Cancer is a genetic mutation of the way cells grow in the body. Changes in the DNA cause cells to over produce in an uncontrolled way creating a cell mass, commonly known as a tumour. If left untreated the cells continue to grow and the cancer can spread to other organs and systems in the body.

Ovarian cancer is the second most common kind of gynaecological cancer with nearly 7,000 women diagnosed in the UK each year.

Women have two ovaries located in the pelvis, with one ovary on each side of the uterus. The ovaries produce an egg each month, which is released and travels down the fallopian tubes to the uterus to be fertilised. The disease itself begins in the ovaries and can spread into other parts of the reproductive system including the womb and vagina.

There are several types of ovarian cancer including epithelial which is the most common form, affecting the surface layers of the ovary. Germ cell ovarian cancer originates in the cells that make the eggs and mainly affects teenagers and young women; 90 percent of these cases can be cured. Stromal ovarian cancer develops within the connective tissue cells that hold the ovaries together and produce the hormones oestrogen and progesterone.

Ovarian cancer has the lowest survival rates of all gynae cancers. However, survival rates are improving. The rate has increased to around 40 percent of women surviving for at least 5 years.

Awareness of the symptoms of this disease is very important, the earlier it is detected the higher the survival rate. If the cancer is detected in an early stage, the survival rate can be over 90 percent (Cancer Research UK figures).

Symptoms

Ovarian cancer is often referred to as the ‘silent killer’ because symptoms of the disease can be very difficult to recognise as they are similar to a number of other conditions. For this reason, most cases are not diagnosed until the cancer has already spread, by which time treatment becomes much less effective. 

However, new research has revealed that most women do experience some early symptoms and being able to recognise these and seek help quickly could mean the difference between life and death.

You may only experience one of the following symptoms and they can often seem vague, but if any of them are persistent or frequent, don’t be afraid to ask your GP to check for ovarian cancer.
 

• Pain in your abdomen or pelvic area
• Swollen abdomen
• Digestive problems, such as bloating, indigestion or nausea
• Constipation or other changes in bowel movements
• Urinary problems, such as incontinence or going to the toilet more often
• Abnormal vaginal bleeding
• Lack of appetite
• Weight gain or loss
• Backache
• Tiredness

The symptoms are often similar to common problems such as Irritable Bowel Syndrome (IBS) or urinary tract infections which can make diagnosis difficult. It can also be helpful to keep a diary of the frequency and impact of symptoms.

If you are receiving treatment for any persistent condition which is not clearing up, you should go back to your doctor.

Causes and risk factors.

The exact cause of ovarian cancer is unknown however there are a number of high risk factors which have been identified.

Age- ovarian cancer is more common in post-menopausal women over the age of 50, although there are a number of rare types such as germ cell ovarian cancer that can affect girls and younger women.

Family history- accounts for up to 10 percent of ovarian cancer cases, if there is a history of breast, ovarian and/or colon cancer. If two close female relatives (mother, sister or aunt) have experienced breast cancer or ovarian cancer, through either the mother or father’s side, testing for ovarian cancer should be considered.

Reproductive history- there seems to be some protection from ovarian cancer in women who have had children.

HRT- recent evidence suggests that there may be a small increase in the number of cases of ovarian cancer in women using HRT. This remains unsubstantiated.

Infertility treatment- women who have had fertility treatment may run a slightly higher risk of developing ovarian cancer, but there is conflicting evidence.

The Pill- the contraceptive pill appears to offer some protection from ovarian cancer.

Smoking and diet- women who smoke and those with unhealthy diets seem to be more at risk.

Diagnosis

If ovarian cancer is diagnosed before it has spread beyond the ovaries (at an early stage) then survival rates are high. Unfortunately, there are no screening tests for ovarian cancer and so only a very small proportion of cases are diagnosed at these vital early stages.

