Quick answer
What is ovarian cancer?
Ovarian cancer affects the ovaries or fallopian tubes — often diagnosed late because early symptoms are vague — bloating, feeling full quickly, tummy pain, and needing to urinate often. See a GP if these symptoms are new, frequent (more than 12 days a month), and persistent. CA125 blood test and ultrasound help assessment — not screening test for general population. Treatment is usually surgery and chemotherapy. Higher risk if BRCA gene mutation or strong family history.
Ovarian cancer — the silent spreader
Ovarian cancer includes cancers of ovary, fallopian tube, and primary peritoneum — often grouped as high-grade serous carcinoma — ~7,500 UK cases yearly.
Late diagnosis common — symptoms mimic IBS, UTI, menopause — know persistent pattern.
Symptoms — BEACH / NICE guidance
Persistent (≥3 weeks), frequent (≥12 days/month):
- Bloating — increased abdominal size
- Eating difficulty — early satiety
- Abdominal/pelvic pain
- Changes in bowel/bladder habit
- H — healthcare visit if concerned
Also:
- back pain
- fatigue
- unintentional weight loss
Not: one meal bloating — pattern over weeks.
Risk factors
- age — peak 75–79
- BRCA1/BRCA2 — 40–60% lifetime risk BRCA1
- family history — breast + ovarian
- ** Lynch syndrome (HNPCC)**
- ** endometriosis** — modest increase
- HRT — small increase — individual discussion
- nulliparity, late menopause
Oral contraceptive — reduces risk — protective
No screening programme
UKCTOCS trial — annual CA125 + ultrasound — did not reduce mortality sufficiently — no population screen.
High-risk pathway:
- genetics clinic
- risk-reducing bilateral salpingo-oophorectomy — BRCA after family complete — ~ age 35–40 BRCA1, 40–45 BRCA2
Diagnosis
GP assessment:
- abdominal examination — ascites, mass
- CA125 — if ≥50 or suspicious symptoms younger
- pelvic ultrasound — transvaginal
Risk of malignancy index (RMI) — guides 2-week wait gynae-oncology
CT chest/abdomen/pelvis — staging
Diagnosis — histology at surgery or image-guided biopsy
Treatment
Surgery:
- total hysterectomy, BSO, omentectomy, peritoneal staging
- optimal debulking — no visible residual improves survival
Chemotherapy:
- carboplatin + paclitaxel — 6 cycles
- intraperitoneal selected cases
Maintenance:
- PARP inhibitors — BRCA mutated, HRD positive
- bevacizumab selected
Advanced/recurrent — platinum rechallenge, clinical trials
Ovarian cancer vs IBS
| Ovarian cancer | IBS | |
|---|---|---|
| Onset | New persistent | Often years |
| Bloating | Progressive | Variable |
| Age | Postmenopausal peak | Any |
| CA125/US | May abnormal | Normal |
See IBS — do not label new 60-year-old bloating IBS without examination.
Persistent BEACH symptoms — GP within weeks, not months — curable stages exist when found early.
Common questions
- What are the symptoms of ovarian cancer?
- Persistent bloating, difficulty eating or feeling full quickly, abdominal or pelvic pain, urinary urgency or frequency. Less commonly — back pain, fatigue, changed bowel habit, weight loss. Symptoms usually frequent (more than 12 days monthly) and persistent over weeks — not one-off bloating after large meal.
- Is there a screening test for ovarian cancer?
- No UK national screening — CA125 plus ultrasound in general population not proven to save lives in trials. High-risk women (BRCA carriers) may have risk-reducing surgery (salpingo-oophorectomy) after completing family — specialist genetics clinic.
- What is CA125?
- Blood protein often elevated in epithelial ovarian cancer — GP may check with ultrasound if symptoms suggest. Elevated CA125 has many benign causes — endometriosis, fibroids, liver disease, menstruation. Normal CA125 does not exclude cancer — especially early stage.
- How is ovarian cancer treated?
- Surgery — total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymph node assessment — often followed by platinum-based chemotherapy (carboplatin + paclitaxel). Some receive neoadjuvant chemotherapy before surgery. Targeted drugs — PARP inhibitors (olaparib) for BRCA-mutated or HRD-positive disease maintenance.
- Can ovarian cysts be cancer?
- Most ovarian cysts in premenopausal women are benign (functional cysts). Postmenopausal simple ovarian cysts need ultrasound surveillance — complex cysts with solid components, ascites, or rising CA125 need urgent gynae-oncology referral.