The ovaries and ovarian cancer – what the public wants to know
Three professionals answer some of the most frequently asked questions about the ovaries and ovarian cancer within a woman’s body
Women in the UK have a one in fifty chance of being diagnosed with ovarian cancer at some point in their life, yet awareness of the condition and its symptoms still need more emphasis, as just one in five women are able to identify bloating as one of ovarian cancer’s main symptoms. We recently reached out to a number of health professionals and asked them to answer some of the public’s pressing questions about the ovaries and ovarian cancer.
Shannon, Ron and the Ask Eve team at The Eve Appeal charity, all specialise in cancer research, treatment and support. Shannon and Ron are both doctors of medicine who now specialise in gynaecological cancers and similar conditions and the Ask Eve team are a group of nurses who run the free information service for The Eve Appeal. In this article, they share their expert knowledge and help us to answer some frequently asked questions concerning the ovaries and ovarian cancer.
The ovaries and ovarian cancer
The ovaries are two small glands in the female reproductive system that store a woman’s eggs and produce the hormones oestrogen and progesterone. If abnormal cells in (or around) the ovaries start to spread they can turn into a tumour and cause ovarian cancer.
The main symptoms of ovarian cancer include:
- Persistent bloating
- Pain in the abdomen or stomach
- Feeling full more quickly
- Needing to urinate more often
Each woman with ovarian cancer will experience these symptoms differently and may also experience other symptoms such as a change in bowel habits and fatigue. It’s important to remember that these symptoms are also related to other, more common conditions such as irritable bowel syndrome, but it’s always worth having your symptoms checked by your GP to understand their causes.
Here are some of the most searched questions online, surrounding the ovaries and ovarian cancer within a woman’s body.
Is ovarian cancer genetic?
Ask Eve team: The majority of ovarian cancer cases are not due to an inherited genetic risk, around 20% of the most common type of ovarian cancer are. The risk is higher in some populations.
Ron: Yes. All cancers are genetic (that is not the same as hereditary). Meaning, all cancers have defects in their genes.
Shannon: Approximately 10-20% of all ovarian cancer has a genetic cause. The remainder are “sporadic” type.
Are ovarian cancer and breast cancer linked? If so, how?
Ask Eve team: The link is not common but there are a small number of families who have a higher risk compared to the average of developing both ovary and breast cancer. Angelina Jolie is credited for highlighting the BRCA gene. Her mum died of ovarian cancer and she chose to have a genetic test that showed that she was at risk as, like her mum, she had an alteration to her BRCA 1 gene and she decided to have risk reducing surgery.
Ron: Yes. BRCA1 and BRCA2 genes (discovered in the mid-90s) are cancer susceptibility genes. Women with mutations in these genes are at a much higher risk of getting breast, ovarian, or both cancers during their lifetime.
Shannon: Some forms of breast and ovarian cancer are linked by a genetic syndrome. This involves an abnormality in the BRCA genes. If women have an abnormality (“mutation”) in one of these genes, they are at higher risk of developing breast and ovarian cancer. Some other types of cancer such as pancreatic, prostate, and melanoma are linked to the BRCA genes as well.
Can you get ovarian cancer if you've had your ovaries removed?
Ask Eve team: No, however it is possible to get a type of cancer that originates in the cells that line the abdominal cavity called the peritoneum. This is similar to ovary cancer. We know that many ovary cancers begin in the end of the Fallopian tubes, particularly the part called the fimbria that is attached to the ovary. However, surgeons know this and it will be very unusual for a surgeon to deliberately remove the ovaries to reduce the risk of cancer and not remove the adjoining Fallopian tubes.
Ron: Most ovarian cancers are now believed to actually begin in the fallopian tubes. When a woman at high-risk (e.g. BRCA1/2 mutation carrier) has prophylactic surgery, the surgeon usually removes both the tubes and ovaries. However, if the tumor cells from the fallopian tube shed to the abdominal cavity before surgery, it is possible that one can still get ovarian cancer afterwards. This occurs in about 4% of cases.
Shannon: There is a type of cancer called “peritoneal cancer” which is treated just like ovarian cancer. You can develop peritoneal cancer even if you have had your ovaries removed. The chances of this happening however, are much, much lower.
Will ovarian cancer show up in a smear test/ct scan/ultrasound scan?
Ask Eve team: A smear test is designed to identify molecular changes in the skin cells over the cervix. This can predict if a woman is at risk of developing cervix cancer in the next decade but it is not designed to detect or predict ovary cancer. A CT, MRI and ultrasound scan are all useful tests. If the ovaries look normal then you can be confident you do not have ovary cancer. However, a scan showing that the ovaries are larger than they should be doesn’t necessarily mean cancer. There are many reasons why the ovaries might be enlarged.
Ron: Imaging (CT, MRI, or ultrasound) can reveal a mass but it won't tell you whether the mass is benign (non-cancerous) or malignant (cancerous) – although malignant tumours have some unique features. Moreover, imaging cannot be used for early detection. Those studies have been done and showed that imaging is not specific enough. Similarly, a pap smear, which is used to detect cervical cancer, cannot be used to detect ovarian cancer. There is ongoing research in this area.
