Ovarian Cancer

Ovarian cancer is a challenging disease affecting the ovaries, and can often go undetected. Discover the causes and symptoms of the disease along with treatment and management options available.

What is Ovarian Cancer?

Ovarian cancer is a type of cancer that begins in the ovaries, the female reproductive organs responsible for producing eggs and female hormones.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen, making it difficult to treat. It is the fifth most common cause of cancer-related deaths among women and is responsible for more deaths than any other cancer of the female reproductive system.

Causes

The exact cause of ovarian cancer is not known, but several factors may increase the risk of developing the disease:

• Age: Ovarian cancer is more likely to occur as women get older, with the highest incidence rates observed in women over 50 years of age.
• Family History: Women with a family history of ovarian cancer, breast cancer, or certain genetic mutations (such as BRCA1 and BRCA2) are at increased risk of developing ovarian cancer.
• Inherited Genetic Mutations: Inherited genetic mutations, such as mutations in the BRCA1 or BRCA2 genes, increase the risk of ovarian cancer. These mutations are also associated with an increased risk of breast and other cancers.
• Reproductive Factors: Factors that affect a woman’s reproductive history, such as never having been pregnant, early menstruation (before age 12), late menopause (after age 50), and infertility, may increase the risk of ovarian cancer.
• Hormone Replacement Therapy (HRT): Long-term use of hormone replacement therapy (HRT) may slightly increase the risk of ovarian cancer. However, the benefits of HRT in managing menopausal symptoms often outweigh the risks for most women.
• Endometriosis: Endometriosis, a condition in which the tissue that lines the uterus grows outside the uterus, may increase the risk of certain types of ovarian cancer.
• Obesity: Obesity may increase the risk of developing ovarian cancer, although the exact mechanisms are not fully understood.
• Talcum Powder: Some studies suggest a possible link between the use of talcum powder in the genital area and an increased risk of ovarian cancer. However, more research is needed to establish a definitive association.

Symptoms

Ovarian cancer may cause symptoms, but they are often vague and can be mistaken for other conditions. Common symptoms of ovarian cancer may include:

• Abdominal or Pelvic Pain: Persistent or frequent pain in the abdomen or pelvis, often accompanied by bloating or discomfort.
• Changes in Bowel Habits: Changes in bowel habits, such as constipation, diarrhoea, or changes in stool consistency, that persist for more than a few weeks.
• Urinary Symptoms: Frequent or urgent need to urinate, difficulty emptying the bladder completely, or urinary urgency or frequency.
• Bloating: Persistent or frequent bloating, or a sensation of abdominal swelling or distension.
• Loss of Appetite or Feeling Full Quickly: Loss of appetite, early satiety (feeling full after eating a small amount), or unintentional weight loss.
• Fatigue: Persistent fatigue, weakness, or lack of energy that is not relieved by rest.
• Unexplained Weight Loss: Unexplained weight loss that occurs without dieting or intentional changes in activity level.
• Changes in Menstrual Cycle: Changes in the menstrual cycle, such as irregular periods, abnormal bleeding, or postmenopausal bleeding.
• Pain during Intercourse: Pain or discomfort during sexual intercourse (dyspareunia) may occur with certain types of ovarian cancer.

It is important to note that these symptoms can also be caused by other conditions, and experiencing one or more of these symptoms does not necessarily mean that a person has ovarian cancer. However, if symptoms persist or worsen over time, it is important to see a doctor for evaluation and diagnosis.

