Ovarian cancer
Ovarian cancer
Overview
- What is ovarian cancer?
- Types of ovarian cancer
- Symptoms of ovarian cancer
- Causes and risk factors of ovarian cancer
- Diagnosing ovarian cancer
- Staging and grading of ovarian cancer
- Treatment for ovarian cancer
- After ovarian cancer treatment
What is ovarian cancer?
The ovaries are 2 small, oval-shaped organs in the pelvis (lower area between the hips). They are on either side of the womb (uterus), close to the fallopian tubes. These link the ovaries to the womb. A layer of tissue called the peritoneum supports the ovaries.
About 7,400 women are diagnosed with cancer of the ovary (ovarian cancer) each year in the UK.
The surface of the ovaries, fallopian tubes and peritoneum are very close together. Doctors think most ovarian cancers start in the cells at the end of the fallopian tube and travel to the ovaries or the peritoneum.
Cancers of the ovary, fallopian tube and of the peritoneum are often grouped together because they’re so similar. They’re treated in the same way.
Ovarian cancer can affect anyone who has ovaries and fallopian tubes. This includes women, transgender (trans) men and people assigned female at birth.
Macmillan Cancer Support have more information on what cancer is.
Types of ovarian cancer
Epithelial ovarian cancer is the most common type of ovarian cancer. It starts in the epithelial cells. There are different sub-types.
Serous is the most common sub-type. At least 8 in 10 (80%) ovarian cancers are serous cancers. They are usually high grade which means they can grow more quickly.
Other much less common types are:
- clear cell
- endometrioid
- mucinous
These are usually diagnosed at an earlier stage than serous cancers.
Borderline tumours
Borderline ovarian tumours are also made up of abnormal epithelial cells. But they’re not cancer and grow slowly. They may spread to nearby tissue but don’t grow in these tissues or spread to other parts of the body.
Germ cell ovarian tumours
These are rare tumours that start in the ovarian cells that produce eggs. They’re not epithelial cancers.
Germ cell ovarian tumours usually affect younger people. They may be treated differently to epithelial cancer.
The Children and Young People’s Cancer Association has advice on germ cell tumours in children.
Common Symptoms
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
Causes
Causes and risk factors of ovarian cancer
Doctors don’t know what causes ovarian cancer.
Different things called risk factors can increase the chance of developing it. For example, getting older or having a family history of ovarian cancer.
Having risk factors doesn’t mean someone will get ovarian cancer.
Macmillan Cancer Support have more information about the causes and risk factors of ovarian cancer.
Diagnosis
Your GP will start by asking about your symptoms and will also carry out an internal vaginal examination to check for any lumps or swelling in that area.
CA125 blood test
A CA125 blood test checks whether the level of this protein in your blood is raised, since it can be higher in ovarian cancer.
This test is sometimes repeated during follow-up care, though it is not always needed. If the CA125 level starts rising, it can be an early sign that the cancer has come back, and your doctor may then ask for further tests such as a CT scan.
Even so, doctors usually prefer to wait until symptoms actually appear before starting more treatment. There are good reasons for this: treating before symptoms show up does not lead to better results, it shortens the gap between treatments, and it means side effects begin sooner. That said, you and your specialist can still discuss what your options would be if further treatment becomes necessary.
Ultrasound scans
An ultrasound scan is used to look closely at the organs in your pelvis and abdomen.
If it picks up anything unusual, your GP will refer you to a gynaecological cancer specialist, and you should be able to see them within 2 weeks. If your GP finds a lump in the pelvis or notices fluid building up in the abdomen (known as ascites), you will be referred to a specialist right away.
In some cases, ovarian cancer only comes to light after someone is admitted to hospital because a symptom has made them unwell.
At the hospital
Your specialist will usually ask about your general health, any past health problems, and whether cancer runs in your family. They will also carry out another internal examination, and if you have not already had a CA125 test or an ultrasound, they will arrange these for you.
Risk of Malignancy Index (RMI)
Your doctor may combine your test results into what is called a Risk of Malignancy Index, or RMI, which helps show how likely it is that your symptoms are due to cancer. This takes into account whether you have been through menopause, your CA125 level, and what the ultrasound showed.
Further tests
Your specialist will arrange additional tests to help confirm the diagnosis and plan your treatment.
CT scan: this takes a series of X-ray images that are put together to form a detailed 3D picture of the inside of your body.
Draining fluid from the abdomen: sometimes the swelling in the tummy is due to a build-up of fluid called ascites. If this is happening, your doctor may take a sample of the fluid to check it for cancer cells. A local anaesthetic is used to numb the skin first, then a thin needle is passed through gently to draw off some fluid into a syringe, which is sent to the laboratory for testing.
Biopsy: this involves the doctor taking a small sample of tissue from the lump or the area that looks abnormal. The sample is then examined under a microscope in the laboratory.
Genetic testing: your doctor or nurse may also raise the idea of a blood test to check for a change, or mutation, in the BRCA genes, which can be linked to ovarian cancer. The result helps your doctor work out whether certain targeted therapy drugs are likely to help you. Waiting for results like these can feel stressful, and Macmillan Cancer Support has more information that may be of help during this time.
