Ovarian Cancer

Background and Epidemiology

  • 5th most common cancer in women in the UK.  Lifetime risk of around 2% (6700 new cases each year; incidence of around 17/100,000)
  • Peak incidence between the ages of 60-65 (although incidence rises with age)
  • Very high mortality (most patients present late with stage III disease which has a mortality of between 60-80%)
    • Most common cause of death from a gynaecological cancer
    • Survival rates decrease with age

Aetiology and Risk Factors

  • Family history of breast/ovarian cancer increases the risk, particularly if there is an underlying BRCA1 or BRCA2 mutation contributing
  • Age
  • Lifestyle
    • Smoking
    • Obesity
  • Nulliparity
    • Early menarche and late menopause also
    • Note that the use of the oral contraceptive decreases the risk of ovarian cancer, as does breast feeding, early menopause
  • Endometriosis


  • NB Most patients will first present with vague, non-specific symptoms.  A high index of suspicion for ovarian cancer should be present in women presenting with
    • Persistent abdominal distension (bloating)
    • Ascites
    • Early satiety and/or loss of appetite and/or fatigue
      • Patient can also be short of breath, have indigestion, constipation/diarrhoea
    • Non-specific abdominal/pelvic pain
    • Increasing urinary urgency and/or frequency (where UTI has been excluded)
    • Symptoms of irritable bowel syndrome if >50 years old
  • Other symptoms/signs include
    • Unusual abdominal mass (+/- pain/tenderness)
    • Abnormal uterine bleeding


  • First line: Measure CA125
    • If >35 IU/ml, or if the clinical history/examination warrants (e.g. mass), arrange abdominal/pelvic USS
    • If both are normal, and no other causes can be found, the patient is unlikely to have a malignancy but should return for investigations if symptoms/signs worsen
    • In women <40, measure AFP and β-HCG also to investigate germ cell tumours
    • Calculate the Risk of Malignancy Index (see here)- if >250, high risk for malignancy and requires further investigation
  • Abdominal / Pelvis CT should be performed if ovarian cancer is suspected
  • Biopsy
    • Either laparoscopic or percutaneous image guided biopsy (ideally before treatment)


  • Apparent stage I (localised) disease
    • Perform lymph node assessment (retroperitoneal) to check for lymph node spread
      • If there is spread or if tumour is high grade (3), consider chemotherapy (containing carboplatin x6)
      • If there is no spread and the patient has low grade, localised disease, surgery may be an option
        • NB This is extremely rare
  • Management of advanced (stage II-IV) disease
    • Chemotherapy (ideally with paclitaxel + platinum based chemo) and surgery (resection of all macroscopic disease) can be attempted for radical treatment
    • Palliative care may be more appropriate depending on patient wishes and extent of disease
  • Monitoring and prognosis
    • CA125 may be used to clinically monitor response to treatment, in combination with imaging
    • Whilst up to 75% of patients will show a response to treatment and may even achieve remission, 75% of these patients will relapse with chemotherapy-resistant disease which will usually be fatal

NB The patient’s family may be offered genetic testing if the patient is particularly young or if there is a significant family history

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: