Ovarian cancer: diagnosis, staging, and treatment

What is ovarian cancer?

Ovarian cancer is a form of cancer that starts in the ovaries. These are two small, oval glands in the female reproductive system, and they’re responsible for storing and releasing eggs.

Most ovarian cancers start in the epithelium, which is the outer lining of the ovary. In many cases, you’ll have no symptoms in the early stages. However, you might experience pain and pressure in the lower abdomen, irregular vaginal bleeding, and bloating.

While ovarian cancer can affect females of all ages, like many cancers, it’s more common in older populations. It’s most prevalent in the 75–79 year old age group.

Types of ovarian cancer

There are three main types of ovarian cancer:

• Epithelial: Both the most common and most serious, this form of cancer forms in the lining of the ovary.
• Germ cell: These rare tumours form in germ cells, which are the cells that produce eggs. They can be either malignant (cancerous) or benign (non-cancerous). 
• Stromal: This type of cancer occurs in the stromal cells, which are cells that release hormones.

Epithelial is the most common form, making up about 90% of ovarian cancers. If you’re diagnosed with ovarian cancer, your doctor will explain which type you have, its grade, and its stage.

Risk factors

One of the most significant risk factors for ovarian cancer is genetics. While most cancers aren’t inherited, ovarian is an exception, so it tends to cluster in families. If you have mutations to the BRCA gene, you have a higher chance of developing both ovarian and breast cancer.

If you have a family history of these cancers, you might want to explore genetic testing. This can help you understand your cancer risk and take preventative measures. However, getting tested is a big decision, and you shouldn’t feel pressured to do so.

In addition to genetics, certain factors are also linked to ovarian cancer. They include:

• Being older
• Being at a higher weight
• Not having children
• Having children later in life
• Having hormone replacement therapy (HRT)

Symptoms of ovarian cancer

In its early stages, ovarian cancer can have no symptoms. You can also have relatively minor symptoms that mimic those of common conditions like irritable bowel syndrome (IBS), premenstrual syndrome (PMS), and urinary tract infections (UTIs).

However, if you do have any symptoms of ovarian cancer, you shouldn’t ignore them. It’s important to get them checked, so call your doctor if you have concerns.

Some signs and symptoms to look out for include:

• Pain and pressure in your abdomen or pelvic area
• Back pain
• Irregular vaginal bleeding
• Bloating
• Getting full quickly after eating
• Loss of appetite
• Gas, constipation, and difficulty going to the toilet
• Losing weight without trying
• Fatigue

How ovarian cancer is diagnosed

If your doctor suspects ovarian cancer, they’ll start by taking your medical history and asking if you have a family history of certain cancers. They’ll also perform a pelvic exam. During this check, they’ll gently insert a finger into your vagina and feel for anything abnormal. They may also press down on your abdomen with the other hand.

Depending on your symptoms and risk factors, your doctor might order some or all of the following tests:

• Blood tests: A nurse will draw your blood and send it away to be tested for CA-125. This is a protein found in blood that can indicate certain forms of cancer.
• Imaging tests: A technician can use an ultrasound to look at the shape of your ovaries and check for anything unusual. Your doctor might order an MRI or CT scan for a more detailed picture of your reproductive organs.
• Laparoscopy and biopsy: If your doctor sees a mass on one or both of your ovaries, they can take a closer look with laparoscopy. This is a minimally invasive keyhole surgery, and it’s usually an outpatient (home the same day) procedure. They’ll take a biopsy (tissue sample) and send it to the lab for testing. This is the only test that can confirm if cancer is present.

If you’re diagnosed with ovarian cancer

If your biopsy results confirm ovarian cancer, your doctor will explain the next steps. They’ll explain what the test results showed—for example, what stage and grade the cancer is. This will determine what type of treatment you’ll need.

It’s a good idea to bring a loved one along with you to this and the following appointments. They can emotionally support you throughout the process, and they can also help you ask questions about what to expect. Receiving a cancer diagnosis can be a scary and overwhelming experience, and leaning on friends and family support can provide comfort.

Ovarian cancer stages

Doctors define how serious a cancer is with stages and grades. Stage explains how far the cancer has spread, and grade describes how abnormal the cells look. 

Stage I ovarian cancer

Stage IA: There are cancer cells in one ovary or fallopian tube.
Stage IB: There are cancer cells in both ovaries or both fallopian tubes.
Stage IC: There are cancer cells in one or both ovaries or fallopian tubes. Additionally, there are either cells outside them or cancer cells in your peritoneal cavity, its lining, or abdominal fluid.

Stage II ovarian cancer

 Stage IIA: The cancer has spread from the ovaries to the fallopian tubes or uterus.

Stage IIB: The cancer has spread to your bladder, colon, or rectum.

Stage III ovarian cancer

 Stage IIIA: The cancer has spread to the lymph nodes behind the peritoneum or to the surface of the peritoneum.

Stage IIIB: A mass two centimetres (cm) or smaller can be seen inside the peritoneum. It may have also spread outside the pelvis and to nearby lymph nodes.

Stage IIIC: The cancer is two cm or larger and has spread to the peritoneum, outside of the liver or spleen, and nearby lymph nodes.

Stage IV ovarian cancer

 Stage IVA: There are cancer cells in fluid that’s built up around the lungs.

