Ovarian cancer

What is

Ovarian cancer, or cancer of the ovaries, is one of the most common types of cancer in women.

The ovaries are a pair of small organs located low in the tummy that are connected to the womb and store a woman’s supply of eggs.

Ovarian cancer mainly affects women who have been through the menopause (usually over the age of 50), but it can sometimes affect younger women.

Common symptoms of ovarian cancer include:

  • feeling constantly bloated
  • a swollen tummy
  • discomfort in your tummy or pelvic area
  • feeling full quickly when eating
  • needing to pee more often than usual

The symptoms are not always easy to recognise because they’re similar to those of some more common conditions, such as irritable bowel syndrome (IBS).

See a GP if:

  • you have been feeling bloated, particularly more than 12 times a month
  • you have other symptoms of ovarian cancer that will not go away
  • you have a family history of ovarian cancer and are worried you may be at a higher risk of getting it

It’s unlikely you have cancer, but it’s best to check. A GP can do some simple tests to see if you have it.

Find out more about how ovarian cancer is diagnosed

If you have already seen a GP and your symptoms continue or get worse, go back to them and explain this.

If you have a family history of ovarian cancer, a GP may refer you to a genetics specialist to discuss the option of genetic testing to check your ovarian cancer risk.

The exact cause of ovarian cancer is unknown.

But some things may increase a woman’s risk of getting it, such as:

  • being over the age of 50
  • a family history of ovarian or breast cancer – this could mean you have inherited genes that increase your cancer risk
  • hormone replacement therapy (HRT) – although any increase in cancer risk is likely to be very small
  • endometriosis – a condition where tissue that behaves like the lining of the womb is found outside the womb
  • being overweight
  • smoking
  • lack of exercise
  • exposure to asbestos

The treatment for ovarian cancer depends on things such as how far the cancer has spread and your general health.

The main treatments are:

  • surgery to remove as much of the cancer as possible – this will often involve removing both ovaries, the womb and the tubes connecting them to each other (fallopian tubes)
  • chemotherapy – this is usually used after surgery to kill any remaining cancer cells, but is occasionally used before surgery to shrink the cancer

Treatment will aim to cure the cancer whenever possible. If the cancer has spread too far to be cured, the aim is to relieve symptoms and control the cancer for as long as possible.

The earlier ovarian cancer is diagnosed and treated, the better the chance of a cure.

But often it’s not recognised until it’s already spread and a cure is not possible.

Even after successful treatment, there’s a high chance the cancer will come back within the next few years.

If it does come back, it cannot usually be cured. But chemotherapy may help reduce the symptoms and keep the cancer under control for several months or years.

Overall, around half of women with ovarian cancer will live for at least 5 years after diagnosis, and about 1 in 3 will live at least 10 years.

Cancer Research UK has more information about the survival statistics for ovarian cancer.

Symptoms

The symptoms of ovarian cancer can be difficult to recognise, particularly early on.

They’re often the same as symptoms of less serious conditions, such as irritable bowel syndrome (IBS) or PMS (pre-menstrual syndrome).

The most common symptoms of ovarian cancer are:

  • feeling constantly bloated
  • a swollen tummy
  • discomfort in your tummy or pelvic area
  • feeling full quickly when eating, or loss of appetite
  • needing to pee more often or more urgently than usual

Other symptoms of ovarian cancer can include:

See a GP if:

  • you have been feeling bloated, particularly more than 12 times a month
  • you have other symptoms of ovarian cancer that will not go away – especially if you’re over 50 or have a family history of ovarian or breast cancer, as you may be at a higher risk

It’s unlikely you have cancer, but it’s best to check. A GP can do some simple tests for ovarian cancer to see if you have it.

If you have already seen a GP and your symptoms continue or get worse, go back to them and explain this.

Causes

Ovarian cancer happens when cells in the ovaries grow and multiply uncontrollably, producing a lump of tissue called a tumour.

It’s not clear exactly why this happens, but there are factors which may increase your risk of getting ovarian cancer.

The risk of ovarian cancer increases as you get older, with most cases happening after the menopause.

About 8 in every 10 women diagnosed with ovarian cancer are over 50, but some rare types of ovarian cancer can happen in younger women.

