Ovarian cancer

Ovarian cancer is most common in women and anyone with ovaries who has been through the menopause (usually over the age of 50). It can affect women and anyone with ovaries of any age.

As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such as persistent bloating, pain in the pelvis and lower stomach, and difficulty eating.

It's important to speak to your GP if you experience these symptoms, particularly over a long period of time. Read more about how ovarian cancer is diagnosed.

The ovaries are a pair of small organs in the female reproductive system that contain and release an egg once a month. This is known as ovulation.

Different types of ovarian cancer affect different parts of the ovaries. Epithelial ovarian cancer, which affects the surface layers of the ovary, is the most common type. This topic focuses on epithelial ovarian cancer.

What causes ovarian cancer?

The exact cause of ovarian cancer is unknown, but certain things are thought to increase a woman's risk of developing the condition, such as age, the number of eggs the ovaries release and whether someone in your family has had ovarian or breast cancer in the past. However, only 1 in 10 cases of ovarian cancer has a genetic link.

Read more about the causes of ovarian cancer

Treating ovarian cancer 

The treatment you receive for ovarian cancer will depend on several things, including the stage of your cancer and your general health. Chemotherapy is the main treatment for ovarian cancer, but your treatment will usually involve a combination of surgery and chemotherapy.

Read more about how ovarian cancer is treated

As with most types of cancer, the outlook for ovarian cancer will depend on the stage it's at when diagnosed – that is, how far the cancer has advanced. The Cancer Research UK website has more information about the outlook for ovarian cancer.

Being diagnosed with ovarian cancer can affect daily life in many ways. However, support is available for many aspects of living with ovarian cancer, including emotional, financial and long-term health issues.

Ovarian cancer screening

There are methods of screening for ovarian cancer but, currently, they haven't been fully tested. Screening is only available for women and anyone with ovaries who are at high risk of developing the condition due to a strong family history or inheritance of a particular faulty gene. Clinical trials in the UK are currently being carried out to assess the effectiveness of screening in high-risk groups and in the general population. A cervical screening test, which used to be called a smear test, can't detect ovarian cancer.

Read more about preventing ovarian cancer

The symptoms of ovarian cancer can be difficult to recognise, particularly in its early stages.

This is because they are often the same as symptoms of other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS).

However, 3 main symptoms are more frequent:

• increased abdominal size and persistent bloating (not bloating that comes and goes)
• persistent pelvic and abdominal pain
• difficulty eating and feeling full quickly, or feeling nauseous

Other symptoms, such as back pain, needing to pass urine more frequently than usual, and pain during sex may be the result of other conditions in the pelvic area. However, they may be a sign of ovarian cancer.

If you have these types of symptoms, try keeping a diary to record how many of these symptoms you have over a longer period. Bear in mind that ovarian cancer is rare in women and anyone with ovaries under 40 years of age.

Speak to your GP if you have these symptoms regularly (on most days for 3 weeks or more). Although it's unlikely they're being caused by a serious problem, it's best to check.

If you've already seen your GP and the symptoms continue or get worse, you should go back and explain this. You know your body better than anyone.

Read further information:

• Target Ovarian Cancer: ovarian cancer symptoms

Several possible causes of ovarian cancer have been identified, along with risks that may make developing the condition more likely.

Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.

In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer isn't identified at an early stage, it can spread to the abdomen and pelvis, including other parts of the female reproductive system.

Increased risk

The exact cause of epithelial ovarian cancer (the main type) isn't known, but certain things may increase your risk of developing it.

Age

Your risk of ovarian cancer increases with age, with most cases occurring after the menopause. Most cases of ovarian cancer occur in women and anyone with ovaries who are over 50 years of age.

Family history

If you have 2 or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer, your risk of also developing the condition may be increased.

If your relatives developed cancer before the age of 50, it's more likely it was the result of an inherited faulty gene. BRCA1 and BRCA2 are faulty genes that are linked to ovarian cancer. They're also known to increase the risk of breast cancer.

Having relatives with ovarian cancer doesn't mean you definitely have a faulty gene in the family – the cancer could have happened by chance. Only 1 in 10 (10%) of ovarian cancers are thought to be caused by a faulty gene.

You may be at high risk of having a faulty gene if you have:

• 1 relative diagnosed with ovarian cancer at any age and at least 2 close relatives with breast cancer whose average age is under 60; all of these relatives should be on the same side of your family (either your mother's or father's side)
• 1 relative diagnosed with ovarian cancer at any age and at least 1 close relative diagnosed with breast cancer under the age of 50; both of these relatives should come from the same side of your family
• 2 relatives from the same side of the family diagnosed with ovarian cancer at any age 

If you're at a higher risk of having a faulty gene, your GP can refer you for tests to check for faulty BRCA1 and BRCA2 genes.

