The symptoms of ovarian cancer can be mistaken for something else. Photo / Getty Images
Dubbed the ‘silent killer’, its symptoms are easy to miss and can often be confused with other conditions.
Like many cancers, ovarian cancer has long been known as “a silent killer” because its symptoms tend to be vague, easy to miss, or mistaken for something else.
A 2022 study by Target Ovarian Cancer found 79 per cent of women didn’t know that bloating was one of the symptoms of ovarian cancer, for example, while 68 per cent didn’t know abdominal pain is a sign. Meanwhile, many of the women surveyed felt their symptoms were dismissed by their GPs, with some mistakenly believing symptoms appear in only the later stages.
In reality, they can present earlier, and like many serious health conditions, the sooner it’s caught, the better it responds to treatment.
Each year in the UK about 7500 people are diagnosed, making it the sixth most common cancer among women. In New Zealand, more than 300 people are diagnosed each year.
March is Ovarian Cancer Awareness Month in the UK (in NZ it’s February), so here’s everything you need to know about spotting the symptoms before it is too late.
Ovarian cancer is where abnormal cells in the ovaries begin to grow and divide, and eventually form a tumour. If left untreated, these cancer cells can spread into surrounding tissues and make their way to other organs in the body.
“Cancer in general is more common as we get older and our body’s cells ‘make mistakes’,” says Nicola Smith, a senior health information manager at Cancer Research UK. “Genetic faults can build up in our cells over time, which is why cancer is strongly related to age. There are just over 4000 deaths from ovarian cancer in the UK each year.”
Ovaries are a pair of female glands where eggs are formed and then released, and they’re involved in your menstrual cycle and fertility. Your ovaries are also where the female hormones oestrogen and progesterone are made.
They’re buried deep within the pelvis, and as a result symptoms of ovarian cancer can be vague or often mistaken for IBS (irritable bowel syndrome), bloating, or conditions like cystitis.
There are several types of ovarian cancer. Epithelial ovarian cancer is the most common, accounting for about 90 per cent of cases, and is where the cancer started on the surface of the ovary. This type includes fallopian tube cancer, where a tumour forms in the fallopian tube, which connects the ovary to the uterus.
Much rarer are germ cell ovarian tumours, which affect young women up to their early 30s, are mostly benign (non-cancerous) and are removed by surgery. If they’re cancerous, you may have chemotherapy to treat them.
Sex cord-stromal tumours, also known as SCSTs, are also very rare, accounting for about 5 per cent of all ovarian cancer cases. They begin in the tissues (the sex cords) that support the ovary. Lastly, borderline ovarian tumours are abnormal cells that form in the ovary, but these are benign and can usually be removed by surgery.
Like most cancers, ovarian cancer is categorised by four stages. Stage 1 means the cancer is in one or both ovaries; stage 2 means it has spread within your pelvis, for example to your fallopian tubes or womb; in stage 3 it has spread to your lymph nodes or the tissue lining the abdomen; while stage 4 means the cancer has spread to another organ outside of the pelvis.
“Feeling full quickly, loss of appetite, bloating, pain in your abdomen and needing to wee more often, or more urgently, are some of the main symptoms,” says Smith. “However, you may also have unexplained tiredness or weight loss, and changes in bowel habits.”
The problem is, these can also be attributed to conditions like IBS.
“The key with ovarian cancer, indeed any cancer, is to know what’s normal for you,” she says. “If something doesn’t feel right for you, speak to your doctor. Around one in four cases of ovarian cancer are diagnosed at a later stage, which impacts treatment options. However, survival rates are improving all the time and that’s partly to do with improved treatments [see below], but also greater awareness. And part of that is knowing symptoms and seeing your doctor sooner rather than later.”
Experts now know that symptoms do show earlier than previously thought. A study from Imperial College London and UCL, published last January, of supermarket loyalty cards found women diagnosed with ovarian cancer increasingly bought pain and indigestion products up to eight months before their diagnosis.