You’re more likely to get ovarian cancer if you have a history of it in your family, particularly if a close relative (sister or mother) has had it.

Sometimes this may be because you’ve inherited a faulty version of a gene called BRCA1 or BRCA2. These increase your risk of developing both ovarian and breast cancer.

But having relatives with ovarian cancer does not mean you definitely have a faulty gene. Only around 1 in every 10 ovarian cancers is thought to be caused by 1 of these genes.

The charity Ovarian Cancer Action has a tool to help you check whether your family history puts you at risk of ovarian cancer.  

Speak to a GP if you’re worried that your family history might mean you’re at a higher risk of ovarian cancer. They may refer you to see a genetic counsellor, who may suggest having a test to check for faulty genes.

Read more about genetic testing for cancer risk genes.

It has been suggested that taking hormone replacement therapy (HRT) may increase your risk of ovarian cancer. But studies looking at this have so far had conflicting results.

It’s thought that if there is any increase in cases of ovarian cancer in women taking HRT, the risk is very small.

Any increased risk of ovarian cancer is thought to decrease after you stop taking HRT.

Research has shown that women with endometriosis may be more likely to develop ovarian cancer.

In endometriosis, the cells that usually line the womb grow elsewhere in the body, such as in the ovaries or tummy.

These cells still behave as if they were in the womb, including bleeding during periods. But as there’s no way for the bleeding to leave the body, it becomes trapped and causes pain in the affected area.

Other things that may increase your risk of ovarian cancer include:

  • being overweight or obese – losing weight through regular exercise and a healthy diet may help to lower your risk
  • smoking – stopping smoking may help to reduce your risk of ovarian cancer and many other serious health problems
  • exposure to asbestos – a whitish material that was used in buildings for insulation, flooring and roofing in the past, but is no longer used
  • using talcum powder – some research has suggested that using talcum powder between your legs could increase your risk of ovarian cancer, but the evidence for this is inconsistent and any increase in risk is likely to be very small

Further information

Diagnosis

See a GP if you have symptoms of ovarian cancer. They can do some initial tests and you may also need further tests in hospital.

A GP may:

  • ask about your symptoms and general health
  • gently feel your tummy to check for any swelling or lumps
  • do an internal examination
  • ask if there’s a history of ovarian or breast cancer in your family
  • take a sample of blood – this will be sent to a laboratory and checked for a substance called CA125

In some cases, you may be referred straight to a hospital specialist (usually a gynaecologist) for further tests without having a blood test.

If the GP thinks your symptoms could be due to ovarian cancer, they’ll recommend having a blood test to check for a substance called CA125.

CA125 is produced by some ovarian cancer cells. A high level of CA125 in your blood could be a sign of ovarian cancer.

But a raised CA125 level does not mean you definitely have cancer, as it can also be caused by other conditions such as endometriosis, fibroids and even pregnancy.

If the test shows a high level of CA125, you’ll be referred for a scan to check for possible causes.

Sometimes your CA125 level can be normal in the early stages of ovarian cancer. If you’ve had a normal blood test result but your symptoms do not improve, go back to the GP as you may need to be re-tested.

Lab Tests Online UK has more information on the CA125 test.

The GP will arrange for you to have an ultrasound scan if a blood test suggests you could have ovarian cancer.

This is a type of scan where high-frequency sound waves are used to create an image of the inside of your body.

There are 2 ways it can be done:

  • abdominal ultrasound – a small device called an ultrasound probe is moved over your tummy to create an image of your ovaries
  • transvaginal ultrasound – an ultrasound probe is passed into your vagina to create a clearer image of your ovaries

The scan can show changes in your ovaries that could be caused by cancer or another problem such as endometriosis or a build-up of fluid.

If any abnormalities are found, you’ll be referred to a specialist for further tests to confirm the cause.

The following tests may be done by a specialist in hospital to confirm or rule out ovarian cancer:

  • a CT scan – a type of scan where several X-rays are taken from different angles to create a detailed image of your ovaries
  • a chest X-ray to check if cancer has spread to your lungs
  • a needle biopsy – a needle is passed through your tummy to remove a sample of ovary cells, or fluid from around the ovaries, so it can be checked for cancer
  • a laparoscopy – a small cut is made in your tummy and a thin tube with a camera on the end is inserted, so your ovaries can be examined; a small tissue sample may also be removed for testing

If ovarian cancer is found, these tests can also help determine how far it has already spread.

