Ovarian cancer

What is it?

The ovaries are two small organs that store eggs and make female sex hormones. The most common type of ovarian cancer starts in the cells that cover the ovary. Cancers of the fallopian tubes and of the lining inside the tummy (peritoneum) are very similar and are treated the same way, so they are grouped together. This is why you can still get it after your ovaries have been removed.

The risk grows with age. It mostly affects women over 50. It sometimes runs in families: faulty genes, such as the BRCA genes or those linked to Lynch syndrome, can raise the risk. Endometriosis, being overweight and smoking also raise the risk.

The first signs

Ovarian cancer may not cause early signs, and the signs are not always obvious. The main signs, often happening 12 or more times a month, are:

• a swollen tummy or feeling bloated;
• pain or tenderness in your tummy or between your hips (pelvis);
• no appetite, or feeling full quickly after eating;
• an urgent need to pee, or needing to pee more often.

Other signs are indigestion, constipation or diarrhoea, back pain, feeling tired all the time, losing weight without trying, and unusual bleeding from the vagina, for example after the menopause.

How doctors find out

Your family doctor usually arranges a blood test (for a marker called CA-125) and an ultrasound scan, either with a small probe inside the vagina or over the tummy. If the results point to ovarian cancer, you are sent to a gynaecological cancer specialist at a hospital.

Other tests can include a CT scan, a needle biopsy (a small sample of cells or fluid), or a laparoscopy: a camera on a thin tube put in through a small cut in the tummy. You may need more tests to find out the size of the cancer and how far it has spread. A specialist explains the results, and it helps to bring someone with you. A specialist nurse is your main contact during and after treatment.

Current treatment

Surgery and platinum-based chemotherapy

Will it get worse?

It depends on the type of cancer, how far it has spread, whether surgery can remove all of it, gene changes such as BRCA, and your general health. Ovarian cancer is often found late: in more than half of people it has already spread to distant parts of the body. Finding it early can make it easier to treat.

The cancer can come back, in the same place or elsewhere, so you have regular check-ups and tests after treatment. If it cannot be cured, treatment aims to hold it back, ease the symptoms and help you live longer, with help from a palliative care team.

Medicines: what helps, and what to watch for

Chemotherapy is medicine that kills cancer cells. It can be given before or after surgery, on its own, or if the cancer comes back. Chemotherapy can be given through a thin tube into a vein, or in some cases straight into the belly through a thin tube. Targeted medicines may be added: bevacizumab with chemotherapy, or PARP inhibitors (such as olaparib, niraparib or rucaparib), which stop cancer cells repairing their DNA. These medicines may be an option for some types of advanced ovarian cancer, or cancer that has come back. A gene test may help your team decide on your treatment plan. Hormone treatment is rarely used.

Good to know:

• Most people get some side effects of chemotherapy, but not all of them. Common ones are tiredness, feeling sick, a sore mouth, hair loss that is usually temporary, and numbness or tingling in the hands or feet;
• Treatment can affect periods and fertility in younger women. There may be ways to keep your fertility, and your specialist team will advise you about them;

Exercise and everyday care help too

Rest, but also some gentle physical activity, can help with tiredness. It can be hard to know whether your symptoms are due to the cancer and its treatment, or to the menopause.

Surgery, for most people

Most people have surgery to remove as much of the cancer as possible. If it has not spread beyond the ovaries, the surgeon may remove one or both ovaries and fallopian tubes, and the womb and cervix. If it has spread, the surgeon may also take out fatty tissue in the tummy, lymph nodes, and sometimes parts of the bowel or other organs.

Radiotherapy may be used to treat advanced cancer if other treatments are not right for you, or to help with symptoms such as bleeding, pain or discomfort.

Is there a cure?

It depends on the stage. Found early, it can be easier to treat. Advanced ovarian cancer may not be curable, and it can come back after treatment. Clinical trials are testing new treatments, such as vaccine therapy, and people at any stage can think about joining one.

See the 890 trials you can join

Median survival

About 3 to 4 years with surgery and chemotherapy, for advanced cancer

Measured in: Advanced-stage disease, in three trials (GOG-0182, 4,312 patients; ICON7, 1,528 women; GOG-0218, 1,873 women)

Sources

Written in plain words by Frontlight from these pages:

1. NHS: Ovarian cancer – Overview
2. NHS: Ovarian cancer – Symptoms
3. NHS: Ovarian cancer – Treatment
4. MedlinePlus: Ovarian Cancer
5. NHS: Ovarian cancer – Causes
6. NHS: Ovarian cancer – Tests and next steps
7. NCI PDQ: Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment (PDQ) – Patient Version
8. NCI SEER: Cancer Stat Facts: Ovarian Cancer
9. NHS: Chemotherapy – Side effects
10. Cancer Research UK (charity): Coping and support when you have ovarian cancer
11. NCI PDQ: Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment (PDQ) – Health Professional Version