In the UK, around 7,500 women are diagnosed with ovarian cancer annually – making it around the 6th most common cancer in women. Unfortunately, due to its common and often misdiagnosed symptoms, ovarian cancer is usually found late which can make it harder to treat.
May 8 marks Ovarian Cancer Awareness Day, which aims to raise awareness of the symptoms of ovarian cancer. We spoke to Professor Jay Chatterjee, Consultant Gynaecologist at Cromwell Hospital, to find out more about the condition and treatment options available.
What is ovarian cancer?
Ovarian cancer is a cancer of the female reproductive system. It occurs when abnormal cells begin to grow and divide, eventually developing into a tumour. If ovarian cancer is not caught early, it can spread to other parts of the body.
Ovarian cancer can occur in women of any age, but is more common in women over 50.
There are several different types of ovarian cancer:
- Epithelial ovarian cancer – the most common type, accounting for around 90% of cases.
- Germ cell tumours – an uncommon type of cancer that usually affects women under 30.
- Sex cord stromal tumours – a rare, usually benign type of cancer.
- Borderline ovarian tumours – a type of tumour of uncertain malignant potential that is usually removed and staged like a cancerous mass.
- Primary peritoneal and fallopian tube cancer – this is the most common type of ovarian cancer.
Epithelial ovarian cancer
Epithelial ovarian cancer is the most common type of ovarian cancer, which accounts for around 90% of cases.
This type of cancer starts in the cells that line the ovaries and fallopian tubes, called the epithelium. There are different types:
- High-grade serous ovarian cancer (or high-grade carcinoma) – this type accounts for around 50% of epithelial ovarian cancer cases. It is most common in women between 40 and 60.
- Low-grade serous ovarian cancer (or low-grade serous carcinoma) – a rare, slow-growing type of cancer that usually occurs in women between 45 and 55.
- Endometrioid ovarian cancer – a type of cancer linked to endometriosis, accounting for around 20% of epithelial ovarian cancer cases.
- Clear cell ovarian cancer (or clear cell carcinoma) – a rare type of cancer usually affecting women over 50. It is also linked to endometriosis.
- Mucinous ovarian cancer tumours – a rare type of cancer usually found in women over 50.
- Undifferentiated or unclassified tumours – the term used for cancers that cannot be easily classified, as it is impossible to tell which cell type the cancer started in. They account for around 15% of cases.
- Brenner tumours – a rare type of benign (non-cancerous) tumour, generally occurring in women over 40.
- Ovarian carcinosarcoma – the term used for tumours which display a mixture of epithelial (carcinoma) and stromal (sarcoma) characteristics.
What are the risk factors for ovarian cancer?
Anyone can develop ovarian cancer, but you may be more at risk if:
- You are over the age of 50
- Two or more people in your family have had ovarian cancer under the age of 50
- There has been more than one case of ovarian and breast cancer in your family
- You have a long menstrual history – you started your periods early, reached menopause at a later age, or have never given birth
- You have endometriosis
- You use hormone replacement therapy (HRT).
Signs and symptoms of ovarian cancer
The most common symptoms of ovarian cancer are:
- Appetite – you have no appetite, or you feel full quickly after eating
- Bloating – you have a swollen stomach or feel bloated
- Urination – you need to wee more often, or your need to wee feels urgent
- Pain – your stomach, or the area between your hips, feels painful or tender.
Ovarian cancer symptoms occur frequently – usually more than twelve times per month.
Other symptoms include:
- Changes in bowel habits, such as constipation or diarrhoea
- Back pain
- Feeling tired
- Unexplained weight loss
- Vaginal bleeding after the menopause.
The symptoms of ovarian cancer often occur in many other less serious conditions, which means that they can often be dismissed or go unnoticed.
If you are experiencing any of the above symptoms, it is important to visit your GP – especially if you are over 50.
How is ovarian cancer diagnosed?
If your GP or consultant thinks you could have ovarian cancer, you’ll be recommended some initial tests:
- Blood tests – to check for high levels of CA125 in your blood. CA125 is a protein that is sometimes produced by ovarian cancer cells.
- CT or ultrasound scan – both scan types are useful for identifying abnormalities or masses inside the body.
- MRI of the pelvis/abdomen – to characterise any complex ovarian masses
If your tests indicate that ovarian cancer could be present, then you’ll be referred for gynaecological surgery:
- Laparoscopy – a type of keyhole surgery, which uses a long, thin tube (laparoscope) with a camera and a light to investigate the abdomen.
- Laparotomy – an open surgery, where a larger incision is made along the abdomen to open up the area and do procedures to remove all cancerous lesions.