Ovulation and fertility

Every time an egg is released into the reproductive system, the surface of the ovary breaks to let it out. The surface of the ovary is damaged during this process and needs to be repaired. Each time this happens, there's a greater chance of abnormal cell growth during the repair. 

This may be why the risk of ovarian cancer decreases if you take the contraceptive pill, or have multiple pregnancies or periods of breastfeeding. At these times, eggs aren't released.

There's no strong evidence to show that those who have infertility treatment have an increased risk of developing ovarian cancer. However, it's thought that infertility itself may increase ovarian cancer risk and research into this area is being carried out. 

Hormone replacement therapy (HRT)

Women and anyone with ovaries who take hormone replacement therapy (HRT) have been shown to have a small increased risk of developing ovarian cancer. However, if HRT is stopped, after 5 years the risk is reduced to the same level as those who've never taken HRT.

Endometriosis

Endometriosis may also increase your risk of ovarian cancer. In endometriosis, the cells that usually line the womb grow elsewhere in the body.

These endometrial cells behave as if they were in the womb, so thickening and bleeding that usually occurs during menstruation, occurs in other parts of the body. There's no way for this endometrial tissue to leave the body so it becomes trapped, leading to pain, swelling and bleeding in that area.

Read further information:

• Cancer Research UK: Ovarian cancer risks and causes

Speak to your GP as soon as possible if you have any symptoms of ovarian cancer.

Your GP will gently feel your tummy (abdomen) and ask you about your symptoms, general health and whether there's a history of ovarian or breast cancer in your family.

They may carry out an internal examination and may take a blood sample or refer you for an ultrasound scan.

If needed, you may also be referred to a specialist (a gynaecologist or gynaecological oncologist) at a hospital.

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of ovarian cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected ovarian cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.

Blood test (CA125)

You may have a blood test to look for a protein called CA125 in your blood. CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer.

However, CA125 isn't specific to ovarian cancer and it can be raised in conditions including endometriosis, fibroids, pelvic inflammatory disease and pregnancy, so a raised CA125 level doesn't definitely mean you have ovarian cancer.

The Lab Tests Online UK website has more information on the CA125 test.

The National Institute for Health and Care Excellence (NICE) has produced guidance that recommends testing for CA125 if you frequently experience: 

• bloating
• feeling full quickly and/or loss of appetite 
• pelvic or abdominal pain 
• needing to urinate urgently and/or frequently  

Read the full NICE guidance about the recognition and initial management of ovarian cancer (PDF, 179kb).

If you experience unexplained weight loss, fatigue or changes in your bowel habits, such as diarrhoea or constipation, you may also be tested for CA125.

If you're 50 or over and you've experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

Around half of all women and anyone with ovaries with early-stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised, you'll be referred for an ultrasound scan.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of your ovaries. You may have an internal ultrasound where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach.

The image produced can show the size and texture of your ovaries, plus any cysts or other swellings that are present.

Further tests

If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and if it's spread. This is called staging.

Other tests you may have include:

• a chest X-ray
• a CT scan or MRI scan
• abdominal fluid aspiration – a thin needle is passed into your abdomen, so that a fluid sample can be taken and tested for cancerous cells 
• laparoscopy – a thin tube with a camera on the end is inserted through a small incision in your lower abdomen, so that your ovaries can be examined; a small tissue sample may also be taken from your ovaries for testing (a biopsy)

Staging helps your doctors to decide on the best kind of treatment for your condition. However, it's important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

The Cancer Research UK website has more information on further tests for ovarian cancer.

Stages and grades of ovarian cancer

Staging

If your test results indicate that you have ovarian cancer, it will be given a stage. The stage describes the size of the cancer and how far it has spread. The 4 commonly used stages of ovarian cancer are:

• stage 1 – where the cancer only affects one or both of the ovaries
• stage 2 – where the cancer has spread from the ovary and into the pelvis or womb
• stage 3 – where the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis
• stage 4 – where the cancer has spread to other parts of the body, such as the liver, spleen or lungs 

This is a simplified guide. Each stage is further divided into categories A, B and C. Ask your doctor if you're not sure what stage you have.

Grading

The grade of cancer refers to the appearance of cells under a microscope. The grades are as follows:

• low grade – although abnormal, cells appear to be slow-growing
• moderate grade – cells look more abnormal than low-grade cells
• high grade – cells look very abnormal and are likely to be fast-growing

The Cancer Research UK website has more information on the stages and grading of ovarian cancer.

Surgery

Most people with ovarian cancer will be considered for surgery. It sometimes isn't possible to confirm the stage of the cancer until surgery is carried out.

