Ovarian Cancer

This section provides information about ovarian cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of ovarian cancer treatments available.

Your ovaries are an important part of your reproductive system along with your vagina, womb and fallopian tubes. Every month from puberty your ovaries release an egg, which travels down one of the fallopian tubes to the womb where it might be fertilised.

Your ovaries also produce the female sex hormones called oestrogen and progesterone. These control your menstrual cycle until you reach the menopause.

Normally your body’s cells grow and replenish in an orderly way when and where they’re needed. If you have ovarian cancer, the cells in your ovaries have started to multiply in an abnormal way.

Facts about ovarian cancer

  • Ovarian cancer is the fifth most common cancer in women1
  • In the UK, more than 7,100 women are diagnosed ovarian cancer each year2
  • Ovarian cancer is most common in women who have been through the menopause.

1 Cancer Research UK, Ovarian cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/ovarian-cancer-risks-and-causes
2 Cancer Research UK, Ovarian cancer risks and causes http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/ovarian-cancer-risks-and-causes

There are a few types of ovarian cancer, although epithelial ovarian cancer is by far the most common. Nine out of ten ovarian tumours are a type of epithelial ovarian cancer.3

Epithelial ovarian cancer
Most cases of ovarian cancer are classed as epithelial ovarian cancer. This means that the cancer started in the layer of tissue that covers the ovary. There are different types of epithelial ovarian cancer that affect different cells. There are:

  • serous (the most common type)
  • endometrioid
  • clear call
  • mucinous

Around one in ten epithelial ovarian cancers are classed as undifferentiated or unclassifiable. This is because the cells are undeveloped so it’s impossible to know what cell the cancer started in.

Generally, you’ll have the same treatment regardless of the type of epithelial ovarian cancer you’re diagnosed with.

Germ cell tumours
One or two out of a hundred ovarian cancers are germ cell cancers.4 This type of cancer starts in the cells that make the eggs.

Stromal tumours
Stromal tumours are another rare form of ovarian cancer. The tumour forms in the cells that support the ovary called the stroma. Only five out of a hundred women diagnosed with ovarian cancer have this type.5

3 Cancer Research UK, Types of ovarian cancer http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/types-of-ovarian-cancer
4 Cancer Research UK, Types of ovarian cancer http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/types-of-ovarian-cancer
5 Cancer Research UK, Types of ovarian cancer http://www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/types-of-ovarian-cancer

We don’t know what causes ovarian cancer, but there are certain factors known to increase your risk.

Getting older
Your risk of ovarian cancer goes up as you grow older. Most cases of ovarian cancer happen after the menopause, which is why around eight in ten cases are in women over 50.6

Family history
If you have at least two close relatives who’ve had ovarian or breast cancer, you have a higher risk of developing the condition. A close relative means your mother, sister or daughter.

Having breast cancer
If you’ve had breast cancer, you could have twice the risk of ovarian cancer compared to women who haven’t. This is because sometimes breast cancer and ovarian cancer are linked to the same faulty genes.

Fertility and egg release
When your ovaries release an egg each month, the surface bursts to let it out. Every time this happens your ovary has to repair itself, which means cells need to divide. The more times your ovary produces an egg, the more times it needs to repair itself and the greater the chance of abnormal cell growth.

This could be why your risk of ovarian cancer falls if you take the pill, have multiple pregnancies or breastfeed. During these times, your ovaries do not release eggs.

Smoking
Smoking increases the risk of mucinous ovarian tumours. If you stop smoking, your risk will eventually go back down to normal.

Being overweight or tall
The risk of ovarian cancer is higher in women who have a BMI over 30 but haven’t been through the menopause yet. Research has also found taller women are more at risk of ovarian cancer than shorter women.7

6 NHS Choices, Causes of ovarian cancer http://www.nhs.uk/Conditions/Cancer-of-the-ovary/Pages/Causes.aspx
7 Cancer Research UK, Ovarian cancer risks and causes www.cancerresearchuk.org/cancer-help/type/ovarian-cancer/about/ovarian-cancer-risks-and-causes

The signs of ovarian cancer are often related to other less serious conditions. But if you notice any symptoms that happen most days, last for three weeks or more, start suddenly and are quite severe you should see a doctor as soon as possible – especially if you’re over 50 or have a family history of ovarian or breast cancer.

Screening
At the moment, there aren’t any reliable screening tests to pick up the early stages of ovarian cancer. Researchers are currently trying to identify effective screening methods, including blood tests and ultrasounds.

Symptoms of early ovarian cancer
Often women in the early stages of ovarian cancer won’t notice any symptoms at all. And because the signs are so vague, it can be hard to identify. Symptoms can include pain in your lower tummy (abdomen) or side, or you might feel bloated and full.

Symptoms of ovarian cancer growing outside the ovary
If the cancer’s started growing outside your ovary, you might notice other symptoms. These are caused as the tumour grows in your pelvis:

  • irregular periods
  • vaginal bleeding after menopause
  • back pain
  • needing to pee more often
  • constipation
  • pain during sex
  • swollen abdomen
  • loss of appetite.

Symptoms of ovarian cancer that’s spread
If the cancer’s spread to another organ, as well as the symptoms already listed, you might feel:

  • sick
  • tired
  • short of breath.

Getting symptoms checked
If you notice any of these symptoms, you should see your doctor. Your doctor might examine you to see if your womb and ovaries feel normal. They’ll ask you to lie on your back with your knees up so they can fall gently apart. Then your doctor will feel for things like lumps or swellings by putting two fingers into your vagina and pressing your tummy with their other hand.

