Ovarian cancer
Reviewed by Dr Paul Klenerman, consultant physician and infection specialist
What is ovarian cancer?
Women have two ovaries, one on each side of the uterus (womb), situated relatively close to the Fallopian tubes.
The ovaries are fairly loosely connected and able to move in relation to their surroundings. Normal ovaries are smooth, oval and measure no more than a couple of centimetres in diameter - slightly more if measured lengthwise.
Most ovarian tumours are benign and remain so. However, some may later become malignant or cancerous. Others are malignant from the beginning.
Some ovarian cancers have spread (metastasised) from cancers originating in other organs of the body.
Who is most at risk of ovarian cancer?
Ovarian cancer is most common in menopausal women (over 50 years of age). It is rare in women under 40.
As far as we know, ovarian cancer cannot be prevented. But women who have used oral contraceptives in the past have a reduced risk of ovarian cancer compared to women who have never used them.
Rarely, ovarian cancer can run in families and there may be a genetic defect to explain this. Genetic counselling and testing is available from specialist centres.
What are the symptoms of ovarian cancer?
The symptoms of ovarian cancer are not specific to ovarian cancer and this often results in a late diagnosis of the disease.
The cancer has often spread throughout the pelvis and abdomen by this time, and is therefore more difficult to treat successfully.
Ovarian cancer may be discovered by chance during a routine gynaecological examination or it may be discovered because the tumour has grown so large that you can feel it, or because it is pressing on the bladder or intestines.
Other symptoms can include an expanding waistline due to the collection of fluid within the abdomen from the cancer.
How is ovarian cancer diagnosed?
The only certain means of diagnosis are either an operation or a biopsy taken during a special procedure called a laparoscopy. Ultrasound examination is a very useful tool since it enables a doctor to identify an ovarian tumour and certain features that might make him or her suspect a cancer.
A blood test can detect substances produced from the ovarian cancer and these substance are useful in monitoring the course of the disease.
All cysts or tumours over a certain size that are discovered during an examination should be removed - or a biopsy should be carried out so that an accurate diagnosis can be made.
The size of the growth is not the sole indication of whether it is cancerous or not. Ovarian cysts can be quite large, yet completely benign (non-cancerous).
How is ovarian cancer treated?
This will depend upon a number of factors including the extent of the tumour and the age of the woman. Most women will be advised to undergo surgery to remove the uterus, both Fallopian tubes and ovaries.
If the cancer is at an early stage, no further treatment may be necessary. However, the majority of women will be advised to undergo chemotherapy in addition to their surgery.
Cure rates vary enormously according to the extent of the cancer, stage of the disease, tissue type of the cancer as well as the woman's age and general health.
Based on a text by Dr Erik Fangel Poulsen, specialist and Dr Per Grinsted
Last updated 01.05.2005
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