Ovarian Cancer – Symptoms, Stages & Treatment of Ovarian Cancer

Ovarian cancer is a serious disease and the leading cause of death among women with tumours of the reproductive system. In the later stages, treatment options are limited, which is why early detection is crucial for successfully treating the tumour.

Ovarian cancer is the eighth most common cancer in women – so this isn't something to brush aside with a "it won't happen to me" attitude when it comes to prevention. Here you'll find out what you need to know about risk factors, symptoms and the stages of the disease, what treatment options are available and which preventive measures really matter.

What is ovarian cancer? 

Ovarian cancer is a complex disease affecting the female reproductive organs. It is characterised by the uncontrolled growth and multiplication of abnormal cells in the ovaries, but also in the fallopian tubes or in the peritoneum (the thin membrane lining the inside of the abdominal wall).

These cancer cells eventually form a tumour which – if not detected early – gradually invades the surrounding tissue as well.

Incidence in the UK

In the UK, around 7,600 women are diagnosed with ovarian cancer each year and around 3,900 die from it (Cancer Research UK). It is the 6th most common cancer in women in the UK.

Ovarian cancer – risk factors 

The precise causes of ovarian cancer remain unclear, but studies suggest that certain mutations in the DNA of cells may play a role, encouraging the rapid multiplication of abnormal cells and the development of a tumour.

There are, however, several risk factors that can increase the likelihood of ovarian cancer, such as age, genetic factors and endometriosis.

Age 

The risk of ovarian cancer rises with age. In fact, most cases occur after the menopause, in women over 50.

That said, younger women can also develop rarer forms of ovarian cancer.

Family history

The risk of breast and ovarian cancer is higher in women whose close relatives (particularly a mother or sister) have the disease or have had it.

Around 10% of ovarian cancer cases are genetic in origin, as mutated variants of the BRCA1 and BRCA2 genes can be inherited.

Hormone replacement therapy

Study findings on the link between ovarian cancer and hormone replacement therapy are contradictory; researchers believe, however, that any possible link – if it exists at all – is only slight.

They nevertheless assume that avoiding hormone replacement therapy lowers the risk of ovarian cancer.

Endometriosis

Endometriosis is a condition in which cells similar to those of the womb lining (endometrium) grow outside the uterus – above all on the ovaries and within the abdominal cavity. Studies show that patients with endometriosis have an increased risk of ovarian cancer.

Previous ovarian tumours

Women who have already had an ovarian tumour carry a higher risk of developing ovarian cancer again in the future – either in the other ovary or in other parts of the body.

Ovarian cancer – symptoms 

In the early stages, ovarian cancer rarely makes itself clearly felt, and when it does, it is usually through subtle, easily overlooked symptoms such as bloating. In more advanced stages, the following complaints may occur:

• Unexplained weight loss
• Bloating or a swollen abdomen
• Pelvic discomfort (lower abdominal pain)
• Frequent constipation
• Chronic fatigue
• Back pain
• Burning when passing urine
• Pain during sexual intercourse

Ovarian cancer – stages of the disease 

Ovarian cancer is divided into four stages. The first two correspond to the early stage, in which treatment has the highest success rate. The last two correspond to the advanced stage, in which treatment options are more limited.

Ovarian cancer – stage I 

In the first stage of the disease, only the ovaries are affected. This stage is in turn divided into three sub-stages: stage IA, stage IB and stage IC.

Stage IA means that the disease affects only one of the two ovaries.

In stage IB, the cancer spreads to the other ovary as well, meaning both ovaries are affected.

In stage IC, the disease progresses to the point where cancer cells spread beyond the ovaries and can even be detected in the fluid within the abdominal cavity.

Ovarian cancer – stage II 

Stage II ovarian cancer is characterised by the growth of cancer cells outside the ovaries within the pelvic region (bounded by the hips). Like the first stage, the second stage also comprises three sub-stages: A, B and C.

Stage IIA means the cancer has spread to the fallopian tubes or the uterus.

Stage IIB refers to the growth of cancer cells in other pelvic tissues, such as the sigmoid colon, the rectum or the bladder.

In stage IIC, the cancer is also present in other pelvic tissues, and cancer cells are found in fluid taken from the abdominal cavity.

