Cancer begins with a change in the structure of the DNA that is present in all cells. DNA provides the cells with instructions, including when to grow and reproduce. A change in the DNA’s structure is known as a mutation and it can alter the instructions that control cell growth. This means that the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably they produce a lump of tissue called a tumour.

As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such as pain in the pelvis and lower stomach, persistent bloating and difficulty eating.

If you experience these symptoms, particularly over a long period of time, it is important to see your GP.

There are several types of ovarian cancer. They include:

·         epithelial ovarian cancer, which affects the surface layers of the ovary

·         germ cell tumours, which originate in the cells that make the eggs

·         stromal tumours, which develops within the cells that hold the ovaries together

Epithelial ovarian cancer is by far the most common type of ovarian cancer. This information concentrates on epithelial ovarian cancer.

The exact cause of ovarian cancer is unknown, although a number of possible factors are thought to be involved. 1 in 10 cases of ovarian cancer has a genetic link.

SYMPTOMS

The symptoms of ovarian cancer can be difficult to recognise, particularly in early stages of the disease.

This is because they are often the same as symptoms of other, less serious, conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS).

Three main symptoms are more frequent in women diagnosed with ovarian cancer:

·         persistent pelvic and abdominal pain

·         increased abdominal size/persistent bloating (not bloating that comes and goes)

·         difficulty eating and feeling full quickly, or feeling nauseous

Back pain and needing to pass urine more urgently and frequently than normal are symptoms probably not due to ovarian cancer, but may be present in some women with the disease.

Remember that ovarian cancer is rare in women under 40 years old. If you regularly have any of these symptoms, talk to your GP. If you've already seen your GP and the symptoms continue or get worse, it is important to go back for review.

CAUSES

In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer is not identified at an early stage, it can spread to nearby parts of the body, including other parts of the female reproductive system.

Increased risk

Family history

If you have two or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer, you may be at higher risk of developing the condition.

Faulty genes linked to ovarian cancer include BRCA1 and BRCA2. They are also known to be linked to the development of breast cancer.

About one in 10 ovarian cancers are thought to be caused by a faulty gene.

Increased risk of having a faulty gene:

·         One close relative (such as your mother, sister or daughter) diagnosed with ovarian cancer at any age, and at least two close relatives who have breast cancer. The relatives with breast cancer should come from the same side of your family, and should have an average age of less than 50 years.

·         One close relative diagnosed with ovarian cancer at any age, and at least one close relative with breast cancer diagnosed under the age of 40. These relatives should come from the same side of your family.

If you are concerned you may be at higher risk of ovarian cancer because of your family history, talk to your GP. If you are at high risk, your GP can refer you to a genetic counselling clinic. It is possible to test for the BRCA1 and BRCA2 genes.

Age

Ovarian cancer risk increases with age and most cases of ovarian cancer occur after the menopause. Over 8 out of 10 cases are in women over 50 years old.

Fertility and egg release

Every time an egg is released into the reproductive system at ovulation, the surface of the ovary has to break to let the egg out. The surface of your ovary is damaged during this process and needs to be repaired. When this happens, there is a greater chance of abnormal cell growth during the repair.

Eggs are not released when taking the contraceptive pill, during pregnancy and when breastfeeding. The risk of ovarian cancer may therefore be decreased in women who have had multiple pregnancies, breastfed or used the pill.

Hormone replacement therapy (HRT)

There is a small increased risk of ovarian cancer in those using HRT. However, if HRT is stopped, after five years the risk is reduced to the same level as women who have never taken HRT.

Endometriosis

Endometriosis may increase the risk of ovarian cancer. Endometriosis is a condition where cells that usually line the womb grow elsewhere in the body. These endometrial cells behave as if they were in the womb, so thickening and bleeding that usually happens during menstruation occurs in this other part of the body.

DIAGNOSIS

It is important to see your GP if you are experiencing symptoms as described above.

The GP will take a history about the symptoms, general health and history of ovarian or breast cancer in the family.

The GP is likely to carry out a vaginal or internal examination to investigate the size of the ovaries and womb. A blood sample may be requested and referral for an ultrasound scan.

If necessary, specialist referral may be necessary in order to undertake further tests to confirm the diagnosis of ovarian cancer, including a blood test and ultrasound.

Blood test (CA125)

This blood test check for a chemical called CA125 in the blood. This chemical is produced by some ovarian cancer cells. A very high level of CA125 in the blood may mean you have ovarian cancer.

This test is not specific to ovarian cancer and may also be raised in many benign conditions. A raised level of CA125 does not conclude a diagnosis ovarian cancer.

