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Encyclopaedia


Cancer of the ovary

Introduction

Cancer of the ovary

Ovarian cancer, or cancer of the ovaries, is one of the most common types of cancer in women.

The ovaries are a pair of small organs located low in the tummy that are connected to the womb and store a woman's supply of eggs.

Ovarian cancer mainly affects women who have been through the menopause (usually over the age of 50), but it can sometimes affect younger women.

This page covers:

Symptoms of ovarian cancer

Common symptoms of ovarian cancer include:

  • feeling constantly bloated
  • a swollen tummy
  • discomfort in your tummy or pelvic area
  • feeling full quickly when eating
  • needing to pee more often than normal

The symptoms aren't always easy to recognise because they're similar to those of some more common conditions, such as irritable bowel syndrome (IBS).

Read more about the symptoms of ovarian cancer.

When to see your GP

See your GP if:

  • you've been feeling bloated most days for the last three weeks
  • you have other symptoms of ovarian cancer that won't go away
  • you have a family history of ovarian cancer and are worried you may be at a higher risk of getting it

It's unlikely you have cancer, but it's best to check. Your GP can do some simple tests to see if you might have it. Read more about how ovarian cancer is diagnosed.

If you've already seen your GP and your symptoms continue or get worse, go back to them and explain this.

If you have a family history of ovarian cancer, your GP may refer you to a genetics specialist to discuss the option of genetic testing to check your ovarian cancer risk.

Causes of ovarian cancer

The exact cause of ovarian cancer is unknown.

But some things may increase a woman's risk of getting it, such as:

  • being over 50 years of age
  • a family history of ovarian or breast cancer – this could mean you've inherited genes that increase your cancer risk
  • hormone replacement therapy (HRT) – although any increase in cancer risk is likely to be very small
  • endometriosis – a condition where tissue that behaves like the lining of the womb is found outside the womb
  • being overweight

Read more about the causes of ovarian cancer.

Treatment for ovarian cancer

The treatment for ovarian cancer depends on things such as how far the cancer has spread and your general health.

The main treatments are:

  • surgery to remove as much of the cancer as possible – this will often involve removing both ovaries, the womb and the tubes connecting them to each other (fallopian tubes)
  • chemotherapy (where medicine is used to kill cancer cells) – this is usually used after surgery to kill any remaining cancer cells, but is occasionally used before surgery to shrink the cancer

Treatment will aim to cure the cancer whenever possible. If the cancer has spread too far to be cured, the aim is to relieve symptoms and control the cancer for as long as possible.

Read more about how ovarian cancer is treated and living with ovarian cancer.

Outlook for ovarian cancer

The earlier ovarian cancer is diagnosed and treated, the better the chance of a cure. But often it's not recognised until it has already spread and a cure isn't possible.

Even after successful treatment, there's a high chance the cancer will come back within the next few years.

If it does come back, it can't usually be cured. But chemotherapy may help reduce the symptoms and keep the cancer under control for several months or years.

Overall, around half of women with ovarian cancer will live for at least five years after diagnosis and about one in three will live at least 10 years.

Cancer Research UK has more information about the survival statistics for ovarian cancer.

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Symptoms

The symptoms of ovarian cancer can be difficult to recognise, particularly early on.

They're often the same as symptoms of less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS).

Main symptoms

The most common symptoms of ovarian cancer are:

  • feeling constantly bloated
  • a swollen tummy
  • discomfort in your tummy or pelvic area
  • feeling full quickly when eating, or loss of appetite
  • needing to pee more often or more urgently than normal

Other symptoms

Other symptoms of ovarian cancer can include:

When to see your GP

See your GP if:

  • you've been feeling bloated most days for the last three weeks
  • you have other symptoms of ovarian cancer that won't go away – especially if you're over 50 or have a family history of ovarian or breast cancer, as you may be at a higher risk

It's unlikely you have cancer, but it's best to check. Your GP can do some simple tests for ovarian cancer to see if you might have it.

If you've already seen your GP and your symptoms continue or get worse, go back to them and explain this.

