Ovarian cancer is the 6th most common cancer in the UK, with 7,500 women diagnosed every year. (1) Early detection increases the likelihood of successful treatment, so it is important to know what signs and symptoms to look out for, who is at higher risk, and what treatment options are available.
First, let’s go over some biology.
What is cancer?
Hasn’t everyone heard of cancer?
Perhaps, but do we really understand what cancer is?
Our bodies, organs and tissues are made up of millions of cells. These microscopic structures grow and divide by a process called mitosis to keep us alive. There are different types of cells in different parts of our bodies, to carry out different functions. For example, cells in the heart are different to those in the lungs. The body has mechanisms in place to ensure that cells grow and divide at the right pace to keep us healthy. (1)
But sometimes, this can go wrong. Cells can divide too much and accumulate to form a lump of cells: a tumour. Broadly, there are two types of tumours:
- Benign tumours are not cancerous. They are localised and do not spread.
- Malignant tumours are cancerous. These could spread in the body, and take up the place of normal, healthy cells in the body. Depending on which normal cell is compromised, this can cause various symptoms in the body.
In summary, a cancer is a lump of abnormal cells in the body, which can spread and cause problems where the normal cells should have been.
The ovaries are two almond-shaped organs on either side of the womb (uterus). In women of child-bearing age, i.e. between puberty and menopause, ovulation happens once a month, around the 14th day of a regular cycle. Ovulation is when the ovaries release an egg, which travels down the fallopian tubes where it can be met by a sperm cell (if one is present). If fertilised by the sperm, the egg travels to the womb, where it can start to develop into a baby. If it is not fertilised, it will be shed with the lining of the womb as a period. (1) People do not ovulate before their periods start, once their periods stop (after menopause), when they are pregnant and exclusively breastfeeding. (2)
So, ovarian cancer is a cancer of the ovaries?
Yes – ovarian cancer affects anyone with ovaries (women, transmen, non-binary and intersex people with ovaries). You cannot have ovarian cancer if your ovaries have been removed. (4) Ovarian cancer is an abnormal accumulation of cells in the ovaries. There are two subtypes of ovarian cancer based on the type of cell it starts from in the ovary. Each of these types is further divided into benign, borderline malignant, or malignant. Malignant ovarian cancers can spread to other surrounding tissues and organs, such as the bowel, liver, or lungs. (2) The risk of spread is reduced if the cancer is caught early.
Who is at greater risk of developing ovarian cancer?
Women with a higher number of ovulations throughout their lifetime are at higher risk. This includes women who start their periods at a young age, have been on the combined oral contraceptive pill (the pill that contains oestrogen), have no children, and have a late menopause. It also includes women undergoing in vitro fertilisation (IVF) and taking hormonal replacement therapy (HRT) for menopause. As with all treatments, discuss whether the benefits outweigh the risks with your doctor. Genetics are also at play, with higher rates of ovarian cancer in women with ovarian or breast cancers in their families. Finally, as for most cancers, the risk increases with age and lifestyle factors such as smoking, obesity.
Is ovarian cancer preventable?
Ovarian cancer is not preventable as such; however, you can take certain steps to decrease your risk. As with most cancers, not smoking and maintaining a healthy weight limit your risk of developing cancer. Ask your GP for more information, including on the NHS website and your local smoking cessation and weight loss support programmes. Finally, try to avoid exposure to asbestos, as this has a link with increased rates of ovarian cancer.
What symptoms should I look out for?
Having cancer can cause symptoms like fever, fatigue, and unplanned weight loss. There are several reasons for these symptoms. As a tumour grows, it can use up a lot of the body’s energy. The body’s immune system will try to fight the tumour, causing symptoms throughout the body. Finally, a tumour can press on surrounding structures in the body, such as blood vessels, organs, and nerves. (3) The symptoms for ovarian cancer are vague and can overlap with other conditions. These symptoms include feeling bloated, a decreased appetite, lower tummy pain, passing urine more often, changes in bowel movements, and bleeding from the vagina that is not your period. (2)
How is ovarian cancer diagnosed?
If you are concerned that you may have ovarian cancer, or are experiencing unusual symptoms that are worrying you, contact your GP. Investigations include: (2)
- An examination: your GP will feel your tummy and may use a speculum to look inside your vagina, depending on the symptoms you have been experiencing. Remember to let your doctor know if you are uncomfortable at any point – you are in control of the examination.
- Blood tests: general screening blood tests can sometimes be abnormal in cancer. Your doctor may want to look for specific cancer markers, like ca125.
- Referral for a pelvic ultrasound: this ‘jelly scan’ is like the one you would have in pregnancy, and allows doctors to have a closer look at your ovaries. It will involve a probe placed on your tummy, or a small tube in your vagina to look inside your tummy. It is a quick, painless test.
- Referral to the specialist gynaecology department. They will see you within 2 weeks if a cancer is suspected.
- Other possible tests are a CT scan or surgery using a camera to look at your ovaries (laparoscopy), take a biopsy, or remove the ovaries (laparotomy).
You should receive the results within a few weeks. The medical team is there to support you, and you should raise any queries or concerns you may have. It may be helpful to bring a friend or family member with you for support. (4)
I’ve received a diagnosis of ovarian cancer – what next?
Treatment of ovarian cancer is generally more likely to be successful the earlier the cancer is detected, but ultimately depends on the cancer’s size, type and location. Your general health will also influence the treatment choice. The mainstay treatments are surgery and chemotherapy. Other more novel therapies exist, such as hormonal treatments and targeted medication. (4) See our article ‘Ovarian cancer – staging and treatment’ for more information.
What help and support is available?
Your GP and doctors are there to help guide you through this journey and answer your questions. They will give you more information on other members of the medical team who can support you, for example cancer nurses and clinical nurse specialists. Various charities, including Macmillan Cancer Support, Cancer Research UK, Ovacome, Target Ovarian Cancer and Marie Curie, also provide services for ovarian cancer patients. For more information, see the NHS website. (4)
- Ovarian cancer | Cancer Research UK [Internet]. Cancerresearchuk.org. 2022. Available from: https://www.cancerresearchuk.org/about-cancer/ovarian-cancer
- Ovarian cancer | Health topics A to Z | CKS | NICE [Internet]. Cks.nice.org.uk. 2018. Available from: https://cks.nice.org.uk/topics/ovarian-cancer/
- Signs and Symptoms of Cancer | Do I Have Cancer? [Internet]. Cancer.org. 2022. Available from: https://www.cancer.org/treatment/understanding-your-diagnosis/signs-and-symptoms-of-cancer.html
- Ovarian cancer [Internet]. nhs.uk. 2022. Available from: https://www.nhs.uk/conditions/ovarian-cancer/
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