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

·         bloating

·         feeling full quickly

·         loss of appetite

·         pelvic or abdominal pain

·         needing to urinate urgently or frequently

The CA125 test is particularly important if the woman is 50 or over, or experiences these symptoms more than 12 times each month.

Unexplained weight loss, fatigue or changes in to bowel habits, such as diarrhoea or constipation, may also suggest testing for CA125.

If a woman is 50 or over and experiences symptoms that could suggest irritable bowel syndrome in the last 12 months (bloating, abdominal pain or changes in bowel habits) a CA125 level may be tested.

A significant proportion of women with early stage ovarian cancers have a normal CA125 level.

Ultrasound

Ultrasound produces an image of the ovaries. This may be an internal ultrasound (transvaginal), where the probe is inserted into the vagina. Or it may be an external ultrasound, where the probe is put on the abdomen. The images show the size and texture of the ovaries, as well as any cysts that may be present.

Further tests

If a diagnosis of ovarian cancer is made, further tests will be needed to determine the size and extent of the spread. This is called staging.

·         Chest X-ray – to check for spread to the lungs

·         CT scan or MRI scan –to look for signs of cancer elsewhere in the chest, abdomen and pelvis.

Abdominal fluid aspiration – if ovarian cancer has spread it can cause fluid to accumulate in the abdomen. A thin needle is passed into the abdomen to take a sample of fluid to be tested for cancer cells.

Laparoscopy – performed if the gynaecologist wants to take a better look at the ovaries. A thin viewing tube with a camera on the end is inserted through a small cut in the lower abdomen (to examine the ovaries. A small sample of tissue may be taken for testing (known as a biopsy).

Staging

When ovarian cancer is diagnosed, the doctors will give it a stage. The stage describes the size of the cancer and how far it has spread. Ovarian cancer has four commonly used stages:

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 uterus.

Stage 3: the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis.

Stage 4: the cancer has spread to other parts of the body such as liver, spleen or lungs

This is a simplified guide: each stage is divided into further categories called A, B and C. Grading

The grade of cancer refers to the appearance of cells under a microscope.

Low grade: cells though abnormal, 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.

TREATMENT

When deciding on treatment the treatment team will consider:

·         stage of cancer

·         general health

·         whether fertility is an issue

The main treatments for ovarian cancer are:

·         surgery

·         chemotherapy

Treating advanced ovarian cancer

Ovarian cancer is often diagnosed at an advanced stage and may not be curable. The goal of treatment is to put the tumour into remission so it shrinks or disappears. Even if there is no chance of a cure, surgery may be used to remove as much of the cancer as possible. Chemotherapy can reduce symptoms such as pain by shrinking the cancer. Occasionally, radiotherapy may be used to shrink the tumour and reduce pain.

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.

The surgery will probably involve removing:

·         both ovaries and the fallopian tubes (called a bilateral salpingo-oophorectomy)

·         uterus (called a total abdominal hysterectomy)

·         omentum, a fatty layer of tissue within the abdomen (called an omenectomy)

The surgeon may also remove the lymph nodes from the pelvis and abdomen. They may also take samples of nearby tissue and send it to the laboratory 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, only the ovary or ovaries may be removed, leaving the uterus intact. This means you the woman may still be able to carry a pregnancy. For most women, however, pregnancy is not an issue and the normal procedure is to remove both ovaries and the uterus.

PREVENTION

There is no reliable screening test for ovarian cancer at present. However, there are a number of things that may help prevent ovarian cancer.

Stopping ovulation and the contraceptive pill

Anything that stops the process of ovulation can help minimise your chances of developing ovarian cancer. Factors that stop ovulation temporarily or altogether include:

·         pregnancy and breastfeeding

·         the contraceptive pill

·         surgery removing the ovaries

Diet and lifestyle

Research has found links to being overweight or obese. Losing weight through exercise, and having a balanced diet, may help lower the risk of ovarian cancer. Aside from this, it is known regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can help prevent all forms of cancer and heart disease.

Screening for ovarian cancer

At present, there is no screening method for ovarian cancer reliable enough to be used by all women in the UK. Clinical trials into this are continuing.

Women may be eligible for screening if they are at high risk of developing the disease because of a strong family history or they have inherited a particular abnormal gene.

If you are at high risk, your GP can refer you to your local genetics service or family cancer clinic. You may be screened for ovarian cancer once over the age of 35, or once you are five years away from the age at which your youngest relative was diagnosed with the condition. From this point, you will be screened again once a year.

