Ovarian Cancer

Ovarian cancer develops when cells in or around the ovaries grow in an uncontrolled way. The ovaries are two small organs in the pelvis, one on each side of the womb, that store eggs and produce hormones. Many cancers once thought to begin in the ovary are now believed to start in the fallopian tubes or the nearby lining of the abdomen (the peritoneum), and these are treated in a similar way.

There are several types. The most common is epithelial ovarian cancer, which starts in the cells covering the surface of the ovary or the fallopian tube. Less common types include germ cell tumours, which start in the egg-producing cells and tend to affect younger women.

Because the ovaries lie deep in the pelvis, ovarian cancer can grow for some time before causing clear symptoms, which is why it is sometimes found at a later stage.

The main symptoms of ovarian cancer are persistent bloating or a swollen tummy, feeling full quickly or losing your appetite, pain or discomfort in the tummy or pelvis, and needing to pass urine more often or more urgently than usual.

Other symptoms can include changes in bowel habit, unexplained tiredness, unintentional weight loss, and discomfort or bleeding during or after sex. The symptoms can feel similar to less serious conditions such as irritable bowel syndrome, which can make them easy to dismiss.

What matters most is whether the symptoms are persistent and frequent, especially if they are new and happen on most days. A useful guide is to see a doctor if these symptoms occur frequently, around 12 or more times a month, or if they do not settle, particularly in women over 50.

The exact cause is not fully understood, but several factors increase the risk. Getting older is one of the most important, and ovarian cancer is more common after the menopause. A family history of ovarian or breast cancer can also raise the risk.

Inherited changes in genes such as BRCA1 and BRCA2, and conditions such as Lynch syndrome, increase the risk in some families, and genetic counselling and testing may be offered to those affected. Other factors linked to a higher risk include endometriosis, never having been pregnant, and being very overweight. Some hormone treatments may also play a part.

Having a risk factor does not mean a person will develop ovarian cancer, and many people who develop it have no clear risk factors. Some factors, such as having taken the combined contraceptive pill, are linked to a lower risk.

If ovarian cancer is suspected, the first tests are often a blood test for a protein called CA-125 and an ultrasound scan of the pelvis and tummy. A raised CA-125 can be caused by many conditions other than cancer, so the result is always considered alongside the scan and a person's symptoms.

If these tests suggest a problem, further imaging such as a CT scan is used to look more closely and to see whether the cancer has spread. In many cases, a firm diagnosis and the exact type of cancer are confirmed by examining tissue, which is often obtained during surgery.

Putting these results together allows the team to stage the cancer. Knowing the stage and type helps them plan the most suitable treatment.

Treatment depends on the type and stage of the cancer and on a person's general health. The two main treatments are surgery and chemotherapy, and they are often used together.

Surgery aims to remove as much of the cancer as possible. Depending on the situation, this may involve removing the ovaries and fallopian tubes, the womb, and other affected tissue. The amount of surgery is planned carefully, and in some early cancers, especially in younger women, fertility-sparing options may be possible.

Chemotherapy is commonly used after surgery to treat any remaining cancer cells, and sometimes before surgery to shrink the tumour first. Some ovarian cancers, particularly those linked to BRCA gene changes, can also be treated with targeted therapy, including a group of medicines called PARP inhibitors. Genetic testing of the cancer and of the person can help guide these choices.

Because ovarian cancer can be linked to inherited gene changes, people may be offered genetic counselling and testing. This can guide treatment and also give helpful information for close relatives about their own risk.

Support is available for the physical and emotional effects of treatment, including specialist nurses, counsellors, dietitians and support groups. The team can also advise on managing the menopause if it is brought on by treatment, and on looking after long-term wellbeing.

There is no certain way to prevent ovarian cancer, but knowing the symptoms and acting on them promptly can help it be found earlier. People with a strong family history or a known inherited gene change can discuss their risk with a doctor, and some may be offered genetic testing or risk-reducing options, such as surgery to remove the ovaries and fallopian tubes.

Some factors are linked to a lower risk, including having taken the combined contraceptive pill, but decisions about any medicine or surgery should always be made with a doctor who knows the full picture.

The outlook depends mainly on the type of cancer and the stage at which it is found. Because symptoms can be subtle, getting persistent changes checked is one of the most useful things a person can do. The medical team is the best source of information about an individual situation.