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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

Want to know more?

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Diagnosis

See your GP as soon as possible if you have any symptoms of ovarian cancer.

Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether there's a history of ovarian or breast cancer in your family.

They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan.

If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital.

Blood test (CA125)

You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer.

However, CA125 isn't specific to ovarian cancer and it can be raised in conditions including endometriosisfibroids, pelvic inflammatory disease and pregnancy, so a raised CA125 level doesn't definitely mean you have ovarian cancer.

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

The National Institute for Health and Care Excellence (NICE) has produced guidance that recommends testing for CA125 if you frequently experience:

  • bloating
  • feeling full quickly and/or loss of appetite
  • pelvic or abdominal pain
  • needing to urinate urgently and/or frequently

Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb).

If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation, you may also be tested for CA125.

If you're 50 or over and you've experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

Around half of all women with early stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised, you'll be referred for an ultrasound scan.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of your ovaries. You may have an internal ultrasound where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach.

The image produced can show the size and texture of your ovaries, plus any cysts or other swellings that are present.

Further tests

If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and if it's spread. This is called staging.

Other tests you may have include:

  • a chest X-ray
  • a CT scan or MRI scan
  • abdominal fluid aspiration – a thin needle is passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells
  • laparoscopy– a thin tube with a camera on the end is inserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy)

Staging helps your doctors to decide on the best kind of treatment for your condition. However, it's important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

The Cancer Research UK website has more information on further tests for ovarian cancer.

Stages and grades of ovarian cancer

Staging

If your test results indicate that you have ovarian cancer, it will be given a stage. The stage describes the size of the cancer and how far it has spread. The four commonly used stages of ovarian cancer are:

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

This is a simplified guide. Each stage is further divided into categories A, B and C. Ask your doctor if you're not sure what stage you have.

Grading

The grade of cancer refers to the appearance of cells under a microscope. The grades are as follows:

  • low grade – although abnormal, cells appear to be slow-growing
  • moderate grade – cells look more abnormal than low-grade cells
  • high grade – cells look very abnormal and are likely to be fast-growing

The Cancer Research UK website has more information on the stages and grading of ovarian cancer.

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Treatment

People with cancer should be cared for by a team of specialists who work together to provide the best treatment and care.

This is called a multidisciplinary team. It will often consist of specialist cancer surgeons (gynaecological oncologists), a medical oncologist (a chemotherapy specialist) and a specialist cancer nurse. Other members may include a radiologist, pathologist, physiotherapist, a dietitian and an occupational therapist.

When deciding which treatment is best for you, your doctors will consider:

  • the stage of your cancer (how big it is and how far it has spread)
  • your general health
  • whether fertility is an issue

You can discuss your treatment with your care team and ask any questions at any time.

The main treatments for ovarian cancer are:

  • surgery
  • chemotherapy

The treatment you have will depend on the stage your cancer has reached.

Treating advanced ovarian cancer

Ovarian cancer is often diagnosed at an advanced stage (3 or 4) when it has spread to other parts of the abdomen. Advanced cancer may not be curable. The goal of treatment is to put the tumour into remission so it shrinks or disappears.

Surgery

The majority of women who have ovarian cancer will be considered for surgery. Sometimes, it is not possible to confirm the stage of the cancer until the surgery is carried out.

Your doctor will discuss with you what will happen during the surgery. The surgery will probably involve removing:

  • both ovaries and the fallopian tubes (a bilateral salpingo-oophorectomy)
  • the womb (a total abdominal hysterectomy)
  • the omentum, a fatty layer of tissue within the abdomen (called an omentectomy)

The surgeon may also remove the lymph nodes from your pelvis and abdomen. They may also take samples of nearby tissue to see if the cancer has spread.

If the cancer has spread, the surgeon will try to remove as much of it as possible. This is known as debulking surgery.

If the cancer is confined to one or both ovaries, you may only need to have the ovary or ovaries removed, leaving your uterus (womb) intact. This means you may still be able to carry a pregnancy.

You will probably be ready to go home three to seven days after your operation, but it can take many weeks to fully recover.

When you go home, you will need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss the types of exercise that are suitable for you with your doctor or physiotherapist.

Want to know more?

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) medication to kill cancer cells. It is often given after surgery for ovarian cancer. In some cases, it can be given before surgery as it may help shrink the tumour and make it easier to remove. This is called neoadjuvant chemotherapy.

Several different drugs can be used in chemotherapy. Often, a combination is given. The choice of drug and how and when it is given depends on the stage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing drug (carboplatin), which is used alone or in combination with another drug, paclitaxel.

Chemotherapy is usually given as a drip into the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen, called intraperitoneal chemotherapy. This is not established routine practice in the UK at the moment, but it is being assessed in clinical trials.

You will usually have chemotherapy as an outpatient, but you may sometimes need a short stay in hospital. It's usually given in cycles, with a period of treatment followed by a period of rest, to allow the body to recover. Most women have six cycles of chemotherapy.

How will I know if the chemotherapy is working?

Over the course of your chemotherapy, you will have tests to monitor how the ovarian cancer is responding to treatment. This can be done in a number of ways.