If you’re diagnosed with ovarian cancer, it will be given a “stage”.

This describes the size of the cancer and how far it has spread. It can help your doctors plan the best treatment for you.

The 4 main stages of ovarian cancer are:

  • Stage 1 – the cancer only affects 1, or both ovaries
  • Stage 2 – the cancer has spread from the ovary and into the pelvis or womb
  • Stage 3 – the cancer has spread to the lining of the tummy, the surface of the bowel or to the lymph glands in the pelvis or tummy
  • Stage 4 – the cancer has spread to other parts of the body, such as the liver or lungs

Your cancer will also be given a “grade”. This is a way of describing how quickly the cancer is likely to grow or spread.

The grades range from grade 1 (more likely to grow slowly) to grade 3 (more likely to grow quickly).

Further information

Treatment

The treatment for ovarian cancer depends on how far it has spread, your general health and whether you’re still able to have children.

Most people have a combination of surgery and chemotherapy.

The aim of treatment is to cure the cancer, if possible. If the cancer is too advanced to be cured, treatment aims to relieve symptoms and control the cancer for as long as possible.

You’ll be cared for by a team of healthcare professionals who will create a treatment plan and support you throughout your treatment.

Surgery is the main treatment for ovarian cancer. The aim is to remove all of the cancer, or as much of it as possible.

Surgery usually involves removing:

  • both ovaries and the fallopian tubes
  • the womb (a hysterectomy)
  • a layer of fatty tissue in the tummy (the omentum)

If the cancer is just in 1 or both ovaries, you may only need to have the ovary or ovaries removed, leaving your womb intact. This means you may still be able to have children.

Surgery is done under general anaesthetic (where you’re asleep). You’ll probably need to stay in hospital for a few days, but it may take many weeks to fully recover.

Read more about recovering from surgery on our page about living with ovarian cancer.

Further information

Chemotherapy is where medicine is used to kill cancer cells. Most women with ovarian cancer have chemotherapy in addition to surgery.

It may be used:

  • after surgery, to kill any remaining cancer cells
  • before surgery, to shrink the cancer and make it easier to remove
  • if ovarian cancer comes back after initial treatment

Chemotherapy medicine is usually given by a drip into a vein, but is sometimes given as tablets. You’ll need to go into hospital to receive the treatment, but you can usually go home the same day.

Treatment is given in cycles, with a period of treatment followed by a period of rest to allow your body to recover. Most people have 6 cycles of chemotherapy, with each cycle lasting 3 weeks.

Chemotherapy can cause some unpleasant side effects, such as:

  • tiredness
  • feeling and being sick
  • loss of appetite
  • hair loss
  • diarrhoea
  • increased risk of infections

Most side effects can be controlled with medicine from your doctor, and they should pass once treatment stops.

Read more about the side effects of chemotherapy.

Further information

Radiotherapy uses carefully directed beams of radiation to kill cancer cells.

It’s not used very often to treat ovarian cancer, but may be used:

  • after surgery for early ovarian cancer, to kill any cancer cells left behind
  • to shrink tumours and reduce symptoms if ovarian cancer has spread and cannot be cured

Common side effects of radiotherapy include sore skin, tiredness and hair loss in the treated area. These should pass after treatment stops.

Further information

Targeted therapies are medicines that change the way cells work and help to stop cancer from growing and spreading. Not all types of ovarian cancer can be treated with targeted therapies.

There are 2 targeted therapies for ovarian cancer:

  • olaparib (Lynparza)
  • niraparib (Zejula)

These medicines are only suitable for some types of ovarian cancer and may be given if cancer comes back after a course of chemotherapy.

They are taken as a tablet or capsule. The side effects of targeted therapies include:

  • breathlessness
  • feeling sick
  • loss of appetite
  • diarrhoea
  • tiredness

Further information

Research into newer and better treatments for ovarian cancer is ongoing through clinical trials.