Stage IVB: The cancer has spread outside the abdomen. It may be in further lymph nodes and organs.

Treatment for ovarian cancer

Your treatment plan will depend on a range of factors. Your healthcare team will consider the stage and grade of the cancer as well as your age, overall health, and other risk factors. In many cases, treatment will start with surgery to remove the cancer. You’ll then have chemotherapy to kill the remaining cells and prevent cancer from coming back.

Surgery

The type of surgery you’ll need depends on how much the cancer has spread. If your cancer is caught early and is isolated to one ovary, you may only need the ovary and connected fallopian tube removed. For those who haven’t reached menopause, this may be a preferred option because it retains the ability to possibly fall pregnant in the future. 

However, many people with ovarian cancer have surgery to remove their ovaries, fallopian tubes, and uterus (womb). Your doctor will aim to remove as much of the cancer as possible. Then, they can treat any remaining cancer cells with chemotherapy.

Chemotherapy 

If your cancer is stage IC or above, you’ll likely need chemotherapy in addition to surgery. You might also need it if you have IA or IB cancer that’s higher in grade.

You can receive chemo as an injection or through an intravenous (IV) drip in your arm. You’ll usually have it once every three weeks, as this gives your body time to recover from the side effects. Each session lasts about 3–4 hours, but you’ll be able to go home from the hospital afterward to rest.

Targeted therapy and immunotherapy

Targeted therapy is a newer form of treatment. These drugs target specific functions in your body and make it harder for cancerous cells to divide and grow. They’re usually used if you have advanced ovarian cancer or cancer that’s come back after other treatments.

Immunotherapy, another promising treatment, boosts your immune system and helps it fight and destroy cancer cells. While it’s still fairly new, clinical trials have shown positive results.

Recovering from ovarian cancer treatment

Cancer treatment can be both physically and emotionally draining. After you’ve completed your course of treatment, taking time to focus on recovery is essential.

Physical recovery

Your doctor will schedule regular check-ups, but if you have any questions or concerns that pop up, be sure to give them a call. You might feel stressed about not speaking with your healthcare team as often, so it can be useful to make a plan with them before your treatment is finished.

Surgery and chemotherapy will likely leave you feeling physically different than you did before. Try to focus on what your body can do, instead of what it can’t. This can look like gradually getting active in ways that feel comfortable for your body and making an effort to spend time outside where possible.

Emotional recovery

After treatment, you’ll likely feel a range of emotions. People who have gone through cancer treatment often experience feelings like grief, sadness, anxiety, and worry. However, you might also feel that you have a different outlook on life, and concerns about things like work stress and family drama seem trivial. 

During this time, it can be useful to speak with a therapist or counsellor who can help you process what you’ve been through. You can also join a support group to speak with others with a cancer or ovarian cancer diagnosis.

Living with ovarian cancer

Creating a treatment and monitoring plan

As you recover from treatment, you’ll have regular check-ups with your healthcare team. These may become less frequent over time, but it’s still important to get screenings to make sure your cancer hasn’t come back. This can help ease your worries as you’ll feel in control knowing what’s going on in your body.

Managing side effects

The side effects of cancer treatment can be both physical and emotional, and you may feel their lasting effects for months or years.

Hair loss can be emotionally one of the most difficult side effects for women. However, know that people close to you won’t see you differently. Despite this, it’s important to recognise your feelings or sadness and allow yourself to grieve things you’ve lost during treatment. For many people, options like wigs, scarves, jewellery, and makeup help them feel beautiful through their body’s changes.

Having surgery to remove the womb and ovaries can also be very upsetting, even if you’ve been through menopause. If you’ve not yet reached this stage, having them removed will have triggered menopause symptoms. Your healthcare team and GP can help you cope with these.

Coping with your diagnosis

The experience of a cancer diagnosis and treatment can be difficult, and it’s important to lean on your support network during this challenging time. It can be helpful to make a list of questions before appointments and bring along a friend or family member for support. Getting a lot of information all at once can be overwhelming, so having someone to speak with can help you process what’s happened.

Your diagnosis and treatment might affect your personal and romantic relationships, but know that those closest to you will always be there to support you. Try to be open with your partner about how you’re feeling, both mentally and physically, and let them know how they can best support you. 

Additionally, you might be worried about practical concerns like how cancer will affect your work, finances, childcare responsibilities, and more. Speak with your nurse about these, as they may be able to put you in touch with a support worker who can help. You can also reach out to support groups run through charities like Macmillan, Eve Appeal and Ovacome.

Why choose Circle Health Group for ovarian cancer support?

Experiencing ovarian cancer symptoms and receiving a diagnosis can be scary, but having a healthcare team you trust can help. 

Circle Health Group offers expert care and personalised treatment options, and you’ll be supported by our network of experienced providers every step of the way.

To learn more about our diagnostic and treatment options, book your appointment online today or call a member of our team directly.

 

Clinical review and sources

 

• Ovarian cancer, Cancer Research UK
• Ovarian cancer, Medline Plus
• Ovarian cancer incidence statistics, Cancer Research UK
• Ovarian cancer risk factors, American Cancer Society
• Predictive genetic tests for cancer risk genes, NHS
• Stages of ovarian cancer, Memorial Sloan Kettering Cancer Center
• Tests and next steps, NHS