’s known as ‘partial remission’. Sometimes the cancer cells resist the effects of chemotherapy drugs, and the disease doesn’t improve. Your doctor will then discuss alternative treatments with you.

It’s important to attend hospital appointments after your operation and have regular tests to see if any of the cancer remains. You may be able to have further treatment.

If you have any questions about your surgery and what results you can expect from it, ask your surgeon or doctor for advice.

• Further Information
  • Target Ovarian Cancer 020 7923 5470 www.targetovariancancer.org.uk
  • Macmillan Cancer Support 0808 800 0000 www.macmillan.org.uk
  • Cancer Research UK 0808 800 4040 www.cancerresearchuk.org
  • Ovacome 0845 371 0554 www.ovacome.org.uk
  • UK Collaborative Trial of Ovarian Cancer Screening www.ukstocs.org.uk

• Source
• Ovarian cancer risks and causes. Cancer Research UK.www.cancerhelp.org.uk, published 18 March 2011
• Cancer. National Statistics.www.statistics.gov.uk, published 15 December 2010
• Ovarian cancer: the recognition and initial management of ovarian cancer. National Institute for Health and Clinical Excellence (NICE), April 2011.www.nice.org.uk
• Types of ovarian cancer. Cancer Research UK.www.cancerhelp.org.uk, published 1 November 2010
• Abdul Razak AR, Li L, Bryant A, et al. Chemotherapy for malignant germ cell ovarian cancer in adult patients with early stage, advanced and recurrent disease. Cochrane Database of Systematic Reviews 2011, Issue 3. doi: 10.1002/14651858.CD007584.pub2
• Key messages for ovarian cancer for health professionals. Department of Health, February 2009.www.dh.gov.uk
• Ovarian cancer. eMedicine. www.emedicine.medscape.com, published 29 March 2011 Schorgea JO, Modesittb SC, Coleman RL, et al. SGO White Paper on ovarian cancer: etiology, screening and surveillance. Gynecol Oncol 2010; 119(1):7–17. doi:10.1016/j.ygyno.2010.06.003
• Ovarian cancer tests. Cancer Research UK.www.cancerhelp.org.uk, published 1 November 2010
• Referral guidelines for suspected cancer in adults and children. National Institute for Health and Clinical Excellence (NICE), 2005.www.nice.org.uk
• Types of treatment for ovarian cancer. Cancer Research UK.www.cancerhelp.org.uk,published 3 November 2010
• Standard treatments. Target Ovarian Cancer.www.targetovariancancer.org.uk, accessed 20 April 2011
• Tangjitgamol S, Manusirivithaya S, Laopaiboon M, et al. Interval debulking surgery for advanced epithelial ovarian cancer. Cochrane Database of Systematic Reviews 2010, Issue 10. doi:10.1002/14651858.CD006014.pub5
• Chemotherapy. Ovacome.www.ovacome.org.uk, published 2009
• Yina L, Grandia N, Raum E, et al. Meta-analysis: circulating vitamin D and ovarian cancer risk. Gynecol Oncol 2011. doi:10.1016/j.ygyno.2011.01.023
• Consensus vitamin D position statement. British Association of Dermatologists, Cancer Research UK, Diabetes UK, the Multiple Sclerosis Society, the National Heart Forum, the National Osteoporosis Society and the Primary Care Dermatology Society, published December 2010
• Fact sheet 15: Is there a link between ovarian cancer and using talcum powder? Ovacome, July 2009.www.ovacome.org.uk
• Ovarian cancer screening. Cancer Research UK.www.cancerhelp.org.uk, published 1 November 2010
• Protocol for the United Kingdom collaborative trial of ovarian cancer screening (UKCTOCS). UCL Institute for Women's Health, September 2008.www.instituteforwomenshealth.ucl.ac.uk
• Menon U, Gentry-Maharaj A, Hallett R, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet 2009; 10(4):327–40. doi:10.1016/S1470-2045(09)70026-9
• Surgery. Ovacome.www.ovacome.org.uk, published 2009