Diagnosis and Evaluation

If ovarian cancer is suspected based on symptoms or risk factors, diagnostic tests and evaluations may be performed, which may include:

• Pelvic Examination: A pelvic examination may be performed to assess the size, shape, and texture of the ovaries and surrounding structures. However, ovarian tumours may not always be palpable during a pelvic exam, especially in early stages of the disease.
• Transvaginal Ultrasound: Transvaginal ultrasound uses sound waves to create images of the ovaries and uterus. This imaging test can help detect ovarian tumours, assess their size and characteristics, and determine if they are solid or fluid-filled (cystic).
• CA-125 Blood Test: The CA-125 blood test measures the level of CA-125, a protein that is often elevated in the blood of women with ovarian cancer. However, CA-125 levels can also be elevated in other conditions, such as endometriosis, pelvic inflammatory disease, or benign ovarian cysts, so this test is not specific for ovarian cancer.
• Imaging Studies: Additional imaging studies such as CT scan, MRI, or PET scan may be performed to evaluate the extent of the disease, detect metastases, or assess involvement of nearby structures.
• Biopsy: If ovarian cancer is suspected based on imaging studies or blood tests, a biopsy may be performed to obtain tissue samples from the ovaries or surrounding tissues for microscopic examination. Biopsy is the definitive diagnostic test for ovarian cancer and helps determine the type, grade, and stage of the disease.

Staging and Evaluation

Once a diagnosis of ovarian cancer is confirmed, further staging and evaluation may be performed to determine the extent of the disease and guide treatment decisions. Staging may include:

• Surgical Staging: Surgical exploration of the abdomen and pelvis may be performed to assess the extent of the disease, remove tumour tissue for biopsy, and stage the cancer based on the size, location, and spread of the tumour.
• Pathologic Evaluation: Pathologic examination of biopsy specimens or surgical specimens provides information about the histologic type, grade, stage, and extent of the tumour, as well as lymph node involvement and presence of metastases.
• Imaging Studies: Additional imaging studies such as CT scan, MRI, or PET scan may be ordered to evaluate for metastases, detect involvement of distant organs or tissues, or assess treatment response.

Treatment and Management

Treatment for ovarian cancer depends on various factors, including the stage, grade, histologic type, extent of the disease, and the patient’s age, overall health, and preferences. Treatment options may include:

• Surgery: Surgical removal of the ovaries (oophorectomy), uterus (hysterectomy), fallopian tubes (salpingectomy), and surrounding tissues (debulking surgery) is the primary treatment for ovarian cancer. The goal of surgery is to remove as much tumour tissue as possible and stage the cancer to guide further treatment.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells or inhibit their growth and may be used as adjuvant therapy (after surgery) or neoadjuvant therapy (before surgery) to reduce the risk of recurrence, shrink tumours, or improve treatment outcomes. Chemotherapy may be administered intravenously or intraperitoneally (directly into the abdominal cavity) and may be combined with surgery or radiation therapy.
• Targeted Therapy: Targeted therapy drugs that target specific molecular pathways or genetic mutations involved in ovarian cancer growth and progression may be used to block tumour growth, prevent angiogenesis (formation of new blood vessels), or overcome resistance to chemotherapy. Targeted therapy drugs may include PARP inhibitors, angiogenesis inhibitors, or other molecularly targeted agents.
• Immunotherapy: Immunotherapy drugs such as immune checkpoint inhibitors or adoptive cell therapy may be used to stimulate the immune system to recognize and attack cancer cells. Immunotherapy may be used in certain cases of ovarian cancer to enhance treatment response, improve survival, or induce durable remissions.
• Hormonal Therapy: Hormonal therapy may be used to block the effects of oestrogen or progesterone on hormone-sensitive ovarian cancers or to suppress ovarian function in premenopausal women. Hormonal therapy drugs may include gonadotropin-releasing hormone (GnRH) agonists, aromatase inhibitors, or selective oestrogen receptor modulators (SERMs).
• Radiation Therapy: Radiation therapy uses high-energy beams of radiation to destroy cancer cells or shrink tumours and may be used in combination with surgery or chemotherapy for locally advanced or recurrent ovarian cancer. Radiation therapy may be delivered externally (external beam radiation therapy) or internally (brachytherapy) to target the tumour and surrounding tissues.
• Clinical Trials: Participation in clinical trials may offer access to novel treatments, experimental therapies, or investigational drugs that are being evaluated for safety and efficacy in the treatment of ovarian cancer. Clinical trials help advance scientific knowledge and may provide potential benefits to participants.