Dr Susanna Unsworth, a menopause and women’s health specialist and founder of the online clinic Cambridge Women’s Health, says you should see a doctor if something doesn’t respond to lifestyle changes. “For example, if you’re still tired after improving your sleep, or if bloating doesn’t improve with a change of diet or cutting out a certain food.”
Through her work, Unsworth also notices that women often endure health issues silently and seek help only when their symptoms become significant. “Women overwhelmingly take on the lion’s share of caring responsibilities for young children, teenagers or elderly parents,” she says. “We tend to have a lot of things on our to-do list, but we must ensure our health is high up that list too. So if any of the symptoms above persist for two to three weeks, it’s time to see your GP.”
Most cancers are more common as we age, but ovarian cancer particularly so. “The most common age group affected are those between 75 and 79, and more than a quarter of all cases are found in those aged 75 and over,” says Smith. “It can affect younger women, but the risk mostly begins to rise in your mid-40s.”
Smith says between 5 and 15 per cent of cases are caused by an inherited gene, such as BRCA1 and BRCA2, which can also increase your risk of breast cancer. “Having an immediate family member, such as a mother or sister, who’s had ovarian cancer can also increase your risk,” she adds. “That doesn’t necessarily mean you have the BRCA1 or 2 gene, but a family history could indicate a genetic link, so speak to your GP about being referred for genetic testing.”
In terms of ethnicity, there’s a lower incidence of ovarian cancer in Asian, black and mixed ethnic groups, but a higher risk among those with Jewish heritage. “In February 2024, the NHS launched the national Jewish BRCA Testing Programme, which offers people over the age of 18 with Jewish ancestry a saliva test for the BRCA1 or BRCA2 genes,” says Unsworth.
“Anything that reduces your overall risk of cancer will reduce your risk,” says Smith. “So there are plenty of things that will stack the odds in your favour, like not smoking, limiting alcohol, eating a healthy, balanced diet and staying active.”
Smith says ovarian cancer isn’t a typically preventable cancer, and only about 10 per cent of cases are linked to lifestyle factors that could be prevented. “For example, we know that being overweight and obese can increase your ovarian cancer risk.
“Another slightly complicated area is hormones. If you take the combined contraceptive pill it slightly decreases your risk of ovarian cancer, while HRT can slightly increase your risk. Not by a significant amount, but it is something people should be aware of so they can speak to their doctor if they’re concerned about it.”
There is no national screening programme for ovarian cancer in the UK. Your GP may feel your stomach and pelvic area, or offer you a CA125 blood test. CA125 is a protein made by ovarian cancer, so this test can detect a tumour. However, conditions like fibroids and endometriosis can also cause raised CA125 levels, so it’s not always reliable (about 50 per cent of women with early-stage ovarian cancer have raised CA125 levels, while more than 90 per cent of those with late-stage cancer do). Depending on your levels, your GP might refer you for an ultrasound, further blood tests, a CT scan or a biopsy.
“This will depend on the type and stage of your cancer,” says Unsworth. Patients with early-stage ovarian cancer will have surgery to remove as much of it as possible, while those with more advanced cancer may also have chemotherapy and hormone therapy. Radiotherapy is rarely used in the treatment of ovarian cancer.
Treatment for ovarian cancer won’t necessarily make you infertile, but for patients who want children, it can make it trickier. Surgery may include the removal of one or both of your ovaries, but if the cancer is caught early enough and only one ovary is removed, it’s still possible to have children after treatment. However, if you also need chemotherapy on your remaining ovary, or the chemotherapy puts you into an early menopause, then your fertility will be affected. Younger patients who want to have children will need to discuss with their doctor how the treatment will affect fertility.
In June, researchers from the Royal Marsden cancer hospital and the Institute of Cancer Research in London reported on a combination of drugs they called a “breakthrough” — avutometinib and defactinib — that could slow the growth of cancer for patients with low-grade serous ovarian cancer (LGSOC).
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