Vague symptoms may be a sign that you need to take action. There is also a newly-approved drug available, says Dr Mel Wynne-Jones

Ovarian cancer

Many risks of ovarian cancer appear to be related to how the ovaries work ©iStock

Ovarian cancer affects around one in 50 UK women – that’s 7,100 each year – but it can be hard to diagnose early, as symptoms are often vague to start with.

It’s commonest after the menopause or over the 
age of 50, but can affect younger women too – although most ovarian swellings in premenopausal women tend to be benign.

What causes it?

The hormonal cycle egg release (ovulation) in our ovaries may play a part 
in both cancerous and benign tumours, but other factors influence our risk too.

Around one in 10 
cases is linked to a faulty inherited gene such 
as BRCA1 or 2 (see ‘Is screening available’), or the newly identified mutated BRIP1, estimated to affect one in a thousand women, tripling their risk.

Women who have endometriosis (which 
is a gynaecological condition) may be slightly more likely to get ovarian cancer, but it’s not clear whether having had 
fertility treatment or 
a hysterectomy, taking hormone replacement therapy, smoking, diet, taking aspirin or even using talcum powder 
on the vulva may affect our risk too.

However, taking the oral contraceptive 
pill, having children and breastfeeding can protect.

What are the symptoms?

These include pain in 
your side or lower tummy, discomfort during 
love-making, back pain, 
feeling bloated or easily full, a swollen tummy, passing urine more frequently, irregular or postmenopausal vaginal bleeding, constipation, nausea and poor appetite or fatigue.

It’s a long list, and many of these symptoms can be caused by other conditions, many of which are not serious.

But if symptoms are persistent or frequent (for example, most days for three weeks) or you have 
a family history of breast 
or ovarian cancer, see 
your GP.

You can print out 
a symptom diary or download an app from

Is treatment available?

Sadly, current blood tests and/or scans can’t reliably spot or rule out ovarian cancer in most women who have no symptoms. New results from the 14-year UTOCS trial show that annual screening using both a blood test and scan could cut mortality rates, but would mean some women undergoing unnecessary surgery because 
of false-positive results.

However, if your mother 
or sister had ovarian cancer, especially before they were 
50, your personal risk may be tripled.

And if more than one close family member (on the same side) has had ovarian, breast, bowel, prostate, lung, stomach or womb-lining cancer, or lymphoma, your 
GP can work out whether you may personally be at increased risk and need to see a specialist for genetic and other tests.

You could also use Macmillan’s OPERA Tool 
to look at your own risk – at – but do see your GP too.

The treatment

Diagnosing ovarian cancer early reduces the amount of treatment needed and improves the chances of success.

Most women need removal of both ovaries, their tubes and wombs, samples from the tummy lining to check for spread and chemotherapy (drug treatment) but radiotherapy (X-rays) is used less frequently.

‘Biologicals’, such as the 
drug olaparib (Lynparza – recently NHS-approved) and bevacizumab (Avastin – not approved everywhere) help 
the body to attack cancer cells, and can slow down advanced ovarian cancer.

4 tests you may need

1 Blood test – CA125. This protein is raised in around half of women who have early ovarian cancer. However, it can also be raised in pregnancy, fibroids, pelvic inflammation and endometriosis.

2 Ultrasound scan of the pelvic organs – may be performed through the tummy or internally (known as a ‘condom scan’) – checks the ovaries, tubes and womb.

3 CT scan – multiple X-rays taken after an injection that helps to show internal organs from several angles.

4 Laparoscopy (telescope) or laparotomy (full) operation to look inside your tummy and take a sample.