The screening tests for ovarian cancer are the same as those routinely used to diagnose it. The tests are:

·         blood test for higher-than-normal levels of CA125

·         transvaginal ultrasound

Online Personal Education and Risk Assessment (OPERA)

Macmillan's online interactive assessment tool, called OPERA can assess personal risk.

It is designed to be used by patients and health professionals to assess a person's risk of developing the condition based on their family history of breast cancer and ovarian cancer.

Caroline's story-

"I had Ovarian Cancer 8 years ago and I was 17 when I had my operation, and although I know it's rare to contract it at that age, I would like to tell you my story so that younger women are more aware of the matter.

It's hard to place when the actual symptoms started and which ones were related, but almost two years before being diagnosed, I had the funny, vague complaints. I lost a lot of weight, nearly a stone in a week and another stone subsequently over a short period. Speaking of periods, they stopped suddenly and completely. By the time I had my treatment, I hadn't had a period for almost two years. I also experienced nausea, dizziness and turned a funny yellow colour.

If you would like to tell us your story so we can help and inform other women; more information is available HERE

This Interview was recorded in March 2009

Ovarian Cancer: Text Version

Welcome to this month’s Wellbeing of Women health podcast. Today we will be discussing Ovarian cancer and the little known symptoms that accompany the disease.


Ovarian cancer is often referred to as the ’silent killer’ as it is difficult to detect and treat. You may be surprised to learn that it is the most common form of gynaecological cancer.


7,000 women are diagnosed in the UK each year - around three times the number of cases of cervical cancer and only 30% of those women will survive for more than 5 years after.


Consultant gynaecological oncologist Sean Kehoe joins us today to discuss the disease and it’s little known symptoms.


Hello Sean

Hello


Thanks for joining me today.

You’re very welcome


Those are quite scary statistics really when you think how much press coverage cervical cancer receives and yet women seem to know very little about ovarian cancer, why is that?

I think there is a variety of factors as to why one cancer seems to get more publicity over another which can relate to individuals who are suffering from he disease. If we take the comparison between cervical and ovarian cancer, cervical cancer does impact on quite a lot of younger women and I suppose to that extent we may hear as I call it some more noise about that disease whereas ovarian cancer while it does affect some young women is primarily a disease of the older population and I think that in part explains why you get this discrepancy between the public being aware of one disease over another.

Secondly in comparing both of these, cervical cancer has a screening programme which again if you like has been advertised widely and women are well aware of so that heightens the profile of knowledge of the disease, of cervical cancer compared to ovarian cancer.


Why is ovarian cancer often referred to as the ‘silent killer’?

The reason for that is that in many cases, patients will come with the disease, quite often advanced disease and yet give a story that the health problems they encountered had only occurred a few weeks or maybe a few months prior to being diagnosed with ovarian cancer so to that extent it was felt there was very little lead time into the diagnosis based on clinical symptoms and the term the ‘silent killer’ was proposed for this disease ie. the disease will have spread without the patient knowing until the last minute.


Are there actual symptoms to look out for in that case?

There are symptoms alright, the main ones that women complain of are bloating of the abdomen or swelling of the abdomen, these are very common symptoms in ovarian cancer, part of the difficulty regarding symptoms of ovarian cancer is that many of the symptoms are ones women can suffer from anyway without having cancer so a lot of research is presently ongoing trying to define the optimum or most relevant symptoms that would help the patient and indeed their doctor come to a possible diagnosis of early ovarian cancer and further work on this is awaited.


So you said it’s older people generally who suffer from ovarian cancer, what’s the age group that’s most likely to develop it?

Well, the vast majority of patients with ovarian cancer are post-menopausal so they are over 50 and the highest instance of the disease will be between women aged 50 – 74 and they’ll be the most likely ones to develop it. Another group of women who have an increased risk of it are those with a genetic predisposition to ovarian cancer which links with their predisposition to breast cancer as well but they only account for between 5 and 10% of all cases. Most women who do get ovarian cancer have a sporadic disease, as it’s called.


Do we know what actually causes it in that case in the 90%?

In the 90% that’s where the difficulty lies, we do know some factors that protect against ovarian cancer but the actual cause of the disease itself does remain unknown. There are a lot of associations but a true cause factor still eludes us.


Are there any screening programmes available specifically for ovarian cancer?