When visiting the GP to discuss symptoms they will feel the abdomen and may carry out an internal examination to check for any abnormalities or swellings of the womb and ovaries. He or she may also take a blood sample which can be tested for CA125 and will probably refer to a gynaecologist if there are any concerns.

CA125 is a chemical that is produced by ovarian cancer cells and is raised in women with ovarian cancer. Unfortunately, CA125 levels are not hugely elevated in women with early ovarian cancer, so the diagnosis is not as reliable for early screening. Other conditions of the womb such as endometriosis, fibroids and pregnancy can all produce this chemical.

A gynaecologist may carry out another internal examination and organise an ultrasound to help with diagnosis. The ultrasound may be internal (transvaginal ultrasound) where a probe is inserted inside the vagina or external when it is exactly the same as that used during pregnancy.

The ultrasound is designed to see if the ovaries look to be the correct size and texture and will highlight any cysts. An ovarian cyst may be cancerous and often shows up as a solid area on an ultrasound.

If it is unclear whether a lump or cyst is showing up as abnormal, a CT scan or MRI scan which will offer a more detailed view may be advised. This can assess whether the cancer has spread anywhere else in the body.

A laparoscopy may also be advised, this is a small and simple procedure whereby a thin fibre optic tube with a camera on the end, is inserted into the abdomen under general anaesthetic. This allows the doctor to further assess the ovaries and if necessary take a biopsy (tissue sample) to be examined in a lab.

Treatment

Surgery- is the initial treatment for many women with ovarian cancer. Recently a large study showed that in advanced ovarian cancer you can start with chemotherapy and defer surgery until midway between chemotherapy. This gives the same results as having surgery first. Surgery may include removal of both ovaries, the fallopian tubes, the uterus and other parts of the abdomen, depending on whether the cancer has spread.

Chemotherapy- a drug given, over a specific course of time, it is designed to destroy cancerous cells. This is often used to treat ovarian cancer and may be given before or in most cases it is given after surgery. Doctors may recommend a combination of chemotherapy drugs.

Lymphadenectomy- the removal of all or part of the lymph nodes (these are part of the infection fighting and fluid drainage system in the body). This is only done in appropriate situations.

Radiotherapy- destroys cancer cells using controlled doses of radiation. This is another treatment option but is rarely used in ovarian cancer. However, doctors sometimes use it to help with symptoms when the cancer is advanced.

Prevention

Unlike cervical cancer there is no routine screening method. However, women who are high risk because of strong family history can be offered a screening test which includes a blood test and an ultrasound. These tests are still in the process of development and as such are not yet fully reliable. See our expert interview for more information.

The Pill- the contraceptive pill appears to offer some protection from ovarian cancer.

Methods of contraception all have benefits and risks. A discussion with your GP will help decide what is suitable for you.

Reproductive history- there seems to be some protection from ovarian cancer in women who have had children.

As with all cancer a healthy lifestyle and a balanced diet may help to lower the risk.

Balanced diet- a lower fat, high-fibre diet, which includes wholegrains and at least five portions a day of fresh fruit and veg.

Exercise- regular exercise.

Please consult your GP before starting exercise if this is not a regular activity or you have not exercised for some time.

Caroline's story-

"I had Ovarian Cancer 8 years ago and I was 17 when I had my operation, and although I know it's rare to contract it at that age, I would like to tell you my story so that younger women are more aware of the matter.

It's hard to place when the actual symptoms started and which ones were related, but almost two years before being diagnosed, I had the funny, vague complaints. I lost a lot of weight, nearly a stone in a week and another stone subsequently over a short period. Speaking of periods, they stopped suddenly and completely. By the time I had my treatment, I hadn't had a period for almost two years. I also experienced nausea, dizziness and turned a funny yellow colour.

If you would like to tell us your story so we can help and inform other women; more information is available HERE

This Interview was recorded in March 2009

Ovarian Cancer: Text Version

Welcome to this month’s Wellbeing of Women health podcast. Today we will be discussing Ovarian cancer and the little known symptoms that accompany the disease.


