What is ovarian cancer?

The fallopian tubes attach the womb to the ovaries. They collect the egg when it is released from the ovary and transport the egg to the womb.

Doctors now think that many ovarian cancers may start in the end of fallopian tubes where they attach to the ovary. Ovarian cancer happens when cells in the ovary or fallopian tube become abnormal. These cells can grow and divide uncontrollably.

These cells can fall off from the surface of the ovary or the lining of the fallopian tube and spread throughout the abdominal (tummy) cavity. The cells then attach to the lining of the abdominal cavity (called the peritoneum) or onto the outside of other organs, like the bowel. They can grow into further tumour deposits called metastases. In ovarian cancer, this spread can happen very early, even when there isn’t a visible mass on the ovary or tube. Eventually the abnormal cells can spread to other organs outside of the abdominal cavity.

Around 7,500 women get ovarian cancer in the UK each year. It is most common in women over 50, but younger women can still get it. Some rarer types of ovarian cancer are more common in younger women. Ovarian cancer can affect anyone who has fallopian tubes or ovaries, so some trans men and some non-binary people can also be affected.

The earlier ovarian cancer is diagnosed, the easier it is to treat, but unfortunately, we don’t yet have effective ways to screen for ovarian cancer.

Who is at risk of ovarian cancer?

We don’t yet understand the cause of ovarian cancer. The biggest risk factor for ovarian cancer is getting older and the risk rises steeply from the age of 45. It is most common in women and people who have been through the menopause.

You might also be more at risk of ovarian cancer if a close blood relative, like your mum or sister, has had ovarian cancer, or if you have a family history of breast cancer. This is because some ovarian cancers are caused by an inherited faulty gene – BRCA1 or BRCA2. If you are worried about this, speak to your GP as they can assess your risk and decide whether you would benefit from a referral to a specialist genetics testing service. Lynch Syndrome affects one in 278 people and causes some families to have high rates of some types of cancer, including bowel, womb, prostate, ovarian and stomach cancer.

Around 5-15% of ovarian cancers are caused by a genetic mutation. If you are found to have an inherited risk of ovarian cancer, you can be offered surgery to remove your tubes and ovaries to reduce your risk significantly. Surgery is offered if you do not hope to get pregnant in the future.

Other factors that can affect your risk of ovarian cancer include:

• being younger than average when you started to have periods
• being older than average when you stop having periods at the menopause
• prolonged use of HRT
• being overweight
• smoking

Some things can reduce your risk of ovarian cancer:

• taking the combined oral contraceptive pill for 5-10 years. This can halve your risk of developing ovarian cancer
• removing your fallopian tubes at the time of other abdominal surgery.

What are the symptoms of ovarian cancer?

Symptoms of ovarian cancer are not always obvious, and some people may not notice them, or think they are symptoms of other conditions.

If you do notice symptoms of ovarian cancer, they’re most likely to include:

• persistent swelling of the tummy, often described as bloating. This is called ascites and is caused by extra fluid. More than one in three people with ovarian cancer will have this
• tummy or pelvis pain that keeps coming back
• reduced appetite and feeling full quickly when you eat
• needing to wee more often.

Other symptoms include:

• unexplained weight loss
• extreme tiredness
• changes to your bowel habit (constipation or diarrhoea)
• vaginal bleeding after you have been through the menopause.

If you have any of these symptoms, you should speak with your GP. These symptoms can be often caused by other benign conditions, such as irritable bowel syndrome (IBS), but it’s important to get checked out. This is especially important if you’re over the age of 45 or have been through the menopause.

It’s a good idea to keep a diary of your symptoms and take this when you visit your GP. Useful things to record include date/time of symptoms, if anything makes symptoms worse, when they started and how often they occur. You may want someone to go with you to your appointment for support.

How is ovarian cancer diagnosed?

A GP will first ask you questions about your symptoms. They may investigate further and:

• examine your tummy
• carry out an internal vaginal examination to feel for lumps or tenderness inside your pelvis.
• check your cervix (the neck of your womb). They will use a tool called a speculum to open your vagina so they can see your cervix better. If your cervical screening test is overdue, they may do this at the same time to keep a check on any signs of cervical cancer as well.
• arrange for a blood test, called CA125.

Depending on the outcomes of their investigations, doctors may arrange an ultrasound scan of your tummy and pelvis. This may lead to a referral to a gynaecology cancer specialist. Sometimes your doctor will refer you straight to the specialist before the test results are back. The specialists may arrange for further tests like blood tests, scans or biopsy before they see you.

If they don’t refer you for investigation and you’re still concerned, it’s okay to ask them why and for more information.

If the tests are initially reassuring, but your symptoms persist or worsen over the next few weeks or months, go back to visit your GP again.

What are the treatments for ovarian cancer?

The treatments you receive will depend on the stage and type of ovarian cancer you have.

In some cases, when it is caught early, ovarian cancer can be completely treated. For others the treatment may help to control the disease for months or years before it comes back. All treatments are likely to trigger menopause however, if you have not yet been through the menopause.

Treatments include (often a combination of):

• surgery
• chemotherapy
• radiotherapy
• hormone treatments
• targeted drug treatments

If you are diagnosed with ovarian cancer, your doctor will discuss treatment options with you. You will also be able to ask them any questions that you might have. You will also be assigned a cancer nurse specialist who will be your contact person and is there to support you through your treatment.

It is a good idea to discuss what your options are, and the benefits and risks of each, so that you can reach a decision that is best for you.

Can I still get pregnant?

Many people with ovarian cancer will need to have their ovaries, fallopian tubes and the uterus (womb) removed during surgery. This means you won't be able to become pregnant naturally. There may be other ways to have children such as IVF, surrogacy or adoption.

Sometimes it’s possible to have treatment to remove just one ovary, which means you may still be able to get pregnant in the future.

Ask your doctors and nurses for information about your fertility options.

Stages of ovarian cancer

There are four stages of ovarian cancer. The stage depends on how big the cancer is and how far it has spread. Doctors decide the best treatment for you based on the stage of cancer and how quickly it’s likely to grow (grading).

• Stage 1 is when the cancer is only in the ovaries.
• Stage 2 is when the cancer has grown into parts of your pelvic area, like your womb, bladder or bowel.
• Stage 3 means the cancer has spread into the area of your abdomen which includes your liver, pancreas and kidneys, or it has spread to your lymph nodes.
• Stage 4 has spread to other parts of your body which are further from your ovaries, like your brain, liver and lungs.

Getting support

You can read more about ovarian cancer and the treatments available on the NHS website.

If you are worried about ovarian cancer or have been recently diagnosed, you can get support. All these organisations offer information, help and advice:

• Ovarian Cancer Action
• Target Ovarian Cancer
• Ovacome
• Cancer Research UK
• Macmillan

You can also watch our webinar on gynaecological cancers. Dr Sarah Kitson, an expert in gynaecological cancers, discusses the most common symptoms of the five gynaecological cancers: cervical; ovarian; vulval; vaginal; and womb cancer. She also explains who may be most at risk and the impact a diagnosis can have.

Read about our research into gynaecological cancers

As a women’s health charity, we fund research to save and change the lives of women, girls and babies.

Our research has identified that a simple blood test, which can be given by GPs, could help diagnose ovarian cancer faster and more accurately.