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Ovarian cancer

Ovarian Cancer showing on a body diagram

Facts and figures about ovarian cancer

Ovarian Cancer is the 5th most common female cancer in the UK, accounting for approximately 4% of all new female cancer cases.

Age related, rising sharply from 35 years of age, 75% are diagnosed in the 55+ years age group and an average 25% being 75+ years. 90% are epithelial tumours.

Risk factors include hormone replacement therapy (HRT), smoking, asbestos exposure, having a first degree relative diagnosed with ovarian cancer, family history of breast cancer, BRCA1 and BRCA2 gene mutation, being nulliparous (not had children), diabetes, endometriosis, previous breast cancer and being overweight/obese may also increase the risk.

Unfortunately, many of these patients are diagnosed at an advanced stage.

Ovarian cancer symptoms

  • Pain in the lower back/abdomen.
  • Swollen abdomen/feeling bloated.
  • Irregular bleeding in pre-menopausal women.
  • Post-menopausal bleeding.
  • Urinary frequency and/or urgency.
  • Changes in bowel habits (constipation or diarrhoea).
  • Painful sexual intercourse.
  • Weight gain/loss.
  • Loss of appetite.
  • Unexplained fatigue.

Diagnosis of ovarian cancer

Investigations may include:

  • Physical examination (including internal).
  • Blood tests (will include CA 125 tumour marker).
  • Ultrasound scan.
  • CT scan.
  • Image guided biopsy- using CT or ultrasound a needle is passed into the ovary to take tissue samples.
  • Laparoscopy/Laparotomy- tissue samples will usually be taken during this.

Ovarian cancer treatment

Depends on several factors:

  • The type of tumour.
  • The grade of the tumour.
  • The stage of the cancer.
  • General health.

Surgery

Surgery is used in most cases of ovarian cancer. In very early stage, low grade tumours it may be adequate to remove just the affected ovary and fallopian tube. Biopsies will be taken during surgery to assess the stage of the disease and this may indicate further surgery.

In post-menopausal patients or those not wanting more/any children, patients are usually advised to have both ovaries, fallopian tubes and uterus removed.

Post-operative chemotherapy (adjuvant) will be advised if there is a risk of recurrence due to stage or grade of the tumour. In all cases where the disease has spread from the ovary it is classified as advanced disease.

Surgery may be used to remove as much of the cancer as possible (debulking surgery) depending on the patient’s general health and stage of the disease.

Post-operative chemotherapy would be advised in the majority of cases either to try and cure the disease or control it.

Radiotherapy

Radiotherapy is rarely used to treat ovarian cancer. Occasionally used to treat recurrences after surgery and chemotherapy. It is usually palliative to treat symptoms such as bleeding or pain.

Chemotherapy

Chemotherapy is commonly used post-operatively. In all cases where the staging is 1C or above and the tumour is high grade, chemotherapy is likely to be advised. The most frequently used drug is carboplatin.

Chemotherapy can also be recommended if the tumour has recurred.

Biological therapy

Bevacizumab is a type of monoclonal antibody that blocks the protein to the blood vessels of the cancer cells and consequently stops their growth; this is being used alongside chemotherapy for some patients and is thought to be improving the length of survival.

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