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Ovarian cancer is the sixth most common cancer among women, with approximately 7,500 new cases diagnosed annually in the UK. It develops in one or both ovaries, which are part of the female reproductive system, located in the pelvic area. The reproductive system also includes the vagina, cervix, uterus, and fallopian tubes.

The ovaries have two main functions:

• Producing, storing, and releasing eggsfor reproduction
• Producing female hormonessuch as progesterone and estrogen

Symptoms of Ovarian Cancer

Ovarian cancer often goes unnoticed until it reaches an advanced stage, which may cause symptoms such as:

• Lower abdominal or pelvic pain
• Bloating or an increase in abdominal size
• Bowel-related discomfort
• Frequent and urgent need to urinate
• Difficulty eating or feeling full quickly
• Unexplained weight loss

These symptoms do not necessarily mean you have ovarian cancer. However, it’s important to be aware of changes in your body and discuss them with your doctor. The earlier ovarian cancer is diagnosed, the better the chances of successful treatment.

Types of Ovarian Cancer

Ovarian cancer can develop in different parts of the ovary or even in the fallopian tubes and the peritoneum (a thin membrane covering most abdominal organs).

The three main types of ovarian cancer are:

• Epithelial ovarian cancer(most common) – 90% of cases
• Germ cell tumors– develop in the cells that form eggs
• Stromal tumors– develop in hormone-producing ovarian tissue

This article focuses on epithelial ovarian cancer, the most common type.

Risk Factors

Several factors increase the risk of developing epithelial ovarian cancer, including:

1. Age

• The riskincreases with age.
• 84% of cases occur in women over 50, with more thanhalf diagnosed in women over 65.
• However, ovarian cancercan develop at any age.

2. Obesity & Lifestyle

• Beingoverweight or obese increases the risk.
• Maintaining ahealthy weight through balanced nutrition and regular exercise, along with not smoking, can help reduce the risk.

3. Ovulation Frequency

The fewer times a woman ovulates in her lifetime, the lower the risk.
Factors that reduce ovulation frequency include:

• Oral contraceptive use
• Pregnancy
• Breastfeeding
• Women who have not had children or experience late menopause have a slightly higher risk.

4. Family History & Genetic Mutations

• Afamily history of ovarian or breast cancer increases the risk.
• 10% of ovarian cancersare linked to faulty genes, particularly BRCA1 & BRCA2 mutations.
• If you are concerned about yourfamily history, your doctor may refer you for genetic counseling and testing.

5. Endometriosis

Women with endometriosis have a slightly increased risk of specific types of ovarian cancer, such as clear cell and endometrioid cancers.

How is Ovarian Cancer Diagnosed?

Ovarian cancer may be suspected if an ovary appears abnormal on an ultrasound scan.

Key Diagnostic Tests

• Blood tests(measuring CA125, a protein linked to ovarian cancer)
• Ultrasound scan(to assess ovarian structure)
• Abdominal fluid drainage(if fluid build-up, known as ascites, is present, it is tested for cancer cells)

If cancer is confirmed, a referral to a gynecologic oncologist is necessary to plan further treatment.

Can Ovarian Cancer Be Prevented?

Currently, there is no screening test for ovarian cancer.

Unlike colonoscopies for bowel cancer or Pap tests for cervical cancer, routine ovarian cancer screening is not available.

However, women with a high genetic risk may consider risk-reducing surgery (preventive removal of ovaries and fallopian tubes).

Treatment of Ovarian Cancer

The treatment plan depends on:

• Cancer stage & type
• Overall health
• Personal preferences

Patients must be fully informed about treatment benefits, risks, side effects, and success rates.

A combination of surgery and chemotherapy is the most effective approach.

Surgery

• Most womenwith ovarian cancer will require surgery.
• Theextent of surgery depends on the cancer stage and type.

Surgical Procedures

1. Standard Surgery

• Removal of both ovaries & fallopian tubes (bilateral salpingo-oophorectomy)
• Removal of the uterus & cervix (total hysterectomy)
• Removal of the omentum (a fatty layer inside the abdomen)

2. Staging Surgery

• If cancer is early-stage, biopsies and lymph nodes are removed to determine if further treatment is needed.

3. Cytoreductive Surgery (Debulking)

• For advanced ovarian cancer, surgeons remove as much cancerous tissue as possible, potentially including:
  • Parts of the bowel (if necessary, the bowel is reconnected)
  • The spleen
  • The peritoneum (abdominal lining)
  • Affected lymph nodes
  • Less commonly, the gallbladder or parts of the liver

• The goal is to remove all visible cancerwhile preserving quality of life.
• Complete cancer removal significantly improves survival rates.

4. Fertility-Preserving Surgery

• In early-stage cancer, young women who wish to have children may only have the affected ovary and fallopian tube removed.
• Fertility preservation techniques (egg or embryo freezing) may be considered.

Chemotherapy

• Ovarian cancer is highly responsive to chemotherapy.
• Typically givenafter surgery, but sometimes before surgery to shrink tumors (neoadjuvant chemotherapy).

Common Chemotherapy Drugs

• Carboplatin (platinum-based drug)
• Paclitaxel (often combined with carboplatin)

• Treatment is usuallygiven through an IV drip in cycles of 3 weeks.
• Most women receivesix cycles.

Side Effects

• Nausea & vomiting
• Fatigue
• Hair loss
• Nerve damage (tingling in hands/feet)
• Increased risk of infection
• PARP inhibitors(targeted drugs) are newer, effective treatments for advanced ovarian cancer.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

• • In some cases,heated chemotherapy is applied inside the abdomen after surgery to improve survival rates.
  • Only performed by specialized teamsin hospitals with intensive care facilities.

Remission & Follow-Up

• "Remission"means no signs of cancer after treatment.
• The more advanced the cancer at diagnosis, theless likely complete remission is.
• However, treatment can oftenshrink tumors and relieve symptoms.

Follow-Up Care

• Regular check-ups every 2–3 months
• Blood tests & scansto detect recurrence
• Report any symptoms immediately—don’t wait for your next appointment

Coping with Ovarian Cancer

• The emotional impact of cancer is significant.
• The medical team will support you & your family throughout treatment.
• Counseling and support groups can be helpful.
• Women experiencing early menopause after ovary removal may consider hormone replacement therapy (HRT).

 Expert Ovarian Cancer Care at Thely Clinic.

The gynecologic oncology team at Thely Clinic has extensive expertise in ovarian and peritoneal cancer treatment.