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Causes

Ovarian cancer occurs when cells in the ovaries grow and multiply uncontrollably, producing a lump of tissue called a tumour.

It's not clear exactly why this happens, but the following factors may increase your risk of getting ovarian cancer.

Increasing age

The risk of ovarian cancer increases as you get older, with most cases occurring after the menopause.

About 8 in every 10 cases are diagnosed in women over 50, although some rarer types of ovarian cancer can occur in younger women.

Family history and genes

You're more likely to get ovarian cancer if you have a history of it in your family, particularly if a close relative (sister or mother) has had it.

Sometimes this may be because you've inherited a faulty version of a gene called BRCA1 or BRCA2. These increase your risk of developing both ovarian and breast cancer.

But having relatives with ovarian cancer doesn't mean you definitely have a faulty gene. Only around 1 in every 10 ovarian cancers is thought to be caused by one of these genes.

Ovarian Cancer Action has a tool to help you check whether your family history puts you at risk of ovarian cancer.

Speak to your GP if you're worried your family history may mean you're at a higher risk of ovarian cancer. They may refer you to see a genetic counsellor, who may suggest having a test to check for faulty genes.

Hormone replacement therapy (HRT)

It has been suggested that taking hormone replacement therapy (HRT) may increase your risk of ovarian cancer. But studies looking at this have so far had conflicting results.

It's thought that if there is any increase in cases of ovarian cancer in women taking HRT, the risk is very small.

Any increased risk of ovarian cancer is thought to decrease after you stop taking HRT.

Endometriosis

Research has shown that women with a condition called endometriosis may be more likely to develop ovarian cancer.

In endometriosis, the cells that usually line the womb grow elsewhere in the body, such as in the ovaries or tummy.

These cells still behave as if they were in the womb, including bleeding during periods. But as there's no way for the bleeding to leave the body, it becomes trapped and causes pain in the affected area.

Other factors

Other things that may increase your risk of ovarian cancer include:

  • being overweight or obese – losing weight through regular exercise and a healthy diet may help to lower your risk
  • smoking – stopping smoking may help reduce your risk of ovarian cancer and many other serious health problems
  • using talcum powder – some research has suggested that using talcum powder between your legs could increase your risk of ovarian cancer, but the evidence for this is inconsistent and any increase in risk is likely to be very small

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Diagnosis

See your GP if you have symptoms of ovarian cancer. They can do some initial tests and you may also need further tests in hospital.

Seeing your GP

Your GP may:

  • ask about your symptoms and general health
  • gently feel your tummy to check for any swelling or lumps
  • carry out an internal examination
  • ask if there's a history of ovarian or breast cancer in your family
  • take a sample of blood – this will be sent to a laboratory and checked for a substance called CA125 (see below)

In some cases, you may be referred straight to a hospital specialist (usually a gynaecologist) for further tests without having a blood test.

Blood test (CA125 test)

If your GP thinks your symptoms could be due to ovarian cancer, they'll recommend having a blood test to check for a substance called CA125.

CA125 is produced by some ovarian cancer cells. A high level of CA125 in your blood could be a sign of ovarian cancer.

But a raised CA125 level doesn't mean you definitely have cancer, as it can also be caused by less serious things such as endometriosisfibroids and even pregnancy.

If the test finds a high level of CA125, you'll be referred for a scan to check for possible causes (see below).

Sometimes your CA125 level can be normal in the early stages of ovarian cancer. If you've had a normal test result but your symptoms don't improve, go back to your GP as you may need to be re-tested.

Lab Tests Online UK has more information on the CA125 test.

Ultrasound scan

Your GP will arrange for you to have an ultrasound scan if your blood test suggests you could have ovarian cancer.

This is a type of scan where high-frequency sound waves are used to create an image of the inside of your body.

There are two ways it can be done:

  • abdominal ultrasound – a small device called an ultrasound probe is moved over your tummy to create an image of your ovaries
  • transvaginal ultrasound – an ultrasound probe is passed into your vagina to create a clearer image of your ovaries

The scan can show changes in your ovaries that could be caused by cancer or another problem such as endometriosis or a build-up of fluid.

