Ovarian Cancer Q&A

Dr Anji Anand is a consultant clinical oncologist based at The Park Hospital. Mr Jafaru Abu is a consultant gynaecological oncology Surgeon based at The Park Hospital. They both share their wealth of knowledge to answer your most commonly asked questions about ovarian cancer, covering signs and symptoms as well as available treatments.

What is ovarian cancer?

Dr Anji Anand: Ovarian cancer is any cancerous growth that arises from the different parts of the ovaries. Majority of the ovarian cancers arise from the outer lining (called epithelium) of the ovary and hence are called epithelial ovarian cancers. In the UK, ovarian cancer is the 5th most common cancer among women, after breast cancer, bowel cancer, lung cancer and uterine (womb) cancer.

Mr Jafaru Abu: Ovarian cancer is the fifth most common cancer in women in the UK, affecting over 7000 women every year. It is a disease that affects the ovaries. There are usually two ovaries, one on either side of the womb inside the pelvis. It is a major source of the main female hormone called oestrogen. It also produces eggs which can be fertilised by sperm and then develop into a fetus. There is also a variant of abdominal cancer that behaves like ovarian cancer and the treatment for both is similar. This variant of ovarian cancer affects the lining of the inside of the abdomen and pelvis (peritoneum). It is called primary peritoneal cancer.

What are common ovarian cancer symptoms?

Dr Anji Anand: Symptoms of ovarian cancer are non- specific and often occur when disease is at an advanced stage. Common symptoms are fullness and bloating (often mistaken for irritable bowel syndrome), abdominal discomfort, back pain, changes in bowel habits, indigestion or heartburn, unexplained weight loss and fatigue. If any of these symptoms are persistent over a few weeks then you must see your GP for a check-up without delay.

Mr Jafaru Abu: It is wrong to say that ovarian cancer is a "silent killer". It isn't. About 95% of women with ovarian cancer do report symptoms. The only problem is that most of the symptoms are vague and could be non-gynaecological. The common symptoms are: abdominal bloating (increased girth), feeling full quickly after small meals and difficulties eating, fatigue, bowel related symptoms or change in bowel habit such as constipation and diarrhoea, urinary symptoms, abdominal/pelvic pain, and menstrual irregularities, loss of appetite and loss of weight.

What kind of women are most at risk of developing ovarian cancer?

Dr Anji Anand: Women who have never had children, who had unsuccessful fertility treatments, or had their first child after the age of 30 have an increased risk of ovarian cancer. Also women who started menstruation early (before age of 12) and go through menopause later in life are also at risk. Advancing age, obesity, a family history of breast or ovarian cancer and taking oestrogen only hormone replacement therapy after menopause are some of the other risk factors.

A woman's risk of developing ovarian cancer increases with age. Although ovarian cancer can develop at any age, women over the age of 55 are more likely to develop ovarian cancer. About 70% of women with ovarian cancer are older than 55 years.

Mr Jafaru Abu: There is a strong association between ovarian cancer and age. The incidence rises exponentially from 35-40, peaking at around the age of 80. In the UK, about 75% of all ovarian cancers are diagnosed in women above the age of 55. About 20% are related to some major life style patterns such as hormone replacement therapy, exposure to asbestos, tobacco smoking, irradiation, strong family history (about 3% of cases occur in those with ovarian cancer in their families), infertility, personal history of cancer and genetic factors (5-15% of ovarian cancer cases are due to inherited conditions, majority of which are due to BRCA1 and 2 mutations).

75% of ovarian cancer cases occur in women above the age of 55.

If there is a history of ovarian cancer in the family, should extra precaution be taken?

Dr Anji Anand: If there is a strong family history of ovarian cancer (i.e. more than one member of family has ovarian cancer or even breast cancer) then you must see your GP and discuss this. You may get referred to a family history clinic or even to the specialist clinical genetics clinic. You may receive counselling and also undergo genetic testing (blood test) to establish whether there is an inherited faulty gene (i.e. BRCA1/ BRCA2).

Mr Jafaru Abu: The risk of ovarian cancer is 3 times higher in those whose mother or sister either has or has had ovarian cancer compared with women from families who have not had the disease. There is no nationwide screening for ovarian cancer. However, women who are at risk or have a family history may be offered an annual scan as well as a blood test called CA125. The latter is an ovarian cancer tumour marker and is raised in about 80% of cases. However there is no evidence so far that these tests can pick up cancer early to save lives. For instance, CA125 is only raised in about 50% of women with the early stage disease. The advice is that if you think you are at an increased risk of ovarian cancer, you should talk to your GP.

How is ovarian cancer detected?

Dr Anji Anand: There is no effective screening test for ovarian cancer that we can routinely recommend. But if you have symptoms of ovarian cancer, you must see your GP without delay. He/she will examine your abdomen for any signs (swelling or mass) and may get a blood test done. The blood test checks for a protein called CA125, high levels of which could indicate ovarian cancer. An internal (trans-vaginal) ultrasound scan can show any abnormalities of the ovaries. If the blood test and ultrasound scan are abnormal, you will be referred to a specialist gynaecology unit where you may undergo further tests such as a CT scan.

Mr Jafaru Abu: If you think you have any of the symptoms of ovarian cancer you should see your GP as soon as possible. They will examine you first and then may order some blood tests, which will usually include CA125. If the result of the blood test and the examination suggests you may have ovarian cancer, your GP will then refer you to a Specialist in gynaecological cancer. Your specialist will again examine you and may arrange some imaging investigations such as an ultrasound scan or computerised tomography (CT) scan. These investigations should give your specialist a good idea as to whether you may have ovarian cancer or not and be able to proceed to the next stage of your management.

What treatments are available for ovarian cancer?

Dr Anji Anand: Ovarian cancer is treated primarily by surgery - this involves removal of the uterus, the fallopian tubes, and both the ovaries. Surgery is generally followed by chemotherapy, which reduces the risk of recurrence (stops the cancer from coming back). If the cancer is advanced at diagnosis, surgery may not be appropriate and chemotherapy is given to shrink the cancer before surgery.

Mr Jafaru Abu: The mainstay of treatment for ovarian cancer is primary surgery. Surgery usually involves a big up and down cut on your tummy under a general anaesthesia. The extent of surgery will depend on the stage of the disease. The aim of surgery is usually to remove all visible cancer. Sometimes, if the CT scan shows that the cancer is too advanced, your specialist may recommend that you have chemotherapy first to help shrink the cancer and make it operable at a later date. This is called delayed surgery.