They may also want to look at your cervix – the muscle at the opening of your womb – to see if it looks normal. They’ll use something called a speculum to carefully open your vagina. It shouldn’t be uncomfortable, but let them know if you feel any pain.

Your doctor might refer you to gynaecologist for further tests.

Ovarian cancer tests at BMI Healthcare

At BMI Healthcare, we offer specialised ovarian cancer tests at our clinics across the country. If you choose to have your ovarian cancer tests at a BMI Healthcare Women’s Health clinic, you’ll be seen by one of our expert consultant gynaecologists. These are doctors who specialise in the female reproductive system.Because our specialists are highly experienced, you’ll get expert advice and excellent care, with your test results usually delivered within 48 hours.

Blood tests
Some ovarian cancers produce a protein called CA125, which is carried in the blood. Around nine out of ten women with ovarian cancer have raised CA125 levels. Your consultant gynaecologist might ask you to have a blood test to see if your levels are normal. If your test shows high levels, you’ll need to have further tests to help identify the problem.

Ultrasound scans
Ultrasound scans build up a picture of the inside of your body by using sound waves. Your scan will help to check whether:

  • your ovaries are the right size
  • the texture of your ovaries is normal
  • there are any cysts in your ovaries.

If your scan shows any cysts that look suspicious, you may need surgery to remove them. They’ll then be sent to a laboratory and looked at under a microscope for cancer cells.

CT scans
CT scans give detailed images of your ovaries and the surrounding areas by taking X-rays at different angles.

Risk of malignancy index (RMI)
This index combines your blood test and ultrasound results, and looks at whether or not you’re past the menopause. This gives a final score. If your score’s high, you’ll need to have further tests.

Further tests
If you’re diagnosed with ovarian cancer, you’ll probably need more tests. These show how much the cancer’s grown and if it’s spread.

  • A chest X-ray sees if the cancer’s spread to your lungs or caused fluid build up
  • A CT scan or MRI scan sees if there are signs of cancer elsewhere in your body
  • Laparoscopy uses a small camera to look at your ovaries and the surrounding area without needing an operation
  • Biopsy takes a sample of tissue from your ovaries or abdomen. The samples will be checked for cancer cells in a lab
  • Removing abdominal fluid is sometimes necessary if you have a build up of fluid in your tummy. Your consultant gynaecologist will check some of the fluid for cancer cells.

The stages and grades of ovarian cancer
Once you’ve been diagnosed with ovarian cancer, your specialist will give you a stage and grade. The stage tells you the size of the cancer and how far it’s spread. The grade describes what the cells look like.

  • Stage 1: The cancer only affects the ovaries
  • Stage 2: The cancer has spread to the pelvis or womb
  • Stage 3: The cancer has spread to the lining of your tummy, your bowel and the lymph nodes in your pelvis
  • Stage 4: The cancer has spread to other parts of your body, like your lungs.

For more detailed explanations of each of the stages, please read Cancer Research’s stages of ovarian cancer guide.

  • Low grade: The abnormal cells are growing slowly
  • Moderate grade: The cells look more abnormal than at low grade
  • High grade: The cells look very abnormal and are fast-growing. 

The most common treatments are ovarian cancer surgery and chemotherapy. Because most women are diagnosed with advanced ovarian cancer, they’ll need to have a combination of both. The precise treatment you have will depend on the stage and type of your cancer. Although sometimes it’s not until surgery that the stage of the cancer can be confirmed.

If you’re worried about your fertility, you should get an expert opinion from a gynaecological oncologist who specialises in cancer of the female reproductive system.

Ovarian cancer surgery
If you’re in the very early stages of ovarian cancer, you may only need the ovary and fallopian tube that’s affected removing. This means you might still be able to have children in the future. If you’ve been through the menopause or don’t want to have any more children, you might be advised to have both ovaries and your womb removed.

Beyond the very early stages of ovarian cancer, your consultant surgeon will probably need to remove your:

  • ovaries
  • fallopian tubes
  • womb and cervix.

If the cancer has spread to your pelvis or abdomen, you’ll need debulking surgery. As well as your ovaries, fallopian tubes and womb, your surgeon will need to remove your omentum – the sheet of tissue in your abdomen that supports your organs.

Chemotherapy
Once you’re recovered from surgery, you’ll need chemotherapy. Usually, chemotherapy involves being injected with the drug for a period of time. The aim is either to stop the cancer from coming back or if it wasn’t possible to remove all the cancer during surgery – to shrink the cancer that’s left.

Radiotherapy
Radiotherapy uses high-energy rays to get rid of cancer cells. It’s rarely used to treat ovarian cancer, but it’s sometimes offered to relieve certain symptoms.

After treatment
For at least a couple of years following your ovarian cancer treatment, you’ll need to have regular appointments with your doctor or gynaecologist to see how you’re doing, if you’ve noticed any side effects from your treatment, or if you have any new symptoms. These will probably happen every two or three months.

You won’t need tests at every appointment, but some of your check-ups might include:

  • being examined
  • blood tests
  • X-rays
  • CT scans
  • Ultrasound scans.

If you’re worried or notice anything between appointments, let your specialist know as soon as possible.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.


Want to know more?
If you’d like to read more about ovarian cancer, treatment or living with ovarian cancer, please visit cancerresearchuk.org.uk.

Want to look at other treatments? or find it on the A-Z list.