At the moment there are screening trials ongoing and these will hopefully give us some answers probably in 2012 or 2013. The two trials, the first one is a very, very large trial looking at the general population and that’s recruited over 200,000 women looking at the screening with ultrasound or screening with a blood test called CA-125 blood test and when we have the results of that we’ll know which is the best way of screening for ovarian cancer. The second trial relates to using the same kind of systems ie. scanning or CA-125 in women where there is a strong family history of the disease and again we still have to wait a few years for these trials to report until then, we don’t have any proven screening programme as such for ovarian cancer.


And so when women go for their smear tests, I know a lot of women seem to think that ovarian cancer will show up though that, that’s not the case?

No, that’s not the case, smear tests themselves are aimed to pick up some pre-cancerous changes on the neck of the womb that you can then treat and prevent cervical cancer from occurring. You will occasionally get women with ovarian cancer that are found to have an abnormal smear but that’s just coincidental rather than anything else.



Right, and why are women who take the contraceptive pill or have already had children less likely to develop the disease?

There’s been a theory about for decades now that the amount of time a woman ovulates is directly proportional to her risk of ovarian cancer and whilst there’s a lot of research required to define exactly what’s happening it seems to be holding sound over the decades. Therefore if you stop a woman ovulating by using the pill or with a pregnancy, you get a protective effect and that seems to be something that can stay with a woman for some years for example if you use the pill even for one year, there seems to be a protective effect of reduction in ovarian cancer of 18% up to over 40% depending on the papers you read and that protection seems to last for over 30 years since the woman stopped using the pill. That’s quite interesting in trying to prevent this disease occurring.


Now, you’ve recently carried out some WoW funded research with Joanne Morrison looking at virotherapy of ovarian cancer which I believe has led to some exciting outcomes. Can you explain a little about that and what you discovered?

Essentially what this is about is looking at ways of get ting chemotherapy or treatments into the cancer cell itself and one area that’s always been of interest is using viruses to carry whatever message we want to use be that the chemotherapy agent or the virus itself being the killer agent into the abdomen where ovarian cancer is obviously placed. At the moment, there were various problems with this in the past but at the moment we may have overcome some of those problems. We ‘re at the stage now looking at proceeding further and trying this out in humans to see what effect this may have. I think, whilst it’s exciting work of course, there are many years of further work required before this will be used in general terms and as a part of the normal treatment of ovarian cancer. But we’ve always hope.

So what is the next step?

Well, the next step at the moment will be developing the programme so that we can test it out in some patients with ovarian cancer to see what effect it has in those patients. That’s the next step.


And finally what advice or message do you want to leave with our listeners about ovarian cancer?

Well I think, as with anybody if you have concerns that you may be suffering from ovarian cancer contacting your own doctor seems quite sensible but the symptoms to watch out for which might be of help are sustained swelling or bloating of the stomach which lasts consistently over a few weeks, maybe three or four weeks and at that stage I would suggest making contact with your GP would be worthwhile. The other message I suppose which is equally important is our desire to improve survival rates of ovarian cancer. To do that of course, it’s very important we undertake continuing research and supporting charities that focus down on ovarian cancer such as Wellbeing of Women is always to be recommended.

Thank you very much.

Thank you.


It’s been extremely enlightening and hopefully by keeping an eye out for the symptoms you described, it will help some women out there, thank you.

Thank you very much indeed.
 

Often dubbed the 'silent killer', ovarian cancer has spawned a multitude of misconceptions.

Discover the truth behind the myths surrounding the disease.

Ovarian cancer does not run in my family, so I don’t have to worry about it.

No - most ovarian cancers (90 percent) occur in women with no family history.

There is no cure for ovarian cancer

Women are cured, particularly in the early stages of the disease, where the cancer is localised to the ovaries.

I won’t be able to have children if I’m diagnosed with ovarian cancer

This is not true, it very much depends on the stage and type of ovarian cancer.

My cervical screening test will show if I have ovarian cancer

Cervical screening tests are only for pre-cancerous condition of the cervix.

Fertility drugs cause ovarian cancer

There is conflicting evidence on this one. The most recent study- which is good - says there is no increase.

To find out about our research follow these links:
 

• Enhancing virus killing of cancer cells for the treatment of ovarian cancer

• Improving virus gene therapy for ovarian cancer

• The role of LARP1 protein in the development of ovarian cancer chemotherapy resistance

• Gene linked to treatment resistance in ovarian cancer

• The Royal College of Obstetricians and Gynaecologists website has a wide range of information and guidelines on many women’s health topics. This can be found at: http://www.rcog.org.uk/womens-health/patient-information  

• NHS Choices website also has a range of health information. This can be found at: http://www.nhs.uk/Pages/HomePage.aspx