Ovarian cancer is often referred to as the ’silent killer’ as it is difficult to detect and treat. You may be surprised to learn that it is the most common form of gynaecological cancer.


7,000 women are diagnosed in the UK each year - around three times the number of cases of cervical cancer and only 30% of those women will survive for more than 5 years after.


Consultant gynaecological oncologist Sean Kehoe joins us today to discuss the disease and it’s little known symptoms.


Hello Sean

Hello


Thanks for joining me today.

You’re very welcome


Those are quite scary statistics really when you think how much press coverage cervical cancer receives and yet women seem to know very little about ovarian cancer, why is that?

I think there is a variety of factors as to why one cancer seems to get more publicity over another which can relate to individuals who are suffering from he disease. If we take the comparison between cervical and ovarian cancer, cervical cancer does impact on quite a lot of younger women and I suppose to that extent we may hear as I call it some more noise about that disease whereas ovarian cancer while it does affect some young women is primarily a disease of the older population and I think that in part explains why you get this discrepancy between the public being aware of one disease over another.

Secondly in comparing both of these, cervical cancer has a screening programme which again if you like has been advertised widely and women are well aware of so that heightens the profile of knowledge of the disease, of cervical cancer compared to ovarian cancer.


Why is ovarian cancer often referred to as the ‘silent killer’?

The reason for that is that in many cases, patients will come with the disease, quite often advanced disease and yet give a story that the health problems they encountered had only occurred a few weeks or maybe a few months prior to being diagnosed with ovarian cancer so to that extent it was felt there was very little lead time into the diagnosis based on clinical symptoms and the term the ‘silent killer’ was proposed for this disease ie. the disease will have spread without the patient knowing until the last minute.


Are there actual symptoms to look out for in that case?

There are symptoms alright, the main ones that women complain of are bloating of the abdomen or swelling of the abdomen, these are very common symptoms in ovarian cancer, part of the difficulty regarding symptoms of ovarian cancer is that many of the symptoms are ones women can suffer from anyway without having cancer so a lot of research is presently ongoing trying to define the optimum or most relevant symptoms that would help the patient and indeed their doctor come to a possible diagnosis of early ovarian cancer and further work on this is awaited.


So you said it’s older people generally who suffer from ovarian cancer, what’s the age group that’s most likely to develop it?

Well, the vast majority of patients with ovarian cancer are post-menopausal so they are over 50 and the highest instance of the disease will be between women aged 50 – 74 and they’ll be the most likely ones to develop it. Another group of women who have an increased risk of it are those with a genetic predisposition to ovarian cancer which links with their predisposition to breast cancer as well but they only account for between 5 and 10% of all cases. Most women who do get ovarian cancer have a sporadic disease, as it’s called.


Do we know what actually causes it in that case in the 90%?

In the 90% that’s where the difficulty lies, we do know some factors that protect against ovarian cancer but the actual cause of the disease itself does remain unknown. There are a lot of associations but a true cause factor still eludes us.


Are there any screening programmes available specifically for ovarian cancer?

At the moment there are screening trials ongoing and these will hopefully give us some answers probably in 2012 or 2013. The two trials, the first one is a very, very large trial looking at the general population and that’s recruited over 200,000 women looking at the screening with ultrasound or screening with a blood test called CA-125 blood test and when we have the results of that we’ll know which is the best way of screening for ovarian cancer. The second trial relates to using the same kind of systems ie. scanning or CA-125 in women where there is a strong family history of the disease and again we still have to wait a few years for these trials to report until then, we don’t have any proven screening programme as such for ovarian cancer.


And so when women go for their smear tests, I know a lot of women seem to think that ovarian cancer will show up though that, that’s not the case?

No, that’s not the case, smear tests themselves are aimed to pick up some pre-cancerous changes on the neck of the womb that you can then treat and prevent cervical cancer from occurring. You will occasionally get women with ovarian cancer that are found to have an abnormal smear but that’s just coincidental rather than anything else.



