Ovarian cancer: an overview

Ovarian cancer has in the past been called 'the silent killer' but new research from Barbara Goff (University of Washington, Seattle, 2004) now shows that 90% of women with early stage disease (stages 1 or 2) experience symptoms (see below). When detected at these stages, five year survival rates can be as high as 90%. However, most women are not diagnosed with the condition until the cancer has already spread beyond the ovaries, making it much more difficult to treat successfully, with five year survival around one in five.

It is the fourth most common cancer in women in the UK, with almost 7,000 new cases diagnosed each year, and 29,000 in the USA.

Risk Factors

Age As with most cancers, your risk of developing the disease increases with age.

Family History  About ten percent of ovarian cancers are due to an inherited faulty gene. Individuals who may be at high risk are those who have on one side of their family (mother or father):

• A first degree relative (mother, sister, daughter) who have ovarian cancer and also have a second degree relative (aunt, grandmother) who has suffered from ovarian cancer.
• A first degree relative with ovarian cancer and a second degree relative (male or female) with breast cancer under the age of 50.
• a first degree relative with ovarian cancer and two second degree relatives with breast cancer over the age of 60.
• Known BRCA1 or BRCA2 gene carriers.
• Three or more relatives in total with either colon, stomach, ovarian, endometrial or small bowel cancer.
• A first degree relative of an individual with both breast and ovarian cancer.

Having members on both sides of the family with these cancers does not necessarily increase your risk of developing ovarian cancer.

If you think you are high risk, talk to your doctor who may refer you to a specialist genetics clinic at a hospital. Individuals will have their family history checked, and where appropriate may then be put on a screening programme. For more information on this topic click here:www.cancerbacup.org.uk

Childbirth  There is a slightly increased risk to those individulas who have not had children or breastfed. Ovarian cancer is more prevalent today due to more cycles of ovulation. In previous centuries women would be pregnant or breastfeeding for much of their childbearing years, thus inhibiting ovulation. The ovaries are inactive during this time. The risk of contracting ovarian cancer is therefore reduced with sustained use of the contraceptive pill, which prevents ovulation. In addition it appears that contraceptive pills high in progestins provide added protection.

Weight  Individuals who are overweight may be at slightly increased risk

Other possibilities.  Unproven risk factors include the use of talcum powder on the genital area. Inflammation is now also considered a risk factor, the use of asprin may help reduce inflammation and subsequently reduce one's risk of ovarian cancer.

Symptoms

Recent research has shown that women with ovarian cancer are more likely to experience a number of symptoms, with sudden onset, that are very frequent (20-30 times a month) and persistent than those with benign (non cancerous conditions). It is important that symptoms be reported to your doctor if they persist, or treatment for other conditions does not improve your situation.

• Swollen tummy
• Feeling bloated or full all the time
• Increased urinary urgency
• Indigestion and/or nausea
• Changes in bowel pattern
• Unexplained back or abdominal pain
• Ongoing excessive fatigue
• Abnormal bleeding

In particular these symptoms can be very similar to Irritable Bowel Syndrome which usually occurs in women between the ages of 20 and 40.

Diagnosis

Cysts and benign growths on the ovaries are not uncommon and often have no symptoms. They are sometimes only discovered when tests are being carried out for other reasons. If you are approaching the menopause and have any of the symptoms of ovarian cancer that are persistent and have been ongoing for several weeks, you should draw the attention of your doctor to this disease, and request an internal examination by a gynaecologist. Women with a family history of ovarian cancer may wish to consult a specialist for advice.

Diagnosis can involve the following techniques:

• A tumour can be detected by internal ultrasound scan/CT/MRI scan
• Blood test (CA125)
• Physical examination
• Abdominal fluid aspiration
• Laparoscopy

Screening

Currently a CA125 blood test, plus transvaginal ultrasound scan is used to screen women who are deemed to be high risk. However CA125 levels can be affected by a number of less serious conditions, and whilst being good at indicating a recurrence of ovarian cancer, may not be as reliable at diagnosing the disease at an early stage. There are approximately twentyfive other markers of ovarian cancer currently being tested around the world. A smear test will not detect ovarian cancer.

Trials

Current research is extensive in molecular biology, better diagnostic procedures, translational research from the lab to the clinic, and bespoke chemotherapy to help treat those women who already have the disease.

For further details on current trials, and the issues surrounding them click here

Treatment

Treatment of ovarian cancer depends on the stage and grading of the cancer, and on your state of health in general. Treatment can include surgery and chemotherapy.

For further information on UK treatment click here
For further information on treatment in the USA click here

Helpline support from CancerBACUP
Freephone 0808 800 1234 or www.cancerbacup.org.uk

To fill out our questionnaires on ovarian cancer click here