Shannon: Ovarian cancer is not diagnosed with a pap smear. It is typically identified with imaging – either a CT scan or transvaginal ultrasound. We also use CA125 as a tumour marker in the blood. It can be elevated in cases of ovarian cancer.
Can ovarian cancer cause constipation, indigestion or diarrhoea?
Ask Eve team: Advanced cancer of any type can affect the digestion system and a change in bowel habits are a symptom of ovary cancer.
Ron: Yes, ovarian cancer typically causes gastrointestinal symptoms. These symptoms are not specific to ovarian cancer and are often caused by other things (change in diet, etc.). This is one reason why the disease is usually detected once it has spread to other areas of the body.
Shannon: Absolutely. The most common symptoms of ovarian cancer are gastrointestinal – such as nausea, constipation, indigestion, bloating. These are often nonspecific and can be easy to overlook, which is why many women may have a delay in diagnosis.
What is the difference between ovarian cancer and endometriosis?
Ask Eve team: Cancer is usually defined by uncontrolled growth of cells that spread to other places. The biology of endometriosis is very unusual but differs from cancer because the growth of cells can usually be controlled by hormones.
Ron: Endometriosis is a risk factor for certain types of ovarian cancer (there are at least 4 major subtypes: (1) High-grade serous carcinoma - the most common by far, (2) Endometrioid carcinoma, (3) Clear Cell carcinoma, and (4) Mucinous carcinoma. Endometriosis is a risk factor for endometrioid and clear cell carcinomas - the less common subtypes.
Shannon: Endometriosis is the presence of non-cancerous endometrial (uterine) tissue outside of the uterus. It can cause painful periods, painful intercourse and painful bowel movements. It is not cancer but less than 1% of the time it can develop into cancer.
Ovarian Cancer and Younger Women
“More than 8 out of 10 cases occur in women over the age of 50, but there are still around 1,000 women under the age of 50 who are diagnosed with ovarian cancer every year.”
For many years, ovarian cancer was seen as a condition that affected older women who had been through menopause. Although ovarian cancer is far more common in older women, it can sometimes affect the ovaries of younger women and more people are trying to raise awareness of this fact so that younger women with ovarian cancer get the right treatment and support. Epithelial cancers (cancers that affect the epithelium, which is a tissue that lines the body's organs) are the most common type of ovarian cancer and usually affect women over 45 years of age. Although younger women can be affected by epithelial cancers, they are more likely to be affected by the rarer types of ovarian cancers, including borderline tumours or germ cell tumours.
Some of the common questions searched for online relate to how ovarian cancer could affect a woman’s life cycle. While it is rare for ovarian cancer to happen to women who are still at an age where they are menstruating, it can happen. Four cancer charities have created a joint guide for younger women who have been diagnosed with ovarian cancer, to help them understand more about areas such as early menopause, fertility and different treatment options.
How does ovarian cancer affect periods?
Ask Eve team: Ovary cancer usually affects older women. It’s rare in women who are young and still menstruating. Anything is possible in biology but ovary cancer does not normally affect menstruation unless the ovaries have been completely destroyed. It is possible that an advanced cancer affecting both ovaries could stop them from producing hormones and that would cause a woman to miss periods but this scenario is extremely rare.
Shannon: The majority of patients diagnosed with ovarian cancer are postmenopausal, which means they no longer have periods. Some younger women may see a change in their periods if they are diagnosed with ovarian cancer. It is possible for ovarian cancer to cause missed periods depending on the cellular type. There is a rare type of ovarian cancer called granulosa cell tumour that can cause heavy bleeding.
Can you still get pregnant if you have ovarian cancer?
Ask Eve team: A very early ovary cancer will not affect the function of a healthy ovary so it is possible for ovary cancer to occur in pregnancy but it is extremely rare, particularly as it doesn’t usually affect women so young.
Shannon: You may be able to get pregnant after the diagnosis of ovarian cancer depending on the type of treatment you receive.
Thank you to Shannon, Ron and all of the Ask Eve team for sharing their knowledge with us.
The Eve Appeal is a fantastic charity that focuses on raising awareness of the 5 gynaecological cancers to help everyone recognise the symptoms and help more people get an early diagnosis. They have a free and confidential nurse-led information service that was created for people to ask any genealogical health related questions, whether it is a question about themselves, their partners or a friend or family member. Contact them by telephone at 0808 802 0019 or by e-mail at [email protected] The Eve Appeal also have lots of information, support and personal stories on their website: eveappeal.org.uk.
There are several charities which solely focus on supporting those affected by ovarian cancer, including Ovacome, Ovarian Cancer Action and Target Ovarian Cancer. These charities offer a great deal of advice, support and information for anyone who has been diagnosed themselves or has family or a friend with ovarian cancer.
If you want to find out more about the ovaries and ovarian cancer, including causes, symptoms and treatments we have an ovarian cancer conditions page or you can visit Cancer Research, the NHS or one of the ovarian cancer charities listed above to find out more.
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- May 13th 2020