Ovarian cancer

Ovarian cancer is when cells in or around your ovaries start to grow abnormally and out of control. You may also hear it called cancer of the ovaries.

Ovarian cancer is the third most common cancer in women in the India; around 50,000 women are diagnosed every year. It mostly affects women over 50, but younger women can get it too. 

About ovarian cancer

The ovaries are two small, oval organs which release an egg every month as part of a woman’s menstrual cycle (period). There are several types of ovarian cancer. These start in different parts of the ovaries and are treated in different ways.

• Epithelial ovarian cancer is the most common type, causing nine out of 10 ovarian cancers. This type develops in the cells covering your ovaries and the ends of your fallopian tubes (the tubes leading from your ovaries to your womb). There are different subtypes of epithelial ovarian cancer, which are named depending on the type of cell involved.
• Non-epithelial ovarian cancer is much less common. Again, there are different subtypes, the most common being cancers that grow from germ cells (the cells in your ovary that make eggs). This usually affects younger women, under the age of 35.

Sometimes, ovarian cancer can spread out of your ovary and fallopian tube, and more widely in your abdomen (tummy). More rarely, it can spread to other organs such as your liver, lymph nodes and lungs. This is known as malignant cancer.

Your doctor will tell you which type of ovarian cancer you have, and how that will affect your treatment options.

Symptoms of ovarian cancer

The most common ovarian cancer symptoms include:

• pain or discomfort in your abdomen or pelvis
• having a swollen abdomen
• constantly feeling bloated
• feeling full quickly and losing your appetite
• needing to pee more often or more urgently
• unexplained changes in your bowel habits, such as constipation, excess wind or diarrhoea
•  other symptoms affecting your digestive system, such as feeling sick or indigestion

Other symptoms include:

• losing weight for no obvious reason
• unexplained extreme tiredness
• abnormal bleeding from your vagina (eg, after you’ve gone through the menopause)
• feeling short of breath

Many ovarian cancer symptoms are very vague and similar to symptoms caused by other, less serious conditions. And many women don’t have symptoms at all in the early stages of the disease. This means by the time many women see their doctor, the cancer is already at quite an advanced stage.

If you do develop any of the symptoms listed above, you’re getting them regularly and they last for longer than a few weeks, contact your doctor.

Diagnosis of ovarian cancer

Your doctor will ask you about your symptoms and medical history. They will examine you by feeling around your abdomen (tummy) and pelvis. They may ask to examine you internally too. They’ll do this by gently feeling inside your vagina, to check your womb and ovaries for any lumps or swellings. 

Tests for ovarian cancer

Depending on what symptoms you have and how long you’ve had them, your doctor may arrange for you to have a blood test. This is to check for a protein called CA125. A high CA125 level can be a sign of ovarian cancer, although other conditions can also raise your CA125 level. If your level of CA125 is found to be higher than normal, your doctor may also organise for you to have an ultrasound scan of your abdomen and pelvis. 

Referral to a specialist

Depending on your test results, your doctor may refer you to a gynaecologist (a doctor who specialises in women’s reproductive health). Sometimes, your doctor may refer you to a gynaecologist urgently (within two weeks), before conducting any further tests. They will then organise any tests and scans for you. 

Staging tests

Your doctor will need to take tissue samples from the tumour, to confirm whether or not it’s ovarian cancer. These are usually taken when the tumour is removed during surgery – see our Treatment section below. Sometimes, your doctor may recommend a procedure to remove a sample (biopsy) of your ovary to test for cancer cells instead.

Your doctor will look at the tissue samples, along with the results of your blood and ultrasound tests to see how large your cancer is and how far it’s spread. Sometimes you’ll need other tests too, like a CT or MRI scan.

Finding out how far your cancer has spread is called staging. Staging can help doctors to estimate how your cancer is likely to progress, and the best course of treatment for you. 

Genetic testing

You should be offered genetic testing after you’re diagnosed with ovarian cancer, to check for faulty BRCA1 and BRCA2 genes. Having these faulty genes can increase your risk of breast and ovarian cancer. If you haven’t been offered testing, talk to your doctor about whether you’re eligible. Knowing whether you have the faulty BRCA genes may help your doctor to better plan your treatment. There are lots of things to think about before having a genetic test – your doctor will talk you through what’s involved.

