What and where are the ovaries?
The ovaries are two small oval organs usually a little smaller than a walnut situated in the pelvis to either side of the womb (uterus). Before puberty they are rather smaller than this and after the menopause they also shrink considerably. Ovaries serve two main functions during the fertile years as part of the reproductive system: they produce eggs, usually on a regular monthly basis and they produce the female sex hormones oestrogen and progesterone in a coordinated way that prepares the body each month for pregnancy.
Some women describe a sense of disbelief and shock at diagnosis, others feel relieved that their symptoms have been explained. Some feel angry that the problem was not found earlier.
How common is cancer of the ovary?
There are around 7,000 new cases of ovarian cancer each year in the United Kingdom of which the majority occur in women over 50 years of age. The disease can however happen at a younger age – indeed there are some characteristic cancers that arise from the ovaries in young women in their teens and early twenties but which may have a much better outlook with appropriate treatment. At the Queen Elizabeth Hospital, King’s Lynn serving a catchment population of about 230,000 people we expect to see around 25-30 new cases of the disease each year.
What is the cause of ovarian cancer?
No single cause has yet been identified but there does seem to be a loose link to the number of ovulations that a woman’s ovaries undergo. Thus the disease is a bit more common in women who have not had children and is significantly less common in women who have taken the combined oral contraceptive pill for long periods. For reasons that are not understood both sterilisation operations and hysterectomy (without removal of ovaries) seem to reduce the likelihood of subsequent development of the disease. There is no evidence to support the previous theory linking ovarian cancer to long term use of talcum powder.
Why does ovarian cancer have such a bad reputation?
Most early cases of cancer of ovary produce very few if any symptoms. Often the first sign that anything is wrong occurs when the disease starts to spread within the abdominal cavity and beyond. At this point the cancer cannot be successfully treated by surgery alone and in many instances the management is now more a matter of control of the disease than of cure. The effect therefore is that most cases are quite advanced on first presentation with infrequent cure. However all is no longer doom and gloom as there have been substantial developments in treatment of these more advanced cases.
What are the typical symptoms of ovarian cancer?
The symptoms are related to the stage of the disease. Early cases may have no symptoms or the awareness of a “lump”. There may be vague lower abdominal pain or pressure symptoms from bladder, bowel or during intercourse or a “mass” may be found by chance during a routine examination done for other reasons. As the illness becomes more advanced there is typically spread within the abdomen and development of a large volume of fluid in the abdominal cavity called ascites. At this time common symptoms include much more marked abdominal swelling, loss of appetite, nausea, bloating and general fatigue.
How can ovarian cancer be suspected?
The first task is to suspect that something may be wrong. An astute general practitioner who knows his/her patient well may be struck by new even though vague symptoms and will request an ultrasound examination in addition to performing careful abdominal and internal examination. Ultrasound scan is a safe painless and harmless investigation using the same equipment as for pregnancy scans. Usually the woman being examined will be asked to attend with a full bladder as this may give a much clearer picture. After spreading some gel on the skin the radiologist or radiographer passes the ultrasound probe over the abdomen creating images of the internal organs. Often it may be helpful also to use the internal vaginal probe because this may give more detail of the pelvic organs. The probe is covered for each examination with a specially designed “condom”. This examination is usually less uncomfortable than a clinical vaginal check. The scan will rarely diagnose ovarian cancer with certainty but may strongly suggest it with a recommendation for the general practitioner to arrange urgent referral to hospital.
How quickly is a hospital appointment available with the right specialist?
Throughout the NHS a system is in place now to provide urgent out-patient assessment of patients whose GP suspects may have cancer. At the Queen Elizabeth Hospital, King’s Lynn an appointment is always available within two weeks at a clinic held every Thursday afternoon in the Brancaster Gynaecological clinic. The clinic is run by Mr Colin Bone and Mr Janusz Stachurski who are both Consultant Gynaecologists specialising in cancer care and supported by Sister Sally Stevenson and Sister Theresa Tonroe who are specialist Gynaecological Cancer Nurses.
What will happen at the hospital clinic?
At the clinic the consultant will ask a lot of questions about present symptoms as well as previous illnesses etc. An examination will be needed – usually a general exam especially of the abdomen followed by a gentle internal check. Often an ultrasound scan will be performed in the clinic. After some full discussion there may be a need for further tests before an early return visit.
What additional tests may be arranged?
It is usually helpful to get the results of some blood tests. A blood count and several other tests will yield helpful general information while a specific test called CA 125 may be particularly useful. The result of this measurement is quite markedly raised in most women with ovarian cancer although a few cases can occur with normal results.
On some occasions it is useful to arrange more detailed scanning – often in the form of CT scan. This is an advanced X-ray investigation for which an appointment is needed and which gives detailed images of the parts of the body examined..
At this point it is often possible to agree a treatment plan. The unit at the Queen Elizabeth Hospital works with other hospitals in the West Anglia Cancer Network to provide consistent high quality care to agreed standards. In some cases treatment will continue at King’s Lynn, in others it will be wise to transfer some aspects of care to the Cancer Centre at Addenbrookes Hospital. The various approaches to treatment are discussed in more detail in the next section of this information on treatment and management.