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Key Points
- Ovarian cancer is generally a cancer of the older person. However, there are some younger women who may be diagnosed with ovarian cancer.
- Women are being encouraged to know and recognise the risk factors and symptoms associated to ovarian cancer.
- Early detection will result in more positive outcomes.
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Overview
Ovarian cancer refers to any cancer that begins in the ovary. Ovarian cancer usually affects women who have been through the menopause. However, it can sometimes affect younger women. Most women who have ovarian cancer present with advanced disease and this has an impact on care outcomes and treatment options. The woman's overall health at the time of presentation will affect what treatments can be offered.
For most women, they will have had symptoms for a number of months before seeking help, which results in delays between presentation and referral.
The ovaries
The ovaries are part of the female internal sex organs, which also include the fallopian tubes, cervix, the uterus and the vagina.
The ovaries are made up of three types of cells:
- epithelial cells cover the surface of the ovaries
- stromal cells hold the structure of the ovary together, making oestrogen and progesterone
- germ cells: these make the
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Risk factors
In 2015 in the UK, it was reported that 11% of ovarian cancers were preventable (Brown et al, 2015). Target Ovarian Cancer (2018) suggests that all women should be aware of the risk factors (Box 1). When women know the risk, they will be empowered to make choices to reduce that risk.
Box 1. Risk factors: increasing the risk of ovarian cancer
- Age
- Family history
- Being overweight
- Using talcum powder in the genital/perineal area (but not elsewhere)
- Use of hormone replacement therapy (HRT)
- Endometriosis
- Smoking
- Diabetes (NICE, 2011).
Age
As is the case with most cancers, the risk of developing ovarian cancer grows as the woman ages. Women aged 50 years and over have a higher risk; the majority of ovarian cancers occur in those who have already gone through the menopause; it should be noted, however, that there are instances of ovarian cancer in pre-menopausal women.
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Symptoms
In a number of cases, ovarian cancer is not diagnosed until it has progressed to an advanced stage (National Institute of Health and Care Excellence (NICE), 2011). This is because, usually, ovarian cancer symptoms are not apparent in the early stages of the disease, or they may mimic common gastrointestinal issues that can be mistaken for trivial complaints and as such it is easy to overlook the signs and symptoms, as they tend to come and go.
A woman is more likely to experience symptoms once the disease has developed beyond the ovaries. The signs and symptoms may occur for a variety of reasons and they may not necessarily be due to ovarian cancer. At one time or another, a number of women will have some of these problems.
These types of symptoms are often passing and in most cases will respond to simple treatments. Box 2 summarises the possible signs and
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Diagnosis
A detailed history is obtained and physical examination will be required. A number of tests and investigations will be needed (Table 1). Sometimes it is not possible to diagnose ovarian cancer until surgery has been performed. The aim is to determine the cause of symptoms.
| Blood tests | Ultrasound scan | CT Scan |
|---|---|---|
| A full blood count is taken so as to assess the woman's overall health status, including how well the liver and kidneys are functioning. | Using high-frequency sound waves to create a picture, the ultrasound scan can show the ovaries, uterus and surrounding structures. A pelvic ultrasound or a vaginal ultrasound can help to diagnose ovarian cancer. | A computerised tomography (CT) scan uses X-rays to take detailed pictures of the body, providing a 3-dimensional image. This type of scan may be requested in order to show the ovaries more clearly. However, it may not |
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Treatment
The main treatments for ovarian cancer are surgery and chemotherapy. Nearly all women with ovarian cancer will require surgery. The type of surgery will depend on the stage and type of cancer. For some women with early–stage ovarian cancer, surgery may be the only treatment that is required. As the majority of women with ovarian cancer are diagnosed with advanced disease, there will be a need for a combination of surgery as well as chemotherapy.
Chemotherapy may be needed after surgery, or before and also after surgery. The evidence that radiotherapy is superior to chemotherapy for advanced Stage III and IV disease is scant. Treatment options will focus on the individual needs of the woman. As many women present late with the condition management may often be directed toward palliative care (Norwitz and Schorge, 2014).
Health promotion
There is no national screening programme for ovarian cancer in the UK, because
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Resources
The author would like to thank Mrs Frances Cohen for her help and support.
Glossary
| Laparoscopy |
type of surgical procedure (‘keyhole surgery’) allowing a surgeon to access the inside of the abdomen and pelvis without having to make large incisions in the skin. |
| Laparotomy | surgical incision into the abdominal cavity |
| Ligaments | the broad ligament of the uterus is the wide fold of peritoneum connecting the sides of the uterus to the walls and the floor of the pelvis. |
| Lymphadenopathy |
disease of the lymph nodes, in which they are abnormal in size, number, or consistency |
| Metastasis | secondary malignant growths at a distance from the primary site of a cancer |
|
Mutated gene |
change in genetic sequencing |
|
Oocyte |
cell in an ovary which may undergo meiotic division, forming an ovum |
|
Ovulation |
release of eggs from the ovaries |
|
Ovum |
the egg cell (the plural is ova) |
|
Pleural effusion |
sometimes referred to as |
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