Ovarian cancer – stage III

In stage III, the cancer also spreads into the abdominal cavity and may involve the lymph nodes in the upper abdomen, behind the uterus and in the groin. As with the previous stages, the severity of stage III ovarian cancer is described by the sub-stages A, B and C.

In stage IIIA, the lymph nodes are not yet involved, but the cancer spreads microscopically, affecting the peritoneum, the peritoneal membranes and the small intestine.

In stage IIIB, the lymph nodes are likewise not involved, but macroscopic tumour deposits measuring less than 2 cm are visible in the peritoneum or outside the pelvis.

In stage IIIC, the tumour deposits exceed 2 cm in size, occur in the peritoneum or outside the pelvis, and may involve the lymph nodes in the upper abdomen, in the groin or behind the uterus. Cancer cells may also appear on the liver or the spleen.

Ovarian cancer – stage IV 

Stage IV is the most advanced stage of ovarian cancer. At this point, the cancer cells reach areas far removed from the ovaries and affect tissues, lymph nodes and even organs. Stage IV comprises only two sub-stages, namely A and B.

Stage IVA is characterised by the spread of cancer cells into the fluid surrounding the lungs.

In stage IVB, the cancer spreads inside the spleen or the liver, and affects lymph nodes far from the ovaries or organs such as the skin, lungs and brain.

Types of ovarian cancer 

Ovarian cancer develops from the cells that make up and support the ovaries. These cells are of different kinds: epithelial cells, which surround the ovaries; germ cells, which produce eggs inside the ovaries; and stromal cells, which provide structure and support hormone production.

Depending on which cells are affected, there are therefore different types of ovarian cancer.

Epithelial tumour 

The epithelial tumour is the most common form of ovarian cancer (around 65 to 90% of cases) and arises from the thin layer covering the outside of the ovaries.

Stromal tumour 

The stromal tumour arises from the cells responsible for hormone production in the ovaries and is usually diagnosed early compared with other cancers. Only around 7% of ovarian cancer cases originate in stromal cells.

Germ cell tumour 

The germ cell tumour is a rarer form of ovarian cancer and arises from the cells that produce eggs inside the ovaries.

This is an aggressive form of cancer, occurring in around 25% of cases, and it particularly affects young women and adolescents. Treatment has a high success rate, however, when the disease is detected early.

How is ovarian cancer diagnosed? 

Ovarian cancer is usually diagnosed by a gynaecologist, taking into account the symptoms, the examination findings and the family history.

The investigations required to reach a diagnosis include blood tests (a raised level of the substance CA 125 in the blood may indicate ovarian cancer) as well as further investigations that can confirm the disease: imaging of the abdominal area and transvaginal examinations to assess the ovaries.

The doctor may also recommend further tests to confirm the diagnosis. These include a CT scan to obtain precise images of the ovaries from various angles, a chest X-ray to establish whether the disease has spread there, a biopsy to examine the ovaries or the surrounding fluid, or a laparoscopy to view the ovaries and take a sample for examination.

Treatment of ovarian cancer 

Treatment for ovarian cancer depends on the stage of the disease, while also taking into account the patient's general health and whether she wishes to have children in the future.

In the early stages, while this is still possible, the main aim of treatment is to cure the cancer. In advanced stages, the goal is to slow the progression of the disease and ease the symptoms.

In most cases, a combination of chemotherapy and surgery is used.

Surgical treatment  

Depending on the stage of the disease, a particular type of operation may be chosen. These procedures are complex, and recovery can take up to three months, with rest and avoidance of strenuous physical activity recommended for the first 3–4 weeks.

In the early stages, when only one of the ovaries is affected, surgery may be performed to remove the affected ovary and the corresponding fallopian tube. At this stage, such an operation does not affect the patient's fertility. As long as the other ovary functions normally, the patient will continue to have her menstrual cycle – that is, monthly vaginal bleeding requiring the use of period products – as well as the ability to have children in the future.

Surgery may also be carried out to remove both ovaries and fallopian tubes if both are affected and the disease has not yet spread further. With this procedure too, the uterus remains untouched, so the patient can still become pregnant – either through previously frozen eggs or embryos, or by means of an egg donation.

Surgical treatment is also possible in advanced stages, but in this case the ovaries and fallopian tubes are removed along with the uterus and the affected lymph nodes. After such an operation, the patient can no longer have children.

