Ovarian Cancer Awareness month 2016: How to spot the signs