Ovarian cancer: symptoms, risk factors & treatment

10 early signs of cancer

Ovarian cancer is no respecter of name or fame. It’s claimed the lives of a stellar cast of celebrities including singer Alma Cogan, actress Diana Dors, novelist Josephine Hart, Lady Saatchi, and recently and most famously, Angelina Jolie’s mother.  This prompted Jolie, who has inherited one of the two BRCA genes that increase the risk of ovarian cancer, to take the protective measure of having her breasts and ovaries removed.

The good news is that the incidence of this deadly female cancer has fallen by around 20 per cent in the past decade – thanks at least partly to the fact that a generation of women who took the Pill, which is protective (see factors that decrease risk, below), in the 1960s and 70s are now reaching the age of highest risk. Ten year survival rates have also almost doubled in the last 40 years, according to Cancer Research UK. 

The bad news is that ovarian cancer remains the most lethal of female cancers. One woman dies of it every two hours. And shockingly eight out of ten are over 60, a statistic all the more disquieting because ovarian cancer can be cured – if caught early.

One of the biggest current problems, according to Dr Sarah Blagden, Consultant Medical Oncologist specialising in ovarian cancer at the Ovarian Cancer Action Research Centre, Hammersmith Hospital is that, ‘Women and even doctors can fail to recognize symptoms (see below) or mistake them for something less serious, such as irritable bowel syndrome. As disturbingly research shows that GPs are less likely to recognize symptoms of ovarian cancer in older women, a third of whom are only diagnosed when they report to A & E with advanced disease.’ 

Better detection for ovarian cancer

Now, however, for the first time a new high-tech cancer risk assessment tool (RAT), a computer programme that flags up suspicious symptom combinations (see below) is being rolled out to encourage GPs to ‘Think ovarian cancer’. It is hoped that this will improve detection rates and lead to a better outlook for the 7,100 women who develop it each year. 

Another glimmer of hope is that that it may soon be possible to detect ovarian cancer much earlier than at present. Experts are eagerly awaiting the results of a large UK-based screening trial (UKCTOCS) involving  more than 200,000 postmenopausal women, of whom 50,000 were invited for an annual blood test for CA125, a marker for ovarian cancer, plus transvaginal ultrasound.

‘We’re expecting an announcement any day now. It could be really significant because it will tell us whether screening women without symptoms can actually save lives,’ comments ovarian cancer specialist Mr Adam Rosenthal, of 9 Harley Street, Clinical Lead on the UK Familial Ovarian Cancer Screening Study (UK FOCSS) at University College London, and a medical advisor to women’s cancers charity, the Eve Appeal and BRCA Umbrella, a self-help group for women with a BRCA gene.

Better treatments for ovarian cancer

The other encouraging development is that treatment is improving. A slew of new medications is on the horizon, which could revolutionise drug treatment of ovarian cancer. And surgical techniques are improving. Says Mr Rosenthal, ‘We now know that removing all the tumour, even if it involves other organs, such as the bowel, is associated with better survival.’ 

An increasing number of women, especially those who are older or less fit are also being given chemotherapy before surgery to shrink the tumour so they need less extensive surgery. And that’s not all. Says Mr Rosenthal, ‘We are moving towards an era of risk-prediction, where women can discover accurately what their risk is and then, like Angelina Jolie,  decide to take action. 

All in all we’ve come a long way since the stars of the 1960s were diagnosed. And with the huge amount of research now going on into the causes of ovarian cancer, plus better ways to diagnose and treat it, for the first time the future is looking brighter. 

Ovarian cancer symptoms: what to look out for

The following symptoms can all be red flags 

• Persistent stomach pain
• Persistent bloating or increased stomach size (abdominal distension)
• Difficulty eating or feeling full quickly
• Needing to urinate more frequently

• Unexplained tiredness 
• Weight loss

Of course these can all be symptoms of less serious problems but if they’re new for you, don’t go away, you experience them most days and have had them for three weeks or more see the GP and say you are concerned about ovarian cancer.

Could you be at risk of ovarian cancer?

Factors that increase risk

• Age (over 50) 
• Family or personal history of ovarian and/or breast cancer, endometrial (womb) and bowel cancer 
• Genetic mutations in two genes BRCA1 and BRCA2, plus some other cancer-causing genes 
• Never having children 
• Early puberty plus late menopause
• HRT 
• Being overweight 
• Being of Ashkenazi (Central and Eastern European) Jewish heritage (1 in 40 chance of BRCA gene mutation)

Factors that decrease risk

• Taking the Pill – women who took it for three or more years are 30-50 per cent less likely to develop ovarian cancer
• Breastfeeding
• Pregnancy 
• Possibly hysterectomy or sterilisation (tubal ligation - having the fallopian tubes tied surgically)

More information about ovarian cancer

Ovarian Cancer Action - ovarian.org.uk

Target Ovarian Cancer - www.targetovariancancer.org.uk

Cancer Research UK - www.cancerresearchuk.org/about-cancer/ovarian-cancer

Ovacome - www.ovacome.org.uk