Treatment of ovarian cancer

A team of specialist doctors, including a gynaecological oncologist (a surgeon who specialises in cancers affecting the female reproductive system), will be involved in planning your care. What treatment they recommend will depend on the type of ovarian cancer you have, whether it’s spread, and if so, how far. They’ll talk to you about all the possible options, and anything that might affect your decision – including your general health and whether you plan to have children.

Surgery

Almost all women with ovarian cancer have surgery. The aim of surgery is to remove as much of the tumour as possible. This is called ‘debulking’ surgery. It usually involves removing both ovaries, fallopian tubes and your womb (a total ). Your gynaecological oncologist may also remove some surrounding tissue (biopsies) and nearby lymph nodes to help find out how far the cancer has spread.

If the cancer hasn’t spread beyond your ovary, and you want to have children in future, you may be able to just have the affected ovary and fallopian tube removed.

Chemotherapy

Most women with ovarian cancer also have . Chemotherapy is a treatment for cancer that uses medicines to destroy cancer cells. It usually involves having several doses of chemotherapy medicines at regular intervals over a period of weeks.

Most of the time, your doctor will offer you chemotherapy after surgery to destroy any cancer cells that weren’t removed by the operation. You might also be offered it before surgery to shrink your tumour, and make it easier to remove.  

The exact chemotherapy treatment you’re offered will depend on the type and stage of your cancer. Your doctor will give you information on the type and course that’s best for you.

Radiotherapy

uses radiation to destroy cancer cells. It’s not often used to treat ovarian cancer, but your doctor may offer it if your cancer comes back in another area of the body. It can also help to relieve symptoms such as pain, if other treatments are no longer possible.

Targeted therapies

These are newer medicines, including monoclonal antibodies and PARP (Poly ADP-ribose polymerase) inhibitors that specifically target cancer cells to stop them growing and multiplying. They may have fewer side-effects than traditional chemotherapy. You may be offered this treatment if you’ve been found to have a faulty BRCA gene, if your cancer is advanced, or if it’s come back. 

After your treatment

You’ll have regular check-ups after your treatment has finished, to check how your cancer has responded and see if it comes back. It’s important not to miss these appointments, even if you’re feeling well. If your cancer has returned, your doctor will talk to you about any further treatment options you may be able to try.

Causes of ovarian cancer

It’s not clear exactly why some women develop ovarian cancer. But it is known that certain things can make you more likely to develop it. These include:

• having a family history of ovarian or breast cancer, or certain other cancers; particularly if you inherit faulty genes called BRCA1 and BRCA2
• getting older – most women who get it are over the age of 50
• taking – this seems to increase your risk by a small amount
• being overweight or obese
• having
• smoking can increase the risk of certain types of ovarian cancer
• starting your periods early, or starting the menopause late in life

There are also certain things that reduce your risk of getting ovarian cancer. These include if you:

• have taken the contraceptive pill
• have had children – the more children you’ve had, the lower your risk
• breastfed your children
• have had a hysterectomy or been sterilised (had your tubes tied)

Prevention of ovarian cancer

Stopping smoking and losing excess weight may help to reduce your risk of developing ovarian cancer, as well as a number of other cancers. This is also important for your general health. Making changes to your lifestyle can’t completely prevent ovarian cancer though, as there are many things – like your age and your genes that you can’t control.

If you have a strong family history (usually two or more close relatives who have had breast or ovarian cancer), your doctor may refer you to a genetic counselling clinic. Specialists at the clinic will be able to assess your risk and advise you on being tested for the BRCA1 and BRCA2 faulty genes. If you test positive for these genes, your doctor will talk to you about the options available to reduce your risk of both breast and ovarian cancer. For ovarian cancer, these include taking oral contraceptives and surgery to remove your ovaries and fallopian tubes (risk-reducing surgery).

Help and support

Being diagnosed with ovarian cancer and facing treatment can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects and practical issues, as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need – make sure you talk to them if you have any concerns.

Talking to your family and friends can help them to understand what you’re going through and how you’re feeling. Organisations and support groups that specialise in ovarian cancer can also be a great source of information and support.