What every woman should know
Why it's so important to be aware
Ovarian cancer is the fourth most common cancer in women, after breast, lung and bowel cancers. Each year some 7,000 women are diagnosed with the disease.
If found in the early stages though, up to 95% of women will survive for more than five years. Unfortunately most women in the UK are not diagnosed with ovarian cancer, until it has already spread, making successful treatment difficult, and survival rates much lower.
Screening tools are currently neither specific, nor accurate enough for widespread use, as they result in unacceptably high levels of surgery for the numbers of cancers they detect. This has just been reconfirmed in a major US study (November 2005).
90% of ovarian cancers are not 'familial'. This means that most women will not have any family history of this cancer, so they may not be aware of symptoms and risk factors.
Awareness can save lives. Recent research has shown that almost all women do experience symptoms, particularly very frequent, persistent and sudden onset ones, even in the early stages of ovarian cancer.
Signs and symptoms
Ovarian cancer action bases its symptoms awareness programmes on the most recent and credible research available.
Ovarian cancer used to be called 'the silent killer', even in medical text books, with most women not being diagnosed until the cancer had spread. But there is now growing scientific evidence that the frequency and combination of particular symptoms could alert women and their doctors to the possibility of ovarian cancer, even when it is in the early stages, when survival rates are much higher1.
Diagnosis can be difficult because symptoms are often similar to those caused by more common, less serious conditions. If you have any of the following symptoms you should not panic, but discuss with your doctor if they have considered ovarian cancer. In particular you should ask your doctor about ovarian cancer if you have one or more of the following symptoms for more than 12 days a month:
Downloading our symptom diary may help you track the symptoms you are having, and help your doctor decide what might be causing them.
Feeling full persistently
Difficulty eating
Abdominal pain
Pelvic pain
Bloating
Increased abdominal size
Increased urinary urgency
Any other sudden onset, frequently recurring or numerous symptoms should also be reported to your doctor. They can include
Abnormal vaginal bleeding
Changes in bowel habit
Excessive fatigue
Indigestion or nausea
1Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, Patras J, Mahony BS, Andersen MR. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2006 Dec 11
Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004 Jun 9;291(22):2705-12.
Risk factors
There are a number of factors which can affect your risk of getting ovarian cancer:
Family history: If you have 2 or more relatives from the same side of your family affected by ovarian, or ovarian and breast cancer, you risk may be increased. For full details see below.
Age: The majority of cases occur in women over the age of 40. However some types of ovarian cancer do appear in women from the age of 20 onwards.
Childbirth: There is a slightly increased risk to women who have not had children, or breastfed.
Weight: Being overweight may also increase risk.
Other factors: As yet still unproven, there is research being undertaken to evaluate the use of talcum powder, and the role of inflammation in the development of ovarian cancer.
Should I be concerned?
If you
develop a number of symptoms suddenly
experience symptoms very frequently (in particular any of the first 6 symptoms more than 12 times a month)
are being treated unsuccessfully for conditions such as irritable bowel syndrome, urine infections, and others or
have a family history (2 or more close relatives) of ovarian, breast or prostate cancer
then it is important to let your doctor know, discuss your history, and if you are still not reassured, seek a second opinion.
Family history
Knowing your family's health history is important. Having just one relative with the disease does not usually mean you are at increased risk. Only around 10% of ovarian cancers are due to an inherited faulty gene. Women who may be at higher risk (relative to the general population) of developing ovarian cancer, are those who have on one side of their family (either father's or mother's)
A first degree relative (mother, sister, daughter) who has had ovarian cancer and also have a second degree relative (aunt, grandmother) who has suffered from ovarian cancer, or
A first degree relative with ovarian cancer and a second degree relative (male or female) with breast cancer under the age of 50, or
a first degree relative with ovarian cancer and two second degree relatives with breast cancer over the age of 60, or
Known BRCA1 or BRCA2 gene carriers, or
Three or more relatives in total with either colon, stomach, ovarian, endometrial or small bowel cancer, or
A first degree relative of an individual with both breast and ovarian cancer.
If there does appear to be a strong familial connection, then you should make this known to your doctor. You may be eligible to join a major screening trial (see below UKFOCS).
Screening
Currently a CA125 blood test, plus transvaginal ultrasound scan is used to screen women who are deemed to be high risk. However CA125 levels can be affected by a number of less serious conditions, and whilst being good at indicating a recurrence of ovarian cancer, may not be as reliable at diagnosing the disease at an early stage. There are approximately twenty-five other markers of ovarian cancer currently being tested around the world. A smear test will not detect ovarian cancer.
In the UK the UKCTOCS (UK Clinical trial for ovarian cancer screening) has just finished recruiting 200,000 randomly selected post menopausal women to complete its study into the potential effects of screening. Its results will not be published until 2011. You can find out more by visiting www.ukctocs.org.uk A very recent US study has just reported interim results declaring that whilst the screening methods did detect ovarian cancer both in the early and late stages, there were unacceptably high levels of surgery performed on women who ultimately did not have the disease www.nih.gov/news/pr/nov2005/nci-07a.htm.
There is a UK trial for women with a strong familial history of the disease (UKFOCCS). The trial organisers are still recruiting candidates. To find out more and whether you might be eligible to join, please call the UKFOCCS team on 020 7380 6916.
Reducing risk
It is important to develop and maintain a healthy lifestyle, by eating plenty of fresh fruit and vegetables, and taking regular exercise. Suppressing ovulation can reduce risk, but must be discussed with a doctor. Methods can include long term use of the contraceptive pill, several pregnancies and breast feeding, or removal of the ovaries (oopherectomy).