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Published by Bupa's health information team, July 2009.
This factsheet is for women who have ovarian cancer, or anyone who would like information about it.
According to Cancer Research UK, each year around 6,800 women in the UK are diagnosed with ovarian cancer. It's the fifth most common cancer in women after breast, lung, bowel and womb (uterus), and mostly affects women over 50.
How cancer develops
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About ovarian cancer
Ovarian cancer is created by the abnormal and uncontrolled growth of cells. The cancer can sometimes spread more widely in the abdomen (tummy) through the bloodstream or the lymph system. It may grow here and form secondary tumours. More rarely it can spread to other organs. The spread of cancer is called metastasis.
The ovaries are two small organs that are part of the female reproductive system where eggs mature. Each month, in women of childbearing age, one ovary releases an egg into the fallopian tube, where it may be fertilised with sperm. If it's not fertilised, the egg passes into the womb and is lost when this sheds its lining as a monthly period.
The ovaries also produce the female hormones oestrogen and progesterone. After the menopause, the ovaries produce less of these hormones and no longer release an egg each month.
The location of the ovaries and surrounding structures
Types of ovarian cancer
There are two main types of ovarian cancer. The most common is epithelial ovarian cancer that affects the lining of the ovaries. Nine out of 10 ovarian cancers are epithelial. There are several different types of epithelial ovarian cancer including the two most common - serous and endometrioid.
Non-epithelial ovarian cancer is much less common. These include germ cell cancers that form from the cells in the ovary that make the eggs. These usually affect younger women.
Symptoms of ovarian cancer
Lack of symptoms or vague symptoms in the early stages of ovarian cancer is why the illness is known as the 'silent killer'. If there are symptoms, they can include stomach pain or a bloated feeling that can be confused with irritable bowel syndrome (IBS). Ovarian cysts and non-cancerous growths also cause the same symptoms as ovarian cancer.
Other symptoms include:
- loss of appetite
- unexplained weight gain
- swelling of your abdomen (tummy)
- pain during sex
- changes in bowel or bladder habits - constipation, excess wind, diarrhoea or needing to pass urine more often
- rarely, abnormal vaginal bleeding
Causes of ovarian cancer
Doctors don't know exactly what causes ovarian cancer, but there are some things that seem to make it more likely. It's more common in women who live in developed countries and for those who have gone through the menopause.
It's known that faulty inherited genes called BRCA1 and BRCA2 increase the risk of ovarian cancer as well as breast cancer. However, having a close relative - mother, sister or daughter - with ovarian cancer doesn't necessarily mean that there is a faulty inherited gene in your family. The cancers could have happened by chance.
Other factors that are thought to make ovarian cancer more likely include:
- hormone replacement therapy (HRT) - especially taking HRT for longer than five years
- being overweight or obese (in pre-menopausal women)
- starting your periods early and having the menopause late
Fertility treatment is no longer considered a risk factor after recent research ruled out the link. A possible link with using talcum powder has been suggested but this needs to be confirmed by more research.
Ovarian cancer may be less common in women who have:
- used the contraceptive pill
- had children - the more children, the lower the risk
- breastfed their children
- had a hysterectomy
Diagnosis of ovarian cancer
Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history, including whether anyone else in your family has had breast or ovarian cancer.
You may have a blood test for a protein called CA125 that can be high in ovarian cancer. The GP may also carry out an internal examination to check your womb and ovaries.
You may be referred to a gynaecologist (a doctor who specialises in women's reproductive health). You may need to have further tests such as an ultrasound, CT scan or MRI scan to view the inside of your pelvis.
If the results of your scans show any abnormalities, you may also have a laparoscopy. This involves inserting a thin, fibre-optic tube (laparoscope) into your stomach via a small cut just below your bellybutton. This allows the surgeon to look at your ovaries and surrounding organs. The procedure is carried out under a general anaesthetic. The surgeon may take a biopsy - this is a small sample of tissue that will be sent to a laboratory for testing.
If fluid has built up in your stomach, it can be drawn out through a needle and examined to see whether cancer cells are present. This is known as abdominal fluid aspiration.
Treatment of ovarian cancer
Treatment depends on the type of ovarian cancer and how far it has spread.
Almost all women with ovarian cancer will need surgery for the best chance of successful treatment. The extent of surgery depends on the type of cancer and how far it has spread. If it hasn't spread beyond the ovary, it may be possible to remove only the single affected ovary and fallopian tube.
If the cancer has already spread beyond the ovary, both ovaries and your womb, together with nearby lymph nodes and any surrounding tissues that the cancer may have spread to, need to be removed. This is called a total hysterectomy and oophrectomy.
Other types of surgery for more advanced ovarian cancer are used to remove, or 'debulk' as much of the tumour as possible.
Chemotherapy uses medicines to destroy cancer cells and can cause side-effects, including tiredness and feeling sick or vomiting. Your chemotherapy treatment will vary depending on the type of ovarian cancer you have. Chemotherapy is usually used to shrink ovarian tumours. However, if you have the rarer type of germ cell ovarian cancer, chemotherapy can sometimes cure the disease.
After surgery, most women with ovarian cancer will be offered chemotherapy to destroy any remaining cancer cells that were not removed by surgery or if there is a risk the cancer may return. Women with very early stage ovarian cancer don't usually need chemotherapy.
If ovarian cancer comes back (relapses), you may be treated with the same chemotherapy medicine or an alternative, depending on the timing of the relapse and whether the cancer has developed resistance to previous chemotherapy medicines.
Your doctor may give you information on clinical trials that are being run to test new treatments for ovarian cancer.
Radiotherapy uses radiation to destroy cancer cells. However, it's not often used to treat ovarian cancer.
Help and support
Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home - this is called palliative care.
Ovarian cancer Q&As
See our answers to common questions about ovarian cancer, including:
Related Bupa products and services
Bupa Wellness offers Bupa Ovarian Health, a supplementary health check including tests which are thought to provide the most effective screening available.
- UK ovarian cancer statistics. Cancer Research UK (Cancerstats). www.cancerresearchuk.org, accessed 17 March 2009
- Epithelial ovarian cancer - a national clinical guideline. Publication number 75. Scottish Intercollegiate Guidelines Network (SIGN), www.sign.ac.uk, 2003
- Types of ovarian cancer. Macmillan Cancer Support www.cancerbackup.org.uk, accessed 17 March 2009
- Ovarian cancer. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 17 March 2009
- Risk factors for ovarian cancer. Cancer Research UK www.cancerhelp.org.uk, www.cancerhelp.org.uk, accessed 17 March 2009
- Guidance on commissioning cancer services. Improving outcomes in gynaecological cancers: the manual. NHS Executive, 1999. www.dh.gov.uk, accessed 17 March 2009
- Surgery for ovarian cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 17 March 2009
- Supportive, palliative and terminal care. Macmillan Cancer Support. www.cancerbackup.org.uk, accessed 17 March 2009
- Fertility drugs do not increase risk of ovarian cancer. BMJ. www.bmj.com, accessed 17 March 2009
- Talcum powder: is there a link? Ovacome. www.ovacome.org.uk, accessed 17 March 2009
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2009