Your doctor will discuss what will happen during surgery. It will probably involve removing:

• both ovaries and the fallopian tubes (a bilateral salpingo-oophorectomy)
• the womb (a total abdominal hysterectomy)
• the omentum – a fatty layer of tissue within the abdomen (an omentectomy)

The surgeon may also remove the lymph nodes from your pelvis and abdomen, and samples of nearby tissue, to find out whether the cancer has spread.

If it has spread, the surgeon will try to remove as much of it as possible. This is known as 'debulking surgery'.

If the cancer is confined to 1 or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to carry a pregnancy.

You will probably be ready to go home 3 to 7 days after your operation, but it can take many weeks to fully recover.

When you go home, you'll need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss the types of exercise that are suitable for you with your doctor or physiotherapist.

Read further information:

• Cancer Research UK: surgery for ovarian cancer
• Macmillan: surgery for ovarian cancer

Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) medication to kill cancer cells. It's often given after surgery for ovarian cancer. In some cases, it can be given before surgery to help shrink the tumour and make it easier to remove. This is called 'neoadjuvant chemotherapy'.

Several different medicines can be used in chemotherapy. A combination is often given. The choice of medicine and how and when it's given depends on the stage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing medicine (carboplatin), which is used alone or in combination with another medicine called paclitaxel.

Chemotherapy is usually given as a drip into the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen – called 'intraperitoneal chemotherapy'. It is not currently established routine practice in the UK, but it's being assessed in clinical trials.

You'll usually have chemotherapy as an outpatient, but you may sometimes need a short stay in hospital. It's usually given in cycles, with a period of treatment followed by a period of rest, to allow the body to recover. Most women and anyone with ovaries have 6 cycles of chemotherapy.

Is chemotherapy working?

Over the course of your chemotherapy, you'll have tests to monitor how the cancer is responding to treatment. This can be done in a number of ways. For example:

• if you had higher than normal levels of the protein CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling
• if you had a tumour visible on a CT scan or ultrasound scan when diagnosed, you may have repeated scans to see whether it has shrunk
• you may have another small operation, known as 'second-look surgery', which is carried out in the same way as a laparoscopy

After your chemotherapy treatment, if all of your tests are clear of cancer, you'll be in remission. This means the cancer is under control.

Side effects of chemotherapy

Side effects of chemotherapy include:

• infections
• loss of appetite
• nausea and vomiting
• tiredness
• hair loss 
• sore mouth

Many side effects can be prevented or controlled with medicines your doctor can prescribe.

Chemotherapy for recurring cancer

Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This is called 'second-line treatment'.

Read further information:

• Cancer Research UK: chemotherapy for ovarian cancer
• Macmillan: chemotherapy for ovarian cancer
• Target Ovarian Cancer: when cancer comes back

Radiotherapy

Radiotherapy uses high energy X-rays. Like chemotherapy, it works by targeting rapidly growing cancer cells.

Radiotherapy isn't usually used to treat ovarian cancer. However, the multidisciplinary team may occasionally recommend it to treat ovarian cancer under very specific circumstances, such as treating pain and bleeding from a localised tumour mass.

Read further information:

• Cancer Research UK: radiotherapy for ovarian cancer
• Macmillan: radiotherapy for ovarian cancer

Clinical trials

In recent years, much progress has been made in ovarian cancer treatment. More women and anyone with ovaries are living longer and experiencing fewer side effects. These advances were discovered through clinical trials, where new medicines and combinations of medicines are compared with standard treatment.

All cancer trials in the UK are subject to careful monitoring, to ensure the trial is worthwhile and safely conducted. Participants in clinical trials can often do better overall than in routine care.

If you're asked about taking part in a trial, you'll be offered an information sheet. If you wish to take part, you'll be asked to give your consent (permission) by signing a form. You're always free to refuse or withdraw from a clinical trial without it affecting your care.

Read further information:

• Cancer Research: ovarian cancer research.

Psychological help

Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support. For example:

• your hospital doctor, specialist nurse or GP can refer you to a counsellor; talk to your GP if you're feeling depressed; a course of antidepressants may help, or your GP can arrange for you to see a counsellor or psychotherapist
• it can help to talk to someone who's been through the same thing as you; many organisations have helplines and online forums; they can also put you in touch with other people who have had cancer treatment

Read further information:

• Macmillan Cancer Support
• Target Ovarian Cancer: sources of support for women with ovarian cancer 

Recovery and follow-up

Many women and anyone with ovaries with ovarian cancer have a hysterectomy. This is a major operation and takes around 6 to 12 weeks to recover from.

During this time, you'll have to avoid lifting things, such as children and heavy shopping bags, and doing heavy housework. You won't be able to drive for 3 to 8 weeks after the operation. You'll usually need 4 to 12 weeks off work after a hysterectomy.

If your ovaries have been removed and you haven't already been through the menopause, you'll experience the menopause after your treatment. You may decide to take hormone replacement therapy (HRT) to control your symptoms. Your GP will help you decide what's best for you.