Staging and grading of ovarian cancer
Staging describes where the cancer began and whether it has spread elsewhere, while grading describes how different the cancer cells look from normal cells under a microscope. In most cases, the exact stage only becomes clear once the cancer has been removed during surgery; if surgery has not yet happened, your doctor will estimate the stage based on your test results. Knowing both the stage and the grade allows your medical team to plan the treatment that suits you best. Macmillan Cancer Support also has further information on staging and grading of ovarian cancer.
Treatment
Your medical team will sit down together to work out the best treatment plan for you. This group of specialists is called a multidisciplinary team, or MDT.
Your cancer doctor and specialist nurse will walk you through the different treatment options and what side effects to expect. They will also help you think through what matters most to you when deciding on treatment.
Surgery
In most cases, surgery is done to remove the cancer entirely or as much of it as possible. This usually means removing the womb, the ovaries and the fallopian tubes.
If your cancer is caught at a very early stage, it may be possible to have surgery that preserves your fertility.
Chemotherapy
Chemotherapy uses anti cancer (cytotoxic) drugs to kill cancer cells. You will usually be given carboplatin together with paclitaxel.
Chemotherapy may be given before surgery, after surgery, or both.
In some cases, if surgery is not possible, chemotherapy is used on its own as the main treatment.
Targeted therapies
Targeted therapies work by acting on something in or around the cancer that helps it grow.
You may be offered a type of targeted therapy known as a PARP inhibitor. This is taken as a tablet, and you continue taking it for as long as it keeps working for you. This is known as maintenance treatment.
Another drug, bevacizumab (also known as Avastin), may be used if the cancer has spread further within the pelvis.
Some treatments may only be available to you through a clinical trial.
Macmillan Cancer Support has further information on treatments for ovarian cancer.
Treating ovarian cancer that comes back
Hearing that the cancer has returned can be very hard news to take in. You may feel shocked, and the thought of going through treatment again can feel overwhelming.
Your doctor and specialist nurse are there to support you through this. They will talk you through the treatment options best suited to you. The goal is to keep the cancer under control for as long as possible.
Your treatment plan will depend on a few things, including which treatments you had before, how long they kept the cancer away, and whether you had any difficult side effects from earlier treatment.
Usually, this means more chemotherapy along with a targeted therapy drug. In some cases, further surgery may also be an option.
Over the following years, you may go through different treatments at different times to keep the cancer under control.
Your doctor may also mention the possibility of newer treatments being tested through a clinical trial.
Other treatments
Some other types of cancer treatment are also used at times.
Hormonal therapy
Hormonal therapy can slow the cancer's growth by blocking or lowering oestrogen levels in the body. It may be considered if the cancer returns and you would rather avoid more chemotherapy, or want to put it off for a while. It is usually used for low grade cancers.
The drugs used are the same ones used in breast cancer treatment, including tamoxifen and letrozole.
Radiotherapy
Radiotherapy uses high energy rays to treat cancer. It is not commonly used for ovarian cancer, but it may help control symptoms such as bleeding or pain in the pelvic area. This is known as palliative radiotherapy.
A more focused form called stereotactic ablative radiotherapy (SABR) may be used if the cancer has spread to just one other part of the body, such as a lymph node, the lung or the brain.
After ovarian cancer treatment
Once treatment ends, you will have regular check ups, usually every few months to begin with.
If you notice any new symptoms, or symptoms you had before come back, get in touch with your specialist doctor or nurse right away. There is no need to wait for your next scheduled appointment.
It can take a while to learn what feels normal for your body again. You may find yourself worrying that every small ache or pain means the cancer has returned. Your specialist nurse can offer support and help you understand which symptoms are worth watching for.
Your sex life after ovarian cancer
Cancer and its treatment can bring both physical and emotional changes that affect your sex life. If you had not yet gone through menopause, treatment will usually bring it on.
You may also notice changes such as scarring or hair loss that affect how you feel about your body. For most people, these difficulties ease gradually with time after treatment ends. Your nurse can offer further guidance and support.
Macmillan Cancer Support also has more advice on sex and cancer.
Complications
Wellbeing and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. Changes to the way you live, like eating well and keeping active, can help your body recover and improve your health and wellbeing.
Macmillan Cancer Support have more information on leading a healthy lifestyle after treatment.
Getting support
Everyone has their own way of dealing with illness and the different emotions they experience. You may find it helpful to talk things over with family and friends or your doctor or nurse.
Macmillan Cancer Support also has further information to support you. You can:
- phone the Macmillan Support Line on 0808 808 00 00
- chat to Macmillan specialists online
- use the Macmillan ovarian cancer forum – you can talk to others affected by ovarian cancer, ask questions and share your experience
Other organisations who offer information and support include:
- Eve Appeal – offer information and support for anyone affected by gynaecological cancers
- Ovacome – offer information and support for anyone affected by ovarian cancer
- Target Ovarian Cancer – offer information and support to anyone affected by ovarian cancer
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