Ovarian cancer. Patient information from the BMJ Group. What is ovarian cancer? What are the symptoms?

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1 Patient information from the BMJ Group Ovarian cancer Ovarian cancer is a serious disease. If it s diagnosed at an early stage, ovarian cancer can usually be cured. But even cancers that are more advanced can be treated and their progress slowed. We've brought together the best and most up-to-date research about ovarian cancer to see what treatments work.you can use our information to talk to your doctor and decide which treatments are best for you. What is ovarian cancer? Normally cells in your body grow and die in an organised way. But if some of the cells start to grow out of control, they can form a lump called a tumour. Not all tumours are dangerous. For example, lots of women have harmless growths on their ovaries called cysts. These aren t cancer and they often go away on their own. But if they cause symptoms, or your doctor is worried they could be cancer, you may need surgery to remove them. If a tumour is cancer, pieces of it can break off and spread to other parts of your body. Most ovarian cancers start in cells on the outside of your ovary. Cells from the tumour tend to spread to other parts of the body nearby, such as your womb, bladder, and bowels, causing new spots of cancer in these areas. Most women who get ovarian cancer are over 50. You re more likely to get this cancer if a close member of your family (mother or sister) has had it. But this is the case for only one in every 20 women who get ovarian cancer. Most women with ovarian cancer have no history of the disease in their family. If you re worried about getting ovarian cancer because a close relative has had it, see your doctor about genetic counselling. A genetic counsellor will be able to work out whether you are at increased risk of ovarian cancer and advise you about what you can do. What are the symptoms? Most women get some symptoms in the early stages of ovarian cancer but they are not always picked up. This is because they are quite common symptoms that are usually a sign of something else. Symptoms include pain in your pelvis (your lower abdomen), constipation, and diarrhoea.you might also feel bloated or full after eating very little, lose weight without trying, or have to urinate more often. One important symptom is persistent bloating, where your abdomen gets bigger and doesn't get smaller again. Other symptoms of ovarian cancer include bleeding from your vagina between your periods, swollen ankles, backache, and a lump in your abdomen. page 1 of 5

2 However, these symptoms can be caused by many things, such as indigestion or an irritable bowel. If you re at all worried you should see your doctor. Your doctor will probably ask you about your symptoms and how long you have had them, and ask about your health and any illnesses in your family. He or she may feel your abdomen and inside your vagina to check your ovaries and fallopian tubes. You may have some tests, such as a blood test and an ultrasound scan to look at the organs inside your abdomen. But even after these tests your doctor probably won't be able to say if you have ovarian cancer. The only way to tell for sure is for the doctor to take samples of tissue and look at these under a microscope. This is called taking a biopsy. To do this you ll need an operation. During the operation the surgeon will remove part or all of your ovary and take some samples of tissue from other parts of your abdomen. What treatments work? The main treatment for ovarian cancer is surgery to remove the cancer. Looking at tissue from your ovaries and your abdomen under a microscope is the only way your doctor can tell if you have ovarian cancer. If your doctor thinks there is cancer he or she will usually try and remove it all during this operation. But this depends also on whether you have finished your family. If you want to have more children your doctor will want to be absolutely certain you have cancer before removing both of your ovaries and possibly your womb. Whether you need any more treatment after surgery will depend on what the surgeons find and the results from the laboratory. If you need more treatment this will usually be chemotherapy. Surgery There are two types of operation to check for ovarian cancer. Whichever kind you have, you'll be given a general anaesthetic so you'll sleep through it. During laparoscopy, your surgeon makes two small cuts in your abdomen. Tiny instruments and a camera are put through the cuts to get a close look at your ovaries, take samples of tissue (biopsies), and remove a cyst or ovary if necessary. You should recover faster from this surgery than from standard surgery. But if your surgeon finds cancer, you may need standard surgery afterwards to remove as much of the cancer as possible. During standard surgery, your surgeon makes a large cut in your abdomen to look at your ovaries. If your surgeon finds a tumour on your ovary that could be cancer, he or she will probably remove your whole ovary. Surgeons do this because cutting away just a piece of the ovary could let cancer cells get out. Your surgeon will send the tumour to the laboratory immediately to check if it is cancer. This is sometimes done during the operation. If the laboratory finds that you have ovarian cancer, your surgeon will try to remove as much of the cancer as possible to give you the best chance of staying well. page 2 of 5