Both types of surgery are used to see if cancer is present, and where it has spread to. Your surgeon will take tissue samples to be sent off for testing at a laboratory.
If you are diagnosed with ovarian cancer, your condition will be assigned a stage ( how far the cancer has spread from the originating site). There are four stages of ovarian cancer:
- Stage one – the cancer is only in the ovaries.
- Stage two – the cancer has spread from the ovaries into the pelvis.
- Stage three – the cancer has spread beyond the pelvis into the abdominal cavity or lymph nodes.
- Stage four – the cancer has spread to other areas of the body, such as the lungs or liver.
The lower the stage your cancer is at, the easier it is to treat – but the vast majority of ovarian cancer patients present at an advanced stage.
Ovarian cancer treatment
There are three main types of treatment for ovarian cancer:
- Chemotherapy and occasionally radiotherapy
- Targeted therapies (medication)
The treatment you receive will depend on what stage of cervical cancer you’re at – but almost all women will need surgery as a first line of treatment, to remove the cancer.
Radiotherapy and chemotherapy are both used to destroy cancer cells. Radiotherapy does this using high doses of radiation, while chemotherapy uses cytotoxic (anti-cancer) drugs.
Targeted therapies are a group of medicine that change the way cancer cells behave and stop them from spreading. The most common drugs used for ovarian cancer treatment are Olaparib (Lynparza) and Niraparib (Zejula).
Is there a screening test for ovarian cancer?
Unfortunately, you cannot be screened for ovarian cancer if you are at low risk of getting it – this is because there are no tests available that can reliably detect ovarian cancer at an early stage.
If you have two or more family members with ovarian cancer, or there is more than one case of ovarian and breast cancer in your family, then you may decide to have genetic testing. Research has indicated that people with faulty BRCA1 or BRCA2 genes may be more at risk of developing ovarian cancer. This group of patients may benefit from screening using blood tests and scans.
How long can you have ovarian cancer without knowing?
Because the symptoms of ovarian cancer are common among many other less serious conditions, a lot of people do not get diagnosed with ovarian cancer until it has reached a later stage – often once the cancer has spread to the pelvis and abdomen. As there are no screening tests for ovarian cancer, it’s crucial to visit your GP if you notice any symptoms.
Where does ovarian cancer spread to?
If not caught early, ovarian cancer will likely spread to surrounding areas, such as the pelvis, abdomen, liver and peritoneal cavity – this is usually known as locally advanced cancer. At later stages, cancer can spread across the body to areas such as the lungs or brain.
How fast does ovarian cancer spread?
How quickly ovarian cancer spreads usually depends on the type of cancer it is. For example, high-grade serous carcinoma – which accounts for around half of all epithelial ovarian cancer cases – can spread to other parts of the body within weeks to months, which makes early detection very important but difficult.
How can I prevent ovarian cancer?
There is no way to prevent ovarian cancer. However, there are several factors that reduce your chance of developing the condition:
- Having a healthy lifestyle – this includes eating a balanced diet, exercising regularly, and not smoking.
- Oral contraceptives – research has shown that combined oral contraceptive pills may reduce the chance of developing ovarian cancer for up to 30 years.
- Giving birth and breastfeeding – giving birth and breastfeeding both reduce the number of ovulations a woman has during her menstrual cycle, therefore reducing the risk of ovarian cancer.
Why choose Cromwell Hospital for ovarian cancer care?
Our Integrated Cancer Campus is an internationally recognised centre of excellence, providing cutting-edge diagnostics and treatment for patients with all types of cancer.
As well as providing Europe’s most advanced radiotherapy in partnership with GenesisCare, we also provide a range of advanced treatments such as minimally invasive and robotic surgery, the latest chemotherapy drugs, and more.
Patients will also benefit from access to specialist cancer counsellors, oncology dietitians, and a range of therapies to help support them throughout their time with us.
About the consultant
Professor Jay Chatterjee is a senior Consultant Gynae-oncologist at the Royal Surrey County Hospital NHS Foundation Trust (Guildford) – associated with the renowned St Luke's Cancer Centre – and sees patients at the Cromwell Hospital.
Professor Chatterjee provides all aspect of surgical gynaecological and gynaecological-oncological care. He is internationally known for his surgical expertise in advanced open abdominal and laparoscopic/robotic operative skills. He is presently working to develop genomic, proteomic and immunomic characterisation of tumours, so that novel therapies can be applied as part of personalised cancer care to improve survival from gynaecological cancers.
Known for his patient-centred focus, Professor Chatterjee employs the most up-to-date clinical techniques in order to ensure that he can provide the utmost in patient care.