If any abnormalities are found, you'll be referred to a specialist for further tests to confirm the cause (see below).

Further tests

The following tests may be carried out by a specialist in hospital to confirm or rule out ovarian cancer:

  • CT scan – a type of scan where several X-rays are taken from different angles to create a detailed image of your ovaries
  • a chest X-ray to check if cancer has spread to your lungs
  • a needle biopsy – a needle is passed through your tummy to remove a sample of ovary cells or fluid from around the ovaries so it can be checked for cancer
  • laparoscopy – a small cut is made in your tummy and a thin tube with a camera on the end is inserted, so your ovaries can be examined; a small tissue sample may also be removed for testing

If ovarian cancer is found, these tests can also help determine how far it has already spread.

Stages and grades of ovarian cancer

If you're diagnosed with ovarian cancer, it will be given a "stage".

This describes the size of the cancer and how far it has spread. It can help your doctors plan the best treatment for you.

The four main stages of ovarian cancer are:

  • stage 1 – the cancer only affects one or both of the ovaries
  • stage 2 – the cancer has spread from the ovary and into the pelvis or womb
  • stage 3 – the cancer has spread to the lining of the tummy, the surface of the bowel or the lymph glands in the pelvis or tummy
  • stage 4 – the cancer has spread to other parts of the body, such as the liver or lungs

Your cancer will also be given a "grade". This is a way of describing how quickly the cancer is likely to grow or spread.

The grades range from grade 1 (more likely to grow slowly) to grade 3 (more likely to grow quickly).

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Treatment

The treatment for ovarian cancer depends on how far it has spread, your general health and whether you're still able to have children.

Most people have a combination of surgery and chemotherapy.

The aim of treatment is to cure the cancer if possible. If the cancer is too advanced to be cured, treatment aims to relieve symptoms and control the cancer for as long as possible.

You'll be cared for by a team of healthcare professionals who will come up with a treatment plan and support you throughout your treatment.

Surgery

Surgery is the main treatment for ovarian cancer. The aim is to remove all of the cancer or as much of it as possible.

Surgery usually involves removing:

  • both ovaries and the fallopian tubes
  • the womb (a hysterectomy)
  • a layer of fatty tissue in the tummy (the omentum)

If the cancer is just in one or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to have children.

Surgery is carried out under general anaesthetic (where you're asleep). You'll probably only need to stay in hospital for a few days, but it may take many weeks to fully recover.

Read about living with ovarian cancer for more information on recovering from surgery.

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Chemotherapy

Chemotherapy is where medication is used to kill cancer cells. Most women with ovarian cancer have it in addition to surgery.

It may be used:

  • after surgery to kill any remaining cancer cells
  • before surgery to shrink the cancer and make it easier to remove
  • if ovarian cancer comes back after initial treatment.

Chemotherapy medicine is usually given as a drip into the vein, but is sometimes given as tablets. You'll need to come into hospital to receive the treatment, but can normally go home the same day.

Treatment is given in cycles, with a period of treatment followed by a period of rest to allow your body to recover. Most women have six cycles of chemotherapy, with each cycle lasting three weeks.

Chemotherapy can cause some unpleasant side effects, such as:

  • tiredness
  • feeling and being sick
  • loss of appetite
  • hair loss
  • diarrhoea
  • increased risk of infections

Most side effects can be controlled with medication from your doctor and they should pass once treatment stops. Read more about the side effects of chemotherapy.

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Radiotherapy

Radiotherapy uses carefully directed beams of radiation to kill cancer cells.

It's not used very often to treat ovarian cancer, but may be used:

  • after surgery for early ovarian cancer, to kill any cancer cells left behind
  • to shrink tumours and reduce symptoms if ovarian cancer has spread and can't be cured

Common side effects of radiotherapy include sore skin, tiredness and hair loss in the treated area. These should pass after treatment stops.

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Clinical trials

Research into newer and better treatments for ovarian cancer is ongoing through clinical trials.