3 As well as the ovary with the cancer in it, your surgeon may remove some other parts of your reproductive system, such as your womb (do a hysterectomy), your other ovary and fallopian tubes. He or she may also remove the lining of your abdomen (the peritoneum) if there's cancer in it and the fold of fat that hangs down from your stomach on the inside of your abdomen (the omentum) because cancer often spreads there. Some lymph nodes from your abdomen and around your ovaries may also be removed to see if they have cancer in them. Your surgeon will send all of these to the laboratory, where they'll be checked under a microscope for cancer. This will tell how far the cancer has spread (its stage). But the surgeon may not be able to remove all of the cancer if there's just too much or it's in places he or she can't get to easily. You'll probably need to stay in the hospital for about one week after your operation. You may have heavy bleeding straight after your operation, get blood clots in your legs, or have problems healing. But once you've recovered from the operation, you should be able to do all the things you did before. If both of your ovaries are taken out during surgery you won't be able to get pregnant naturally, but you may be able to get pregnant with fertility treatments. For example, it may be possible to remove and freeze some eggs from your ovary. If you want to get pregnant then talk to your doctor about the options available to you before you have surgery. If you haven't already gone through the menopause, you may get some of the symptoms of it after surgery, such as hot flushes, sweating at night, and a dry vagina, as well as thinning of your bones (osteoporosis). Treatments can help with some of these problems. Having ovarian cancer is a worrying time and you may need time to adjust to what is happening. You may not feel like having sex for some time. Let your partner know that you need support and understanding. It may help to talk to a counsellor about this. Chemotherapy Most women with ovarian cancer have chemotherapy after surgery. Doctors used to think that women with ovarian cancer that had not spread (the cancer was only in the ovary) did not need to have chemotherapy. They thought that surgery would be the only treatment they needed. But some research has found that some women with early ovarian cancer live longer if they have chemotherapy. The aim of chemotherapy is to kill any cancer cells that are left. Your doctor will usually start it about four weeks after your operation. You ll usually have six treatments in all. Research shows that chemotherapy can help women with ovarian cancer live longer. The chemotherapy is given through a tube that s inserted into a vein. It s usually given during the day and you won t have to stay in hospital for this treatment. There are many different drugs used for chemotherapy. Research shows that for ovarian cancer, chemotherapy that includes a platinum drug (cisplatin or carboplatin) seems to work best and helps you live longer. It's possible that adding another drug called page 3 of 5

4 paclitaxel (brand name Taxol) to chemotherapy with a platinum drug may also help you live longer. But the research is not clear about this and you may get more side effects with the combination. The National Institute for Health and Care Excellence (NICE), the government body that decides which treatments should be available on the NHS, has said that all women with ovarian cancer should be offered chemotherapy with either a platinum drug in combination with paclitaxel, or a platinum drug alone. All chemotherapy causes side effects, but the ones you get will depend to some extent on the drugs you re treated with. You might get changes in your blood that can cause anaemia (a reduction in the number of red blood cells you have, which can make you feel tired) and infections after chemotherapy for ovarian cancer. Nausea and vomiting are also common, but you can get treatment to prevent these. You might also get numbness and tingling in your hands and feet, and hearing problems, but these problems are less common. As with all chemotherapy, you might feel tired, lose your hair, get mouth sores, and lose your appetite. If your cancer comes back after surgery and chemotherapy, you may be given some more chemotherapy. What drugs you re treated with depends on how your chemotherapy worked the first time round. You may be treated with the same drugs again, or with different ones. If chemotherapy using platinum drugs and taxanes hasn't worked, your doctor may suggest you try other chemotherapy drugs. These might be topotecan or pegylated liposomal doxorubicin hydrochloride (PLDH). Other treatments Doctors used to sometimes do a second operation to check for more cancer cells after chemotherapy, or sometimes half way through it. But research shows that a second operation doesn t usually help women live longer, especially if most of the cancer was removed during the first operation. Radiotherapy isn t often used in ovarian cancer. But it might be used to control cancer that has spread to other parts of your body. What will happen to me? No one can say for sure what will happen to you if you have ovarian cancer. But as with most cancers, the less advanced your cancer is (the less it has spread) when you are diagnosed, the better your chance of being cured. However, some women with ovarian cancer that has spread to other organs live for a long time. What happens to you also depends on how much cancer doctors can remove during surgery and how well you respond to other treatments. Remember that figures from research studies tell us how well a lot of women do on average. But they don't predict how well you or your cancer will respond to treatments. page 4 of 5

5 Ovarian cancer Doctors can t tell for sure what course your cancer will take. For this reason, you need to be watchful and have regular check-ups for many years after your treatment has finished. This information is aimed at a UK patient audience. This information however does not replace medical advice. If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These leaflets are reviewed annually. Last published: Sep 16, 2015 page 5 of 5