Ovarian cancer is a type of cancer that develops within the ovaries, when cancer cells grow abnormally and eventually form a tumour. Despite its often subtle signs and symptoms, ovarian cancer is the fifth most common cause of cancer death in cisgender women worldwide (1).
Around 90% of ovarian cancers originate from the surface layer of tissue that covers the ovary (epithelial carcinoma), but there are many different types of ovarian cancer. They can also develop from other areas, including in the ovarian cells that develop into eggs (germ cells), and the tissues that support the ovary(2).
As symptoms of ovarian cancer are often general, they can be easily mistaken for other, more common conditions. That’s why ovarian cancer awareness, and understanding the signs and risk factors of the condition, is so important.
What is the cause of ovarian cancer?
We don’t yet know what exactly causes ovarian cancer, but we do know that there are some risk factors which can increase the chance of it developing.
For example, it is known that age can increase the risk of ovarian cancer, with most cases occurring after menopause — when the ovaries stop producing eggs and periods cease. Around eight in every ten cisgender women diagosed with ovarian cancer are aged over 50 (3).
Family history can also play a role. The risk of ovarian cancer is up to 3.5 times higher for those whose parent or sibling has had ovarian cancer, compared to those with no such family history (4).
Other factors are said to decrease the risk of ovarian cancer, including use of oral hormonal contraception, having given birth to more than one child, or any other condition that makes you ovulate less frequently (5).
If you’re worried about your chances of developing ovarian cancer, speak with your doctor who may be able to advise on a risk management plan — for example, making lifestyle changes such as stopping smoking or making other changes to your wider healthcare plan.
Signs and symptoms of ovarian cancer
Most of the time, the below symptoms are unlikely to be cancer. However, if you experience these common symptoms frequently — which clinical guidance defines as being 12 or more times per month — and they do not go away, you should see your doctor to rule out anything more serious (6).
The most common symptoms of ovarian cancer are (7):
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Feeling bloated
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Having a swollen stomach
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Feeling discomfort in your stomach or pelvic area
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Loss of appetite or feeling full quickly when you eat
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Needing to pee more often or more urgently than you normally would
Other symptoms include:
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Feeling sick or having constant indigestion
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Pain during sex
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Back pain
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Feeling tired all the time
How is ovarian cancer diagnosed?
There is currently no routine way to screen for ovarian cancer, in the same way that a smear test can pick up early indications of cervical cancer, because there aren’t any tests which can reliably identify ovarian cancer at an early stage. However, this is an active area of cancer research (8).
Ovarian cancer is diagnosed through a series of tests that are designed to exclude possibilities and eventually confirm the presence of a cancerous tumour.
If you think you may have ovarian cancer, you should first make an appointment with your GP, who will ask you about the severity and frequency of your symptoms and then carry out an abdominal and pelvic examination. This is to check for signs of fluid in the abdomen or whether the ovary is enlarged.
Your doctor may decide to investigate further by testing your blood for an antigen — a substance in the body that indicates an immune response — known as CA125, which can be a marker of ovarian cancer (9). They may also carry out an ultrasound scan of the abdomen and pelvis to help identify any tumours present.
If ovarian cancer is suspected at this point, you’ll be referred to a specialist for further testing. This is sometimes referred to as an urgent referral, which is not the same thing as a medical emergency — it means that your symptoms need further investigation. More than 90% of people who are referred in this way do not have cancer, but it’s still important to go through the process and get thoroughly checked out (10).
Once referred, you may have tests such as an x-ray or needle biopsy, where a small sample of ovary cells are extracted and checked for cancer.
How is ovarian cancer treated?
Treatment for ovarian cancer depends on the type of cancer and how severe (what stage) it is. Most people diagnosed with ovarian cancer will have a combination of surgery and chemotherapy.
The aim of surgery is to remove as much of the cancer as possible. This can mean removing one or both ovaries and the Fallopian tubes or having a hysterectomy (the entire womb is removed). If the womb hasn’t been taken out, then there is a chance that you may still be able to have children (11).
Chemotherapy uses drugs that destroy cancer cells that are typically injected into a vein through a drip in the arm. In some cases, targeted cancer drugs may be recommended, which can alter the way that cells work and can help the body to control the growth of the cancer.
Cancer treatment always aims to cure the cancer, but if this is not possible, then your doctors will focus on controlling it and making symptoms as manageable as possible.
Can I still have children after cancer treatment?
Depending on the type of treatment that you’ve had, as well as on your age, you may still be able to get pregnant.