Chemotherapy 

Chemotherapy is a treatment method in which medicines (given intravenously or in tablet form) are administered to destroy the cancer cells; it is frequently used in combination with surgery.

Doctors usually recommend chemotherapy after surgery to destroy any cancer cells remaining in the body, reduce their number and eliminate them should the cancer return after the procedure.

Chemotherapy is given in hospital, but patients can return home the same day. Unfortunately, this treatment can bring side effects such as fatigue, nausea, loss of appetite, hair loss, diarrhoea and an increased risk of infection. Chemotherapy is therefore given in cycles (usually 6 cycles of 3 weeks each) with breaks to allow the body time to recover.

Targeted therapy 

Targeted therapy is used above all in recurrent ovarian cancer, as it attacks the vulnerable areas of tumour cells. Once the doctor has tested the cancer cells and confirmed that the treatment will work, targeted therapy involves administering medicines that act directly on the cancer cells.

Breathing difficulties, nausea, loss of appetite, diarrhoea and chronic fatigue are among the possible side effects of targeted therapy; the doctor may recommend physiotherapy sessions to support the recovery process.

In addition, time off work of 1 to 3 months is advised, along with avoiding physical exercise for 3 months and refraining from driving for 1 month after completing treatment.

Radiotherapy 

Radiotherapy relies on the use of radiation to destroy cancer cells and reduce the size of tumours if they have spread to other parts of the body.

Radiotherapy is only recommended in rare cases, usually after surgery, and can have side effects similar to those of chemotherapy: chronic fatigue, sensitive skin and hair loss in the treated area.

Preventing ovarian cancer

As the precise causes are unknown, there are no effective methods that can reliably prevent ovarian cancer from developing. There are, however, some steps that can help reduce the risk of the disease or detect it early – such as regular visits to the gynaecologist and as balanced a lifestyle as possible.

Is there screening for ovarian cancer?

At present there are no specific screening tests for the early detection of ovarian cancer, as the smear test is for cervical cancer. The need for an effective screening method to enable early detection nevertheless continues to occupy the medical world.

Until then, routine gynaecological check-ups with a full pelvic examination are essential for monitoring reproductive health and detecting ovarian cancer at an early stage.

The role of regular gynaecological check-ups

Even though there is no specific screening method, there are procedures for assessing risk and detecting the disease early. Transvaginal ultrasound and the CA 125 blood test are the most commonly used tools for identifying ovarian cancer.

If these routine examinations give grounds to suspect cancer cells in the ovaries, the doctor may recommend further investigations to establish a definitive diagnosis.

Frequently asked questions about ovarian cancer 

Ovarian cancer is a complex, serious disease that raises numerous questions and entirely natural fears. As being well informed is the first step towards prevention, early detection and effective treatment, here you'll find clear answers to the most common questions about this type of cancer.

How common is ovarian cancer? 

Ovarian cancer is the eighth most common cancer in women worldwide.

Can you have children after treatment for ovarian cancer?

In most cases yes, provided the disease is detected at an early stage. After surgery to remove one ovary, you can conceive naturally; children are also possible after the surgical removal of both ovaries if you receive eggs from a donor or have previously frozen eggs or embryos.

In advanced stages, however, the surgical removal of the ovaries and uterus, or prolonged chemotherapy, may affect your ability to have children in the future.

How often should you have a gynaecological check-up to help prevent ovarian cancer?

Although there is currently no effective screening test for ovarian cancer, an annual gynaecological check-up combined with a transvaginal ultrasound can help detect changes early. If you are at increased risk (for example, if you have a family history of ovarian or breast cancer), you should agree how often to have check-ups with your doctor.

Are there natural or alternative therapies for ovarian cancer? 

A healthy diet, acupuncture and stress-reduction techniques are natural approaches that can support the body during treatment. There is, however, no robust scientific evidence that natural or alternative therapies can cure cancer or replace conventional oncological treatment. Always speak to your doctor before trying an alternative method, in order to avoid dangerous interactions with your main treatment.

What are the survival chances by stage? 

Treatment and cure of ovarian cancer have high success rates when the diagnosis is made at an early stage. According to the available statistics, even at stage IV around 33% of patients are still alive at least 10 years after diagnosis and treatment, and 50% survive at least a further 5 years. Survival rates also continue to improve as new treatment methods are developed and become more effective.

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