Speak to your care team if you’re interested in participating in a trial as part of your treatment. They can let you know about any research you may be able to get involved in.

It’s important to be aware that you might not get an experimental treatment (you may be given a standard treatment that’s being compared to the new one) and there’s no guarantee that a new treatment will be more effective.

Further information

Living with

Having ovarian cancer can affect your daily life during and after treatment.

Surgery to treat ovarian cancer is a major operation. It can take up to 3 months to fully recover.

You’ll need to take things very easy for at least the first couple of weeks. Rest as much as possible and try to avoid spending too long on your feet.

You can start to gradually return to your normal activities in the following weeks, but be careful to not do too much too soon.

Your care team will let you know about anything you need to avoid while you recover.

For example:

  • you’ll probably need to take 1 to 3 months off work
  • you might not be able to drive for around a month
  • you may need to avoid strenuous lifting or intense exercise for at least 3 months

A physiotherapist may design an exercise plan to help your recovery.

If both your ovaries have been removed and you have not been through the menopause, you’ll experience it after treatment.

Your doctor may suggest taking hormone replacement therapy (HRT) to control any menopausal symptoms at least until you reach the natural age for the menopause (between 45 and 55).

Further information

After your treatment has finished, you’ll be invited for regular check-ups to see how you’re doing.

These are usually every 2 to 3 months to begin with but tend to become less frequent over time.

These appointments are a chance to talk to your care team about any problems you’re having or any questions you have.

It’s quite common for ovarian cancer to come back within a few years of treatment finishing, so you may have regular blood tests and/or scans to check for this.

Tell your doctor as soon as possible if any of your symptoms return after treatment. Do not wait until your next appointment.

Further information

Dealing with cancer can be a huge challenge for you and your friends and family, both practically and emotionally.

Talking to someone about your feelings or problems can help. 

It may help to:

  • talk to your care team or GP – they may be able to arrange professional support such as counselling
  • speak to your friends and family – be open about how you feel and what they can do to help; do not feel shy about telling them you need some time to yourself if that’s what you need
  • get in touch with a support group or charity – many organisations have helplines, online forums and local support groups where you can meet other people in a similar situation to you

Further information

Ovarian cancer can affect your sex life in several ways.

You’ll probably be advised to avoid having sex for a few weeks after surgery, so your wound has time to heal properly.

But even after your wound has healed, it’s normal to not feel like having sex right away. It takes many women much longer to feel ready.

This may be because surgery has triggered the menopause, or it may just be a combination of tiredness and emotional stress associated with being diagnosed and treated for cancer.

Talk to your partner about how you feel and do not pressure yourself into having sex too soon.

Further information

Fertility and pregnancy

For some women, treatment for ovarian cancer triggers an early menopause and means they’re no longer able to have children.

Talk to your care team about this if it’s a concern for you. It may be possible to have treatment that preserves your fertility if you still want to have children and the cancer has not spread to both ovaries.

If you do lose your fertility, it’s normal to experience a sense of loss or grief. It can help to discuss your feelings with a partner, relative or close friend, or with your specialist nurse.

If your treatment involved chemotherapy and you’re still able to have children, you’ll usually be advised to avoid becoming pregnant for a couple of years in case the cancer comes back and you need further treatment.

Further information

If you have to reduce your working hours or stop working due to your cancer, you may find it difficult to cope financially.

If you have cancer or you’re caring for someone with cancer, you may be entitled to financial support. For example:

  • if you have a job but cannot work because of your illness, you’re entitled to statutory sick pay (SSP) from your employer
  • if you do not have a job and cannot work because of your illness, you may be entitled to employment and support allowance (ESA)
  • if you’re caring for someone with cancer, you may be entitled to carer’s allowance
  • free prescriptions – you can apply for an exemption certificate that gives you free prescriptions for all medicines for 5 years; speak to your GP or cancer specialist about this

It’s a good idea to find out as soon as possible what help is available to you. You may want to ask to speak to a social worker at your hospital, who can give you the information you need.

Further information

If nothing more can be done to treat the cancer, your care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called end of life or palliative care.

It also includes psychological, social and spiritual support for you and your family or carers.

Further information