Right, and why are women who take the contraceptive pill or have already had children less likely to develop the disease?

There’s been a theory about for decades now that the amount of time a woman ovulates is directly proportional to her risk of ovarian cancer and whilst there’s a lot of research required to define exactly what’s happening it seems to be holding sound over the decades. Therefore if you stop a woman ovulating by using the pill or with a pregnancy, you get a protective effect and that seems to be something that can stay with a woman for some years for example if you use the pill even for one year, there seems to be a protective effect of reduction in ovarian cancer of 18% up to over 40% depending on the papers you read and that protection seems to last for over 30 years since the woman stopped using the pill. That’s quite interesting in trying to prevent this disease occurring.


Now, you’ve recently carried out some WoW funded research with Joanne Morrison looking at virotherapy of ovarian cancer which I believe has led to some exciting outcomes. Can you explain a little about that and what you discovered?

Essentially what this is about is looking at ways of get ting chemotherapy or treatments into the cancer cell itself and one area that’s always been of interest is using viruses to carry whatever message we want to use be that the chemotherapy agent or the virus itself being the killer agent into the abdomen where ovarian cancer is obviously placed. At the moment, there were various problems with this in the past but at the moment we may have overcome some of those problems. We ‘re at the stage now looking at proceeding further and trying this out in humans to see what effect this may have. I think, whilst it’s exciting work of course, there are many years of further work required before this will be used in general terms and as a part of the normal treatment of ovarian cancer. But we’ve always hope.

So what is the next step?

Well, the next step at the moment will be developing the programme so that we can test it out in some patients with ovarian cancer to see what effect it has in those patients. That’s the next step.


And finally what advice or message do you want to leave with our listeners about ovarian cancer?

Well I think, as with anybody if you have concerns that you may be suffering from ovarian cancer contacting your own doctor seems quite sensible but the symptoms to watch out for which might be of help are sustained swelling or bloating of the stomach which lasts consistently over a few weeks, maybe three or four weeks and at that stage I would suggest making contact with your GP would be worthwhile. The other message I suppose which is equally important is our desire to improve survival rates of ovarian cancer. To do that of course, it’s very important we undertake continuing research and supporting charities that focus down on ovarian cancer such as Wellbeing of Women is always to be recommended.

Thank you very much.

Thank you.


It’s been extremely enlightening and hopefully by keeping an eye out for the symptoms you described, it will help some women out there, thank you.

Thank you very much indeed.
 

Often dubbed the 'silent killer', ovarian cancer has spawned a multitude of misconceptions.

Discover the truth behind the myths surrounding the disease.

Ovarian cancer does not run in my family, so I don’t have to worry about it.

No - most ovarian cancers (90 percent) occur in women with no family history.

There is no cure for ovarian cancer

Women are cured, particularly in the early stages of the disease, where the cancer is localised to the ovaries.

I won’t be able to have children if I’m diagnosed with ovarian cancer

This is not true, it very much depends on the stage and type of ovarian cancer.

My cervical screening test will show if I have ovarian cancer

Cervical screening tests are only for pre-cancerous condition of the cervix.

Fertility drugs cause ovarian cancer

There is conflicting evidence on this one. The most recent study- which is good - says there is no increase.

To find out about our research follow these links:
 

• Enhancing virus killing of cancer cells for the treatment of ovarian cancer

• Improving virus gene therapy for ovarian cancer

• The role of LARP1 protein in the development of ovarian cancer chemotherapy resistance

• Gene linked to treatment resistance in ovarian cancer

• The Royal College of Obstetricians and Gynaecologists website has a wide range of information and guidelines on many women’s health topics. This can be found at: http://www.rcog.org.uk/womens-health/patient-information  

• NHS Choices website also has a range of health information. This can be found at: http://www.nhs.uk/Pages/HomePage.aspx