Some treatments for ovarian cancer, particularly chemotherapy, can make you feel very tired. You may need a break from your normal activities for a while. Don't be afraid to ask for practical help from family and friends if you need it.

Practical help may also be available from your local authority. Ask your doctor or nurse who to contact.

After your treatment has finished, you'll be invited for regular check-ups to see how well you are responding to treatments. These are usually every 2 to 3 months to begin with.

Read further information:

• Target Ovarian Cancer: sources of support for women with ovarian cancer
• Macmillan: follow-up after treatment for ovarian cancer  

Sex and relationships

Relationships with friends and family

Having cancer isn't always easy to talk about, either for you or your family and friends. You may sense that some people avoid you or feel awkward around you.

Being open about how you feel and what your family and friends can do to help may put them at ease. However, don't feel shy about telling them you need some time to yourself.

Read further information:

• Talking to your kids about cancer
• Macmillan: talking about cancer

Your sex life

Ovarian cancer and its treatment can affect your sex life in several ways.

Early menopause

If you haven't already been through the menopause, removing your ovaries means you'll have an early menopause. You're likely to have symptoms of the menopause, which can include vaginal dryness and loss of sexual desire.

Not feeling like sex

It's common to lose interest in sex after treatment for ovarian cancer. Your treatment may leave you feeling very tired, and you may feel shocked, confused or depressed about being diagnosed with cancer.

You may also feel grief about the loss of your fertility. It's understandable that you may not feel like having sex while coping with all this. Share your feelings with your partner. If your feelings about sex aren't improving with time, you may want to consider speaking to a counsellor or sex therapist.

Money and benefits

If you have to reduce or stop working due to your cancer, you may find it difficult to cope financially. If you have cancer or you're caring for someone with cancer, you may be entitled to financial support. For example:

• if you have a job but can't work because of your illness, you're entitled to statutory sick pay (SSP) from your employer 
• if you don't have a job and can't work because of your illness, you may be entitled to employment and support allowance (ESR)
• if you're caring for someone with cancer, you may be entitled to carer's allowance
• you may be eligible for other benefits if you have children living at home, or have a low household income

It's a good idea to find out as soon as possible what help is available to you. You could ask to speak to the social worker at your hospital, who can give you the information you need.

Read further information:

• Money Advice Service  
• Target Ovarian Cancer: financial hardship for women with ovarian cancer 

Dealing with dying

If you're told that nothing more can be done to treat your ovarian cancer, care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called palliative care. It also includes psychological, social and spiritual support for you and your family or carers.

Read further information:

• Macmillan: support if you're caring for someone with ovarian cancer
• Marie Curie Cancer Care: support for people dying at home

There's currently no reliable screening test for ovarian cancer. However, there are a number of things that may help to prevent ovarian cancer.

Stopping ovulation and the contraceptive pill

Each time you ovulate, your ovaries are damaged by the egg as it breaks through the surface of the ovary and is released into your reproductive system.

The cells that make up the surface of your ovaries divide and multiply rapidly to repair the damage caused by the egg. It's this rapid cell growth that can occasionally go wrong and result in ovarian cancer.

Anything that stops the process of ovulation can help to minimise your chances of developing ovarian cancer. This includes:

• pregnancy and breastfeeding
• the contraceptive pill
• hysterectomy surgery (removal of the ovaries)

Diet and lifestyle

Ovarian cancer may be linked to being overweight or obese. Losing weight through regular exercise and a healthy, balanced diet may help lower your risk of getting ovarian cancer. Aside from this, regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can help to prevent all forms of cancer and heart disease.

Screening for ovarian cancer

At present, there's no screening method for ovarian cancer that is reliable enough to be used by all women and anyone with ovaries in the UK. Clinical trials into this are continuing.

You may be eligible for screening if you're at high risk of developing the condition due to a strong family history, or if you've inherited a specific abnormal gene.

If you're at high risk, your GP can refer you to your local genetics service or family cancer clinic. You may be screened for ovarian cancer when you're over the age of 35, or when you're 5 years away from the age at which your youngest relative was diagnosed with the condition. From this point, you'll be screened again once a year.

The screening tests for ovarian cancer are the same as those routinely used to diagnose it. The tests are:

• a blood test for higher-than-normal levels of CA125 (a protein produced by cancer cells)
• a transvaginal ultrasound – where an ultrasound probe is inserted into your vagina so that the size and texture of your ovaries can be seen, as well as any ovarian cysts that may be present

The tests are used together to produce results that are as accurate as possible. However, as these screening methods are still in the process of being tested, there's no guarantee they'll identify every case of ovarian cancer.

A cervical screening test, previously known as a smear test, can't detect ovarian cancer.

Read further information:

Cancer Research UK: ovarian cancer screening