Follow-Up and Monitoring

After treatment for ovarian cancer, regular follow-up visits with your doctor, gynaecologic oncologist, or oncology team are essential to monitor treatment response, assess disease recurrence, and address any complications or side effects.

Monitoring may include:

• Pelvic Examinations: Regular pelvic examinations may be performed to assess for signs of recurrence, detect new masses or abnormalities, or evaluate the health of the ovaries and surrounding structures.
• Imaging Studies: Follow-up imaging studies such as CT scan, MRI, or PET scan may be ordered to evaluate for recurrence, detect metastases, or assess treatment response.
• CA-125 Blood Test: Periodic CA-125 blood tests may be monitored to assess for signs of disease recurrence or progression. However, CA-125 levels can also be elevated in other conditions, so this test is not specific for ovarian cancer.
• Symptom Assessment: Your doctor will ask about any changes in symptoms, such as abdominal pain, bloating, urinary symptoms, or unexplained weight loss, during follow-up visits.

Prevention and Risk Reduction

While the exact cause of ovarian cancer is not fully understood, several strategies may help reduce the risk of developing the disease:

• Oral Contraceptives: Use of oral contraceptives (birth control pills) has been associated with a reduced risk of ovarian cancer. The protective effect may persist for several years after discontinuation of oral contraceptives.
• Pregnancy and Breastfeeding: Pregnancy and breastfeeding may reduce the risk of ovarian cancer, possibly due to changes in hormone levels or ovulation suppression.
• Tubal Ligation or Hysterectomy: Surgical procedures such as tubal ligation (tying the fallopian tubes) or hysterectomy (removal of the uterus) may reduce the risk of ovarian cancer in women at high risk, such as those with a family history of ovarian cancer or genetic mutations.
• Genetic Counselling and Testing: Genetic counselling and testing may be recommended for individuals with a family history of ovarian cancer, breast cancer, or certain genetic mutations (such as BRCA1 and BRCA2) to assess their risk of developing the disease and guide personalized screening and preventive strategies.
• Healthy Lifestyle Habits: Adopting a healthy lifestyle that includes regular physical activity, maintaining a healthy weight, avoiding smoking, limiting alcohol consumption, and eating a balanced diet rich in fruits, vegetables, whole grains, and fiber may help reduce the risk of ovarian cancer.

Conclusion

Ovarian cancer is a challenging disease that affects the ovaries, the female reproductive organs responsible for producing eggs and hormones.

While the exact cause of ovarian cancer is not fully understood, several factors may increase the risk of developing the disease, including age, family history, genetic mutations, and reproductive factors.

Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen, highlighting the importance of early detection and prompt treatment.

If diagnosed with ovarian cancer, treatment options may include surgery, chemotherapy, targeted therapy, immunotherapy, radiation therapy, or participation in clinical trials.

Prevention strategies such as genetic counselling, risk reduction, and healthy lifestyle habits can help reduce the risk of ovarian cancer and improve outcomes. By working closely with doctors, staying informed about risk factors and screening recommendations, and adopting healthy behaviours, individuals can take proactive steps to protect their health and well-being.

Arranging To Visit A Private GP

To discuss any worrying symptoms that could be an indication of ovarian cancer make an appointment with one of our private GPs. Appointments are available to everyone and can often be booked for the same day. There is no need to be registered with our Buckinghamshire hospital, or live locally.

If you have insurance which covers a GP visit, we can in most cases invoice the insurer directly. Where you are paying directly, the cost for a 30 minute consultation is £125.

Any additional costs will always be discussed. They could apply if you are referred for an MRI scan, or to a consultant, or for other agreed decisions to support your health.

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