Ovarian cancer

Ovarian cancer most often happens when the cells on the surface of your ovaries, called the epithelial layer, start to grow abnormally and multiply in an uncontrolled way. Nine in every 10 cases of ovarian cancer are epithelial. However, there are more rare types of ovarian cancer including germ cell and stromal ovarian cancers. Cancer can also start in your fallopian tubes.

It mostly affects women who are post-menopausal, although younger women can be affected.

Doctors often refer to the silent signs of ovarian cancer, because the symptoms are often mild and mistaken for less serious conditions. This is why ovarian cancer is often diagnosed when it’s already progressed or spread to other parts of your body (metastasised) which makes it harder to treat.

Early ovarian cancer symptoms can often go unnoticed. The main symptoms are:

• A swollen tummy (abdomen)
• Loss of appetite or feeling full quickly
• Needing to pee more often than usual
• Pain in your lower abdomen or leg pain

You may also notice:

• Feeling tired for no reason
• Losing weight without dieting
• A change in your bowel habits
• Pain during sex

These symptoms are most often a sign of something less serious, such as irritable bowel syndrome (IBS). However, if you have these symptoms more than 12 times in a month, you should see your doctor.

Your GP will ask about your symptoms. They may do the following:

• An internal examination to feel for any lumps or swelling around your ovaries or womb (uterus)
• A CA125 blood test to measure a protein called CA125 – a high level can be a sign of early ovarian cancer, although it can also be a sign of endometriosis

You may be referred to hospital or to a gynaecologist for further tests including:

• A vaginal ultrasound
• An abdominal ultrasound

If your doctor suspects ovarian cancer, they may need to take small tissue samples of your ovaries (biopsies) to test, using either:

• A needle biopsy – a thin needle is passed through your tummy button
• A laparoscopy – this is surgery to look inside your abdomen using a small tube with a camera on the end

Other tests will be needed to see if your cancer has spread to other parts of your body, such as a CT scan or a chest X-ray.

These tests will help your doctor to decide what stage your cancer is at and which treatment to use.

The exact cause isn’t known. However, certain things are known to increase your risk of getting ovarian cancer:

• Ovulation, each month an egg breaks through the wall of your ovary as part of your menstrual cycle – this increases the chance of cells dividing abnormally as they repair
• Starting your periods early, late menopause and not having children until late can increase your chance of ovarian cancer as you have more periods
• Age – most women diagnosed with ovarian cancer are over 50
• Family history of ovarian cancer – if a close relative had ovarian or breast cancer before the age of 50 there’s also a chance that you have a faulty gene known as BRCA1 or BRAC2 – it’s possible to test for this if you think you’re at risk
• Endometriosis, a condition where the lining of your womb starts to grow outside your womb
• Cancer of the peritoneum, the membrane that lines the inside of the abdomen

Your treatment will depend on the type and stage of your ovarian cancer and if it’s spread to other parts of your body. These include:

• Surgery to remove your ovaries and fallopian tubes (a bilateral salpingo-oophorectomy)
• Surgery to remove your womb (hysterectomy)
• Chemotherapy drugs to destroy any cancer cells, including those that may have spread to other parts of your body – these can be given before or after your surgery
• Radiotherapy to target and destroy cancer cells
• Targeted therapy – drugs that work on very specific actions inside cancer cells to stop them from multiplying