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Ovarian cancer affects some 7000 British women every year and 165,000 new cases are diagnosed every year, worldwide. Worldwide, ovarian is the sixth most common form of cancer. It develops mostly in women over 55, and half of all cases occur in women of 65 plus, although one in ten patients will be under 45.
Ovarian cancer affects some 7000 British women every year Once known as the "silent killer" (because it gives few, if any, warning signs at the early stage when treatment can be successful) ovarian cancer is perhaps more usefully described as the "whispering" disease, because women who listen to their bodies may pick up possibly life-saving signs. These include:
Pelvic or abdominal discomfort and pain
Cramps
Bloating or swelling
Loss of weight or appetite
Fatigue
Breathlessness
Backache
Urinary problems
Unexplained changes in bowel habits
Unusual vaginal bleeding
Your chances of contracting ovarian cancer are reassuringly small, but any woman noting several of these signs, should consult her GP. Seventy per cent of women diagnosed with ovarian cancer present with disease that has already spread beyond the ovaries, which is why the overall five-year survival rate is only 28 per cent. It can be as high as 90 per cent for those of the 2000 British women diagnosed early every year.
Risk Assessment
Certain risk factors have been identified for the most prevalent form of ovarian cancer, known as epithelial. Much less is known about the rare germ cell and stromal ovarian tumours. Women who have no children are more likely to have this cancer, and women who start a family after 30 also have a slightly greater risk. Menstruation patterns are also implicated - more monthly periods may increase the risk; women who began their periods before the age of 12, who had a late menopause and did not breastfeed may also have a higher risk.
Women who have no children are more likely to have this cancer Dr David Guthrie, consultant clinical oncologist at the Derbyshire Royal Infirmary, stresses that childbearing patterns and ovarian cancer are markedly linked: this cancer is rare in the now scant number of women who have had four or more pregnancies. The unfashionable message seems to be that falling birth rates are bad for ovarian health. Women who have had breast cancer are more likely to develop ovarian cancer and chlamydia has also been linked.
Family Links
A woman with two or more close relatives with ovarian cancer, or one with this cancer and another with breast cancer diagnosed before she was 50, has a strong family history and carries a greater risk. In the past few years scientists have learned much more about genetic predisposition to this form of cancer.
The BRCA1 and BRCA2 genes which women can inherit from their parents are designed to prevent cancer by making proteins to inhibit abnormal cell growth.
Mutations on these genes can make the protein less effective but are thought responsible for less than 5 per cent of ovarian cancer overall. The lifetime risk for women with either of these two mutations rises to something between 17 and 44 per cent.
Lowering the Risk
Despite its vexed reputation for women's health overall, the birth control pill actually lowers the risk for ovarian cancer in women who have taken it for five years. After ten years, says Dr David Guthrie, the risk reduction is a marked 50 per cent.
Women who have undergone tubal ligation to prevent pregnancy or had a hysterectomy also seem to have lowered risk, though this is not a reason for choosing surgery.
The American Cancer Society recommends a diet high in fruits vegetables and wholegrain with a limited intake of red and processed meats. There's been some suspicion that the use of talcum powder in the genital area could double the risk of ovarian cancer: two out of nine studies suggested a significantly raised risk and another five a slightly increased risk
Screening
Internal examinations can only detect large ovarian tumours. Regular smears only rule out cancer of the cervix. But a study of over 5000 women at King's College confirmed that ultrasound could detect many cases of ovarian cancer at an early stage. Another study at the Royal London and Baits Hospital looked at ultrasound combined with a blood test for protein levels of CA125 (which is raised in women with ovarian cancer).
The conclusion was that this dual screening enabled many cases to be detected before any symptoms developed. The problem with screening, however, is that false positives are common and false negatives also occur. Medics have also yet to establish beyond any doubt that screening would actually save lives.
Internal examinations can only detect large ovarian tumours To that end a massively ambitious, randomised UK trial (UKTOCS) is under way involving 200,000 women between 50 and 74 at 13 regional centres.
Before seeking screening even women with a strong family history should seek expert advice - the fact that you have undergone genetic testing could, for instance, affect your life insurance cover.
Treatment
Ovarian cancer usually begins with a laparotomy to establish the site and scale of the problem. A complete hysterectomy will usually be recommended, followed by chemotherapy.
A huge international study of 477 women with early ovarian cancer from 84 centres in five countries concludes that Carboplatin is the gold standard chemotherapy for these particular ovarian cancer patients.
Dr David Guthrie explains that even if surgery appears to remove all visible evidence of ovarian cancer, some microscopic deposits may persist and cause a recurrence in about a third of patients diagnosed at an early stage.
The key question for oncologists has been whether to wait, see and give chemo only when a recurrence is found, or to give it routinely after surgery. This recent trial however suggests that survival is increased by 9 per cent if Carboplatin is given within six weeks of surgery.