  • if you had higher than normal levels of the cancer chemical CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling
  • if you had a tumour visible on a CT or ultrasound scan when diagnosed, you may have repeated scans to see whether it has shrunk
  • you may have another small operation, known as 'second-look surgery', which is carried out in the same way as a laparoscopy

After your chemotherapy treatment, if all of your tests are clear of cancer, you will be in remission. This means the cancer is under control.

Side effects of chemotherapy

Side effects of chemotherapy include:

  • infections
  • loss of appetite
  • nausea and vomiting
  • tiredness
  • hair loss
  • sore mouth

Many side effects can be prevented or controlled with medicines your doctor can prescribe.

Chemotherapy for cancer that has come back

Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This is called second-line treatment.

Want to know more?

Radiotherapy

Radiotherapy uses high energy X-rays. Like chemotherapy, it works by targeting rapidly growing cancer cells.

Radiotherapy isn't usually used to treat ovarian cancer. However, the multidisciplinary team may occasionally recommend it to treat ovarian cancer under very specific circumstances, such as treating pain and bleeding from a localised tumour mass.

Want to know more?

Clinical trials

In recent years, much progress has been made in ovarian cancer treatment. More women are living longer and experiencing fewer side effects. These advances were discovered through clinical trials, where new medicines and combinations of medicines are compared with standard treatment.

All cancer trials in the UK are subject to careful monitoring, to ensure the trial is worthwhile and safely conducted. Participants in clinical trials can often do better overall than in routine care.

If you're asked about taking part in a trial, you'll be offered an information sheet. If you wish to take part, you'll be asked to give your consent (permission) by signing a form. You're always free to refuse or withdraw from a clinical trial without it affecting your care.

Want to know more?

Psychological help

Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support:

  • Your hospital doctor, specialist nurse or GP can refer you to a counsellor. If you are feeling depressed, talk to your GP. A course of antidepressant drugs may help, or your GP can arrange for you to see a counsellor or psychotherapist.
  • It can help to talk to someone who has been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people who have had cancer treatment.

Want to know more?

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Living with

How ovarian cancer will affect your daily life depends on what stage your disease is at and what treatment you are having.

How women cope with the diagnosis and treatment varies from person to person. There are several forms of support if you need it. Not all of these work for everybody, but one or more of them should prove helpful:

  • keep talking to your friends and family, as they can be a powerful support system
  • communicate with other women in the same situation
  • find out about your condition
  • set reasonable goals
  • take time out for yourself

Want to know more?

Recovering from treatment

Many women with ovarian cancer have a hysterectomy. This is a major operation, and takes around six to 12 weeks to recover from. During this time you will have to avoid lifting things (such as children, heavy shopping bags) and doing heavy housework. You will not be able to drive for three to eight weeks after the operation. Most women need four to 12 weeks off work after a hysterectomy.

If your ovaries have been removed and you have not already had the menopause, you will enter menopause after your treatment. You may decide to take hormone replacement therapy (HRT) to control your symptoms. There is no reason why you cannot take HRT after your ovarian cancer treatment. Your GP will help you decide what's best for you.

Some treatments for ovarian cancer, particularly chemotherapy, can make you very tired. You may need a break from your normal activities for a while. Do not be afraid to ask for practical help from family and friends if you need it.

Practical help may also be available from your local authority. Ask your doctor or nurse who to contact.

Follow-up after treatment

After your treatment has finished you will be invited for regular check-ups, usually every two to three months to begin with. At the check-up your doctor will examine you. They may do blood tests or scans to see how your cancer is responding to treatment.

Want to know more?

Relationships with friends and family

Having cancer is not always easy to talk about, either for you or your family and friends. You may sense some people avoid you or feel awkward around you. Being open about how you feel and what your family and friends can do to help may put them at ease. However, don't feel shy about telling them you need some time to yourself.

Want to know more?

Your sex life

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

Early menopause

If you have not already been through the menopause, removing the ovaries means you will have an early menopause. You are likely to have symptoms of the menopause, which can include vaginal dryness and loss of sexual desire.

Not feeling like sex

It is common for women to lose interest in sex after treatment for ovarian cancer. Your treatment may leave you feeling very tired. You may feel shocked, confused or depressed about being diagnosed with cancer. You may also feel grief about the loss of your fertility. It is understandable you may not feel like having sex while coping with all this. Try to share your feelings with your partner. If your sex problems are not getting better with time, you may want to consider speaking to a counsellor or sex therapist.

Money and Benefits

If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support.

  • if you have a job but cannot work because of your illness, you are entitled to statutory sick pay from your employer
  • if you do not have a job and cannot work because of your illness, you may be entitled to employment and support allowance
  • if you are caring for someone with cancer, you may be entitled to carer's allowance
  • you may be eligible for other benefits if you have children living at home or have a low household income

It is a good idea to find out early on what help is available to you. You could ask to speak to the social worker at your hospital, who can give you the information you need.

Dealing with dying

If you're told that nothing more can be done to treat your ovarian cancer, care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called 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 10:24:31

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