Despite ovarian cancer being the 7th most common cancer in women, many women are unaware of the symptoms, resulting in 2/3 of diagnoses being made after cancer has already spread. The common symptoms of ovarian cancer (constantly feeling bloated, abdominal, or pelvic pain, feeling full quickly after eating, or an increased need to urinate) can be mistaken for a range of common conditions, making ovarian cancer the ‘silent killer’.
What is ovarian cancer?
Ovarian cancer is cancer of the ovaries – the ovaries are connected to the womb and store a woman’s supply of eggs. Approximately 80% of women diagnosed with ovarian cancer are over the age of 50. The pathogenesis of ovarian cancer is not well characterised; however, it is believed that the ovarian epithelium undergoes repeated damage over many ovulation cycles, resulting in an increase in proliferation, and thus, an increased probability of spontaneous mutations that may predispose to cancer.
So, who is at risk?
- Being over 50
- Family history of ovarian or breast cancer
- Use of hormone replacement therapy (with the risk being very small)
- Being overweight
- Lack of exercise
- Not bearing children
- Having your first menstrual cycle before the age of 12
- Mutations in BRCA1 or BRCA2
As mentioned, the common symptoms could be attributed to a whole range of conditions, including irritable bowel syndrome. Other symptoms include persistent indigestion, feeling sick, pain during sex, constantly feeling fatigued, or unintentional weight loss. A late diagnosis has a considerable impact on prognosis – over 90% of women with Stage I ovarian cancer have 5‑year survival, with the figure dropping to just 5% for those with the most advanced stage (stage IV).
What treatments are available? What should we look out for?
Most women with ovarian cancer combine surgery with chemotherapy to remove as much cancer as possible and reduce the risk of it spreading. Surgery can be used to remove one or both ovaries, the womb, and fallopian tubes. Radiotherapy is used less frequently but can be useful after surgery for early-stage ovarian cancer, or to shrink tumours if cancer has already spread. Olaprib (Lynparza) and niraparib (Zejula) can be used to treat advanced ovarian cancer.
There is a range of emerging treatments for ovarian cancer which include targeted therapies, immunotherapies, and protein therapies. The novel T-cell immunotherapy vaccine DPX-Survivac, targeting the pro-tumour growth protein survivin, is a promising treatment in clinical trials for advanced ovarian cancer.
Why should we care about ovarian cancer?
The World Ovarian Cancer Coalition published the ‘Every Woman Study’ in 2020, the first-ever global report that holistically captured the experience of women with ovarian cancer. The global incidence of ovarian cancer is set to increase by 55% to 371,000 diagnoses a year by 2035, with 5-year survival rates below 50%, and sadly, 15% of women with ovarian cancer dying within just 2 months of diagnosis. Now is the time to act.
The study found that 69.1% of women were not aware of having ovarian cancer before their diagnosis and only 8.7% of women had no symptoms prior to their diagnosis, suggesting huge room for improvement in raising awareness of the symptoms associated with ovarian cancer. Over 90% of women with ovarian cancer have been left with long‑term effects from treatment, including anxiety, depression, sleep loss, and fatigue. Women with ovarian cancer felt their mental health was overlooked, and that it should be treated with equal importance to their physical health.
The study concluded by making the following recommendations:
- To raise awareness to build political support and funding
- To reduce delays in diagnosis by raising awareness of symptoms
- To improve knowledge around family history with doctors and women
- To improve access to support and relevant information (starkly, a report by NHS England found that only 35% of women felt that they had received all the advice and information they needed)
Evidently, a campaign is needed to promote awareness around ovarian cancer. The 2013 ‘Be Clear on Cancer’ campaign based in the Northwest used regional TV, radio, and press to promote that ‘Feeling bloated, most days for 3 weeks or more could be a sign of ovarian cancer. Tell your doctor. The campaign was used to promote awareness and encourage early diagnosis and was largely successful, demonstrating the power of public health campaigns; 57% of women said the campaign told them something new.
So, what is being done?
NHS England set out a programme for BRCA1/2 genetic testing in 2015, helping to identify women who may be at a greater risk of developing ovarian cancer. More recently, NHS England has commissioned an ovarian cancer clinical audit to reduce variation in cancer treatment. However, there is more to be done, with a recent report showing that ovarian cancer now has the second-longest wait times of all cancers.
Who is there to support you or your loved ones?
Target Ovarian Cancer is a UK-based charity working to help women with ovarian cancer, they offer support, and are pushing for more funding, research, and awareness. Ovacome is also available to provide expert support when you need it. Cancer Research UK has an excellent resource with a list of support and organisations that can provide information on offer.
More women should be aware of the symptoms of ovarian cancer and contact their GP at the earliest opportunity to ensure more women receive an earlier diagnosis and, therefore, receive better treatment for this ‘silent killer’.