Ovarian cancer Q&A with Mr Jafaru Abu

Ovarian cancer is the fifth most common cancer in women, affecting more than 7,000 women every year. Yet research carried out in 2017 for BMI Healthcare found that two thirds of women did not feel confident they knew the signs and symptoms of ovarian cancer, rising to 82% of women over 65. More than four in ten said they had experienced symptoms similar to those of ovarian cancer, but 70% of them did not seek medical advice.

Spotting the subtle signs early matters, because the more obvious symptoms often appear only once the cancer is advanced and harder to treat. So we asked Mr Jafaru Abu, Consultant Gynaecological Oncology Surgeon at The Park Hospital, Nottingham, to answer the questions women ask most often.

What is ovarian cancer?

Ovarian cancer is a disease that starts in the ovaries. Most women have two ovaries, one on each side of the womb inside the pelvis. They are the main source of the female hormone oestrogen, and they produce the eggs that can be fertilised and develop into a pregnancy. You can read a fuller overview on our ovarian cancer page.

What are the symptoms of ovarian cancer?

It is wrong to call ovarian cancer a “silent killer”. About 95% of women with ovarian cancer do report symptoms. The difficulty is that most of them are vague and can easily be mistaken for something else. The common symptoms are:

• bloating or an increase in the size of your tummy
• feeling full quickly after small meals, or difficulty eating
• tiredness
• a change in bowel habit, such as constipation or diarrhoea
• needing to pass urine more often
• tummy or pelvic pain
• irregular periods, loss of appetite or weight loss

Cancer Research UK has a clear guide to ovarian cancer symptoms, and NICE sets out how doctors should recognise and investigate them.

Who is most at risk of ovarian cancer?

Age is the strongest risk factor. The number of cases rises steadily from the age of 35 to 40 and peaks at around 80, and about 75% of ovarian cancers are diagnosed in women over 55. Other factors linked to ovarian cancer include hormone replacement therapy, exposure to asbestos, smoking, previous radiation, infertility, a personal history of cancer and a strong family history.

Should I take extra care if it runs in my family?

Yes. Your risk is about three times higher if your mother or sister has had ovarian cancer. Between 5 and 15% of cases are caused by inherited conditions, most often changes in the BRCA1 and BRCA2 genes.

There is no national screening programme for ovarian cancer. Women at higher risk may be offered an annual scan and a blood test called CA125. CA125 is raised in about 80% of ovarian cancers, but only in about 50% of early-stage cases, and there is no evidence yet that these tests find the cancer early enough to save lives. If you think you are at increased risk, talk to your GP.

How is ovarian cancer diagnosed?

If you have symptoms, your GP will examine you and may arrange blood tests, usually including CA125. If the results suggest ovarian cancer, you will be referred to a specialist in gynaecological cancer. Your specialist will examine you again and arrange imaging, such as an ultrasound or a CT scan, to plan the next step.

What treatments are available?

The mainstay of treatment is surgery, usually through an up-and-down cut on the tummy under general anaesthetic. The extent of the operation depends on the stage of the disease, and the aim is to remove all visible cancer. You can read more about this on our debulking surgery page.

Sometimes the CT scan shows the cancer is too advanced to remove straight away. Your specialist may then recommend chemotherapy first, to shrink the cancer and make it operable later. This is called delayed or interval surgery, and for some women it may be combined with heated chemotherapy, as explained on our ICRS and HIPEC page.

If you are worried about ovarian cancer symptoms, or would like a second opinion, you can book an appointment with Mr Jafaru Abu at The Park Hospital, Nottingham.