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 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 targetovariancancer.org.uk.
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 macmillan.org.uk – but do see your GP too.
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.