If you have undergone surgery to remove one ovary — for example if the tumour is caught early and contained within the other ovary — and still have your womb, there is a possibility that you could become pregnant naturally.
If you still have your womb, i.e. if you haven’t had a total hysterectomy, you may be able to try IVF, which is when eggs are fertilised by sperm outside of your body and then placed inside your womb. Your doctor will be able to advise whether this is an option available to you.
Surgeries to remove ovarian cancer generally cause a drop in oestrogen and progesterone levels, as these hormones are produced by the ovaries. If both ovaries are removed or if you have a hysterectomy, you will experience menopause following treatment — regardless of your age. This means that you will be unable to conceive naturally.
Chemotherapy can also affect fertility temporarily or permanently, depending on the type of drugs you’ve taken and how strong the dose is. This is because chemotherapy drugs can disrupt and damage ovarian function, including in reducing the amount of eggs that can be produced (ovarian reserve) (12).
Your doctor may suggest that you freeze your eggs before undergoing chemotherapy, and wait a few years after the treatment is completed before trying to get pregnant.
Can tracking my cycle help to spot signs of cancer?
Menstrual cycle irregularities are not considered to be one of the main symptoms of ovarian cancer, but in some cases this can be indicative of the disease.(13)
Some studies have found a correlation between irregular periods and ovarian cancer. One prospective study, looking at 15,528 mothers, found a higher incidence of ovarian cancer among those with irregular cycles (14). Other findings are inconsistent and inconclusive, showing that irregular cycles are associated with both increased and decreased risk of cancer (15).
However, progesterone — a hormone produced by the ovaries that plays an important role in the menstrual cycle — is thought to play a protective role against ovarian cancer when its levels are elevated, as during pregnancy or from oral contraceptive use, as this works to reduce ovulation (16). Therefore, a decrease in progesterone, which may happen due to old age or infertility, could indicate an increased risk.
The inne minilab enables you to track your progesterone levels in your saliva daily. The inne app is also a great way to log symptoms, to keep track of what you are feeling and how often. This information alone isn’t enough to tell you whether you have cancer — but can be a useful way of monitoring how frequent and severe your symptoms are, and helping you decide when to see a doctor.
References
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Roett, M.A., and Evans, P., Ovarian Cancer: An Overview. Am Fam Physician. 15;80(6):609-606 (2009)
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NICE, Ovarian Cancer: What is it? Clinical Knowledge Summary, National Institute for Health and Care Excellence. (Updated July 2018). Available from: https://cks.nice.org.uk/topics/ovarian-cancer/background-information/definition/
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NHS, Ovarian Cancer: Causes, National Health Service UK. (Updated February 2020). Available from: https://www.nhs.uk/conditions/ovarian-cancer/causes/
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NICE, Ovarian Cancer: What is it? Clinical Knowledge Summary, National Institute for Health and Care Excellence. (Updated July 2018). Available from: https://cks.nice.org.uk/topics/ovarian-cancer/background-information/risk-factors
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Ibid
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Roett, M.A., and Evans, P., Ovarian Cancer: An Overview. Am Fam Physician. 15;80(6):609-606 (2009)
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NHS, Ovarian Cancer: Symptoms, National Health Service UK. (Updated February 2020). Available from: https://www.nhs.uk/conditions/ovarian-cancer/symptoms/
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Hurwitz, L.M., et al. General population screening for ovarian cancer. The Lancet, 397(10290):2128-2130 (2021)
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Arora, T., et al. Ovarian Cancer. In StatPearls (Updated February 2021). Available from: https://www.ncbi.nlm.nih.gov/books/NBK567760/
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Cancer Research UK, Your Urgent Cancer Care Referral Explained. (Updated May 2020). Available from: https://www.cancerresearchuk.org/cancer-symptoms/what-is-an-urgent-referral
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NHS, Ovarian Cancer: Treatment, National Health Service UK. (Updated February 2020). Available from: https://www.nhs.uk/conditions/ovarian-cancer/treatment
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Waimey, K.E., et al. Understanding Fertility in Young Female Cancer Patients. Journal of Women’s Health. 24(10):812-818 (2015)
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American Cancer Society, Signs and Symptoms of Ovarian Cancer. (Updated April 2018). Available from: https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/signs-and-symptoms.html
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Cirillo, P.M., et al. Irregular menses predicts ovarian cancer: Prospective evidence from the Child Health and Development Studies. Cancer Epidemiology. 139(5):1009-1017 (2016)
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Ibid
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Diep, C.H., et al., Progesterone action in breast, uterine, and ovarian cancers. Journal of Molecular Endocrinology. 54(2): R21-R53. (2015)
