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Ovarian Cancer

I’ve been told that I have ovarian cancer. What is it exactly?  

Ovarian cancer is the second most common group of gynaecological cancers. 

Cancer of the ovary is when the normal cells in the ovary change and grow to form a malignant tumour or cancer. As the ovaries are deep in the pelvis, the tumour, as it gets bigger, may affect nearby organs such as the bladder or the bowel. 

What are the factors that may increase the risk of developing ovarian cancer?

Some factors that may cause an increase in the risk of developing ovarian cancer include: 

  • Reproductive history: If you have never been pregnant or have your first child over the age of 35, you are at greater risk of developing ovarian cancer.
  • Cancer history: women with a previous breast cancer diagnosis face a higher risk of having ovarian cancer.
  • Age: This form of cancer is more common as women age older and have experienced the menopause.
  • Family history: of breast, ovarian or bowel cancer can indicate that you are at greater risk of developing ovarian cancer as you may have inherited cancer genes such as BRCA1 and BRCA2.
  • Hormone replacement therapy (HRT)/fertility treatment: there may be an increased risk of ovarian cancer after HRT or fertility treatment, but this requires more research.
  • Late menopause: studies have suggested that women who experience the menopause later into their 50s may have an increased risk of ovarian cancer.     
  • Endometriosis: women with endometriosis may have more than four times the risk of ovarian cancer than women who do not have the condition.  

The main types of ovarian cancer are: 

Epithelial tumours 

Epthelial tumours (carcinomas) account for 90% of ovarian cancers, usually found in women aged over 40. Epithelial ovarian cancer has few early symptoms and one of the risk factors is having a family history of the disease.

Non-epithelial tumours

These include stroma cell and germ cell tumours of the ovary. They are more common in girls and young women. 

Can I do anything to prevent ovarian cancer?

If you have a family history of ovarian cancer, it may be beneficial to have genetic testing to identify whether you have a higher risk of developing ovarian cancer. If you have a genetic risk of cancer, there are surgical options available to remove ovaries or fallopian tubes to lower your risk.

Studies have also shown that women who have taken oral birth control medication have between a 30% - 50% lower risk of developing ovarian cancer. 

What are the symptoms of ovarian cancer? 

Early-stage ovarian cancer rarely causes any symptoms and can therefore go undetected until it is in the advanced stages when it has become less treatable and widespread. 

Signs and symptoms of ovarian cancer may include: 

  • Bloated feeling 
  • Persistent swollen abdomen 
  • Pain or dragging feeling in your lower abdomen or side 
  • Mild indigestion or nausea 
  • Poor appetite and feeling full quickly 
  • Changes in your bowel or bladder habits, for example, needing to pass water urgently or constipation 
  • Abnormal vaginal discharge or bleeding (rare) 
  • Pain in the pelvic or abdominal area (the area below your stomach and in between your hip bones) 
  • Discharge from your vagina that is not normal for you 
  • Bleeding from your vagina that is not normal for you, particularly if you are past menopause 

How is ovarian cancer diagnosed?  

How gynaecological cancer is diagnosed depends on what type of cancer is suspected. Pelvic exams, imaging tests, biopsies, colposcopy exam and possible diagnostic surgery are all methods of diagnosing gynaecological cancer. 

Once cancer is confirmed, the stage of the cancer is determined, and a treatment plan is developed. Staging refers to how far the cancer has spread to nearby tissue or organs. Among all of the various types of gynaecological cancer, early detection is crucial. However, detection can be very difficult, especially in the early stages. 

Tests such as the following may be carried out: 

  • Transvaginal ultrasound: an ultrasound used to build up a picture of the tissues in your womb. During a transvaginal ultrasound a small metal ‘probe’, covered with a gel, is inserted into the vagina. This then creates the scan. This test is not painful but may be a little uncomfortable. 
  • Hysteroscopy: a hysteroscope is a thin, flexible tube with a light at the end which is passed through the vagina and into the womb. This allows the doctor to look inside the womb and take tissue samples or a biopsy. 
  • Biopsy: a small amounts of tissue samples are taken from the womb during a hysteroscopy. Biopsies are sent to a laboratory and looked at under a microscope to detect if cancer cells are present. 
  • D&C - dilatation and curettage: during a D&C the cervix and entrance to the womb are gently opened. Samples of tissue from the inner lining of the womb are taken with an instrument shaped like a spoon called a curette. The samples are then sent to the laboratory to be examined. 

What are the different stages of ovarian cancer?

There are four stages of ovarian cancer. Within each of these are substages which are used to define the spread of the cancer within each stage.

  • Stage I: has three substages which will indicate whether cancer is in one ovary or fallopian tube, both ovaries or fallopian tubes or, both ovaries and fallopian tubes and outside the ovary.
  • Stage II: has two substages which indicate whether cancer has spread from the ovaries to the uterus, or to other areas close to your pelvis.
  • Stage III: has three substages which indicate whether your cancer has spread into your abdomen or lymph nodes, whether the tumour is up to 2 centimetres in size in these areas, or whether the tumour is larger than 2 centimetres in these areas.
  • Stage IV: indicates that cancer is at its most acute. It has two substages which indicate whether cancer has spread into other major organs, and into the lymph nodes of your chest and groin.

What is the treatment for ovarian cancer? 

When your consultant has identified the stage of your cancer, it will help them to refine your treatment plan.

Treatment options include: 

  • Chemotherapy: is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells in the body by stopping or slowing the growth of cancer cells. 
  • Radiotherapy: uses high-energy rays to damage cancer cells and stop them from growing and dividing.  
  • Surgery: aims to remove the tumour. The method of surgery used will depend on the type and size of the cancer and whether it has spread. 

Laparotomy 

This operation opens up the abdomen so that the organs inside can be examined and tissue samples taken. If the cancer is only in one ovary, it may be possible to remove the affected ovary and leave the other ovary and womb in place. 

Radical hysterectomy and bilateral salpingo-oophorectomy 

In this operation, the cervix, womb, two ovaries and fallopian tubes are removed. A layer of fatty tissue that surrounds the organs in the abdomen (called the omentum) may also be removed. 

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.