Speak to your care team if you're interested in participating in a trial as part of your treatment. They can let you know about any research you may be able to get involved in.

It's important to be aware that you might not get an experimental treatment (you may be given a standard treatment that's being compared to the new one) and there's no guarantee that a new treatment will be more effective.

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Living with

Having ovarian cancer can affect your daily life during and after treatment.

See below for information about what to expect and some tips to help you cope.

Recovering from surgery

Surgery to treat ovarian cancer is a major operation. It can take up to three months to fully recover.

You'll need to take things very easy for at least the first couple of weeks. Rest as much as possible and try to avoid spending too long on your feet.

You can start to gradually return to your normal activities in the following weeks, but be careful not to do too much too soon.

Your care team will let you know about anything you need to avoid while you recover. For example:

  • you'll probably need to take one to three months off work
  • you might not be able to drive for around a month
  • you may need to avoid strenuous lifting or heavy exercise for at least three months

A physiotherapist may help you come up with an exercise plan to help your recovery.

If both your ovaries have been removed and you haven't been through the menopause, you'll experience it after treatment.

Your doctor may suggest taking hormone replacement therapy (HRT) to control any menopausal symptoms at least until you reach the natural age for the menopause (between 45 and 55).

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Follow-up after treatment

After your treatment has finished, you'll be invited for regular check-ups to see how you're doing.

These are usually every two to three months to begin with, but tend to become less frequent over time.

These appointments are a good chance to talk to your care team about any problems you're having or any questions you have.

It's quite common for ovarian cancer to come back within a few years of treatment finishing, so you may have regular blood tests and/or scans to check for this.

Tell your doctor as soon as possible if any of your symptoms return after treatment. Don't wait until your next appointment.

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Help and support

Dealing with cancer can be a huge challenge for you and your friends and family, both practically and emotionally.

Talking to someone about your feelings or problems can help.

It may help to:

  • talk to your care team or GP – they may be able to arrange professional support such as counselling or therapy
  • speak to your friends and family – be open about how you feel and what they can do to help; don't feel shy about telling them you need some time to yourself if that's what you want
  • get in touch with a support group or charity – many organisations have helplines, online forums, and local support groups where you can meet up with other people in a similar situation to you

Want to know more?

Sex and fertility

Ovarian cancer and its treatment can affect your sex life. This can happen in several ways.

Ovarian cancer can affect your sex life in several ways.

You'll probably be advised to avoid having sex for a few weeks after surgery so your wound has enough time to heal properly.

But even after your wound has healed, it's normal to not feel like having sex right away. It takes many women much longer to feel ready.

This may be because surgery has triggered the menopause, or it may just be a combination of the tiredness and the emotional stress associated with being diagnosed and treated for cancer.

Talk to your partner about how you feel and don't pressure yourself into having sex too soon. The "help and support" section above gives details of people and organisations to contact if you'd like to discuss the issue with someone.

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Fertility and pregnancy

For some women, treatment for ovarian cancer triggers an early menopause and means they're no longer able to have children.

Talk to your care team about this if it's a concern for you. It may be possible to have treatment that preserves your fertility if you still want to have children and the cancer hasn't spread to both ovaries.

If you do lose your fertility, it's normal to experience a sense of loss or grief. It can help to discuss your feelings with a partner, relative or close friend, or with your specialist nurse.

If your treatment involved chemotherapy and you're still able to have children, you'll usually be advised to avoid becoming pregnant for a couple of years in case the cancer comes back and you need further treatment.

Want to know more?

Money and Benefits

If you have to reduce your working hours or stop working due to your cancer, you may find it difficult to cope financially.

If you have cancer or you're caring for someone with cancer, you may be entitled to financial support. For example:

It's a good idea to find out as soon as possible what help is available to you. You may want to ask to speak to the social worker at your hospital, who can give you the information you need.

Want to know more?

If your cancer cannot be cured

If nothing more can be done to treat your cancer, your care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called end of life or palliative care.

It also includes psychological, social and spiritual support for you and your family or carers.

Want to know more?

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 20/02/2017 13:57:18

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