Ovarian cancer: your questions answered

More than 7,000 women are diagnosed with ovarian cancer each year in the UK, a cancer that occurs when a group of cells begin to grow uncontrollably in the ovaries or in the nearby areas.

Dr Hafiz Algurafi, a highly experienced consultant medical and clinical oncologist, offers a comprehensive insight into ovarian cancer answering frequently-asked questions, from causes and symptoms to diagnosis, surgery and prognosis.

What are the main causes of ovarian cancer? What are the associated risk factors?

There are no absolute causes that are known for ovarian cancer. We certainly know that there are risk factors associated with it, but an exact cause is not known as yet. The most common risk factors associated with ovarian cancer include:

Increased age: ovarian cancer is uncommon in women less than 45 and more frequent in women especially in their late 70s.

Obesity: women with a BMI of more than 30 have a higher risk of ovarian cancer.

Use of HRT (hormone replacement therapy): can raise the risk of ovarian cancer, with an estimated four per cent of women who use HRT at an increased risk.

A late pregnancy: women who have had their first pregnancy over the age of 35 tend to be associated with a higher risk for ovarian cancer.

A previous breast cancer or bowel cancer: women with a history of breast or bowel cancer may be more susceptible to ovarian cancers as part of a ‘cancer family syndrome’, in which certain mutations or changes in genes can make an individual more susceptible to developing ovarian cancer and possibly other associated cancers such as breast and bowel cancer. The most common of these genes is the BRCA 1 or BRCA 2 gene, although other genes are also involved. Up to 25 per cent of ovarian cancers are genetically linked to a BRCA 1 or a BRCA 2 gene.

We also believe that exposure to IVF (in vitro fertilisation) may be associated with certain subtypes of rare ovarian cancers called borderline ovarian tumours.

There are other risk factors that we are unsure as to whether they may play a role or not are, for example smoking, which while it does not increase the overall risk of ovarian cancer, it does predispose to a particular subtype called mucinous cancer.

How exactly is ovarian cancer diagnosed? What tests are performed?

In most cases, a patient will present with certain symptoms that will then trigger a series of tests. These symptoms may be abdominal pain, bloating with increased urinary frequency (urinating more often or with more urgency), fatigue, back pain or weight loss.

The appearance of symptoms will trigger especially GPs, initially, to assess and refer the patient, who will usually then have a pelvic examination, an ultrasound (an abdominal or a pelvic ultrasound using a transvaginal probe) and a blood test for CA125, a protein tumour marker secreted by most ovarian cancers. These series of investigations, depending on the outcome, may then trigger a further series of tests including an MRI scan of the pelvis and CT scans. Overall, testing involves clinical assessment of symptoms, an ultrasound, a CA125 blood test and then possibly further tests, which can be an MRI scan of the pelvis.

All of these tests will help to identify if there are any specific solid tumours that can be seen and if so, where they are, what the extent of them is and how to plan for the obtaining of their tissue to be analysed in a biopsy.

At what stage would surgery potentially be considered?

We know that surgery is probably the most important prognostic factor, because women who have ‘complete debulking’ of their cancer will tend to do better. When I say ‘complete debulking’, I am referring to surgery which hopes to leave absolutely no disease behind - that tends to bode well in terms of prognosis.

Certainly, women with stage 1 (disease confined to the ovaries) are very suitable candidates for surgery, but so are patients with stage 2 and stage 3, although their surgery may also be associated with chemotherapy as an adjunct to that.

Stage 2 tends to refer to disease that is confined to the pelvis and stage 3 to the upper abdomen. Despite them being more advanced compared to stage 1, they are still amenable to surgery even though chemotherapy as an adjunct may well be used, especially in stage 3 cancers or possibly even before surgery.

Stage 4 cancers which are more advanced and the most advanced of the staging are still operable, but they will need chemotherapy potentially before they have surgery, to try and reduce the volume of disease to make the procedure easier.

All stages of ovarian cancer are very amenable (suitable) to surgery, with aids such as chemotherapy to help in the more advanced setting. Surgery will usually consist of removal of the ovaries, the womb, the lymph nodes and the omentum, which is the layer of fat within the pelvis. A decision will be made on a patient-by-patient basis depending on the extent of their disease.

What are the survival rates of ovarian cancer?

The survival rates for ovarian cancer vary by stage: stage 1 is where the cancer is early and confined to the ovaries; stage 2 which involves the pelvis stage; stage 3 involves the upper abdomen and stage 4 involves other extra pelvic organs (organs beyond just the pelvis and the abdomen).

For all of the stages we use a marker, which is a five-year outcome. This is not to say that patients with ovarian cancer only live for five years, of course, but a cut off is made at five years because it is generally a good marker of how patients are going to do beyond that as well, potentially.

• For stage 1, 90 per cent of patients will still be alive at five years.

• For stage 2, 70 per cent of patients will still be alive at five years.

• For stage 3, 40 per cent of patients will still be alive at five years.

• For stage 4, 15 per cent to 20 per cent will still be alive at five years.

We now have better systemic therapy and better targeted drugs, so these figures will change with time as patients drive benefit from them and as other drugs come into play as well.

If you or one of your loved ones have been diagnosed with ovarian cancer and you wish to receive the utmost quality oncological care from Dr Algurafi, don’t hesitate to visit his Top Doctors profile today.