Diagnosis and treatment of ovarian cancer

Around 7,500 women in the UK are diagnosed with ovarian cancer every year, making it one of the 10 most common cancers affecting women. Ovarian cancer starts in your ovaries and in its early stages, often causes mild symptoms that can be mistaken for other less serious conditions. 

Early signs of ovarian cancer include unexplained fatigue and weight loss, a swollen tummy (abdomen), loss of appetite or quickly feeling full, urinating more often than usual and a change in your bowel habits. You may also experience pain in your lower abdomen or leg and pain during sex. If you experience these symptoms more than 12 times in a month, see your GP as soon as possible. Although several of these symptoms can be caused by other less serious conditions, your doctor will need to rule out ovarian cancer, which will involve an examination and various tests.

Getting a diagnosis of ovarian cancer

Your doctor will ask you about your symptoms and medical history, and may then perform a physical examination called a pelvic exam. This involves gently inserting gloved, lubricated fingers into your vagina, while pressing a hand against your abdomen. This allows your doctor to feel for any abnormalities, such as lumps or swelling, in your pelvic area. 

You may also be sent for blood tests, including a blood test for a protein called CA125, which is often found on the surface of ovarian cancer cells, as well as other proteins that are either commonly produced by ovarian cancer cells or elevated in response to ovarian cancer. These blood tests are not definitive tests for ovarian cancer. You may, therefore, need further tests such as a vaginal ultrasound scan or an abdominal ultrasound scan. 

If your test results suggest you have ovarian cancer, your doctor may recommend minimally invasive surgery — a needle biopsy or a laparoscopy — to collect a tissue sample (biopsy) from your ovary that will be sent to a lab for analysis. This will confirm the presence of ovarian cancer, as well as identify the type of ovarian cancer you have. 

If ovarian cancer is confirmed, your doctor will talk through next steps with you, which may include tests to check whether the cancer has spread elsewhere. This will help your doctor recommend the most appropriate treatment options in your case. Your care team will provide you with all of the information you need to make an informed decision about your treatment. 

Treating ovarian cancer

Your treatment for ovarian cancer will depend on several factors, including the type and stage of your ovarian cancer, the size of your tumour, whether the cancer has spread elsewhere, your general health and your personal preferences. 

In most cases, a combination of different treatments is needed, such as surgery followed by chemotherapy. Your doctor will advise you on the risks, benefits and potential side effects of all of your treatment options. They will also talk to you about how your treatment may affect you physically and emotionally, and advise you on how to prepare for what’s ahead. 

Surgery may involve removing your ovaries and fallopian tubes (a bilateral salpingo-oophorectomy) or having your womb, ovaries, fallopian tubes and the entrance to your womb (cervix) removed (a total hysterectomy). If the cancer has spread to other organs (eg your bladder, colon or small intestine), part of these organs may also need to be removed. 

Before and/or after surgery, you may also be given chemotherapy. For ovarian cancer, this usually involves passing a drug or combination of drugs directly into your bloodstream via a vein. Chemotherapy is usually given in cycles lasting around three weeks, which includes a rest period for you to recover from the side effects. 

Your fertility and ovarian cancer

A common concern about ovarian cancer treatment is the effect it will have on your fertility. Treatment can permanently reduce your fertility or leave you infertile. It is important to talk to your care team about your concerns and in some cases, it may be possible for your doctor to plan a course of treatment that will help preserve your fertility. This will depend on the stage and type of ovarian cancer you have and whether or not it has spread.

Ovarian cancer that is limited to just one ovary may be successfully treated without removing both ovaries and the womb, which can allow you to become pregnant with your own biological child.

If you need both of your ovaries and/or your womb removed, you can speak to your care team about harvesting your eggs before treatment for later use in in vitro fertilisation (IVF). IVF is a type of fertility treatment where your egg is fertilised with your partner’s or donor sperm in a laboratory and then transferred into your womb.

In some cases, urgent treatment is needed for ovarian cancer and you may not have time to harvest your eggs. However, there are still options to explore, including surrogacy, where another woman carries and gives birth to your baby, adoption and fostering.

There are two types of surrogacy — traditional (partial) and host (full). Traditional surrogacy involves fertilising a surrogate’s egg with your partner’s or donor sperm via a process called artificial insemination. Host surrogacy involves fertilising your or a donor’s egg with your partner’s or donor sperm via IVF.

Adoption and fostering after surviving cancer is another route to parenthood. However, you may need a certain number of cancer-free years and/or a letter from your doctor certifying your health status before starting the process of adoption or fostering.

Managing advanced ovarian cancer

Due to the mild symptoms of ovarian cancer in its early stages, it is often not diagnosed until it is advanced. Although in some cases, advanced ovarian cancer can be cured, in most cases, it can’t. It can be incredibly difficult to receive a diagnosis of advanced ovarian cancer but your care team will be there to support you and advise you on what to expect.

In most cases of advanced ovarian cancer, treatment can help relieve your cancer symptoms and control the cancer spread to help you live longer. This may involve chemotherapy and/or targeted therapy, which uses drugs that target substances that help cancer cells multiply and survive. If these treatments aren’t appropriate in your case, your doctor may recommend radiotherapy, which uses high-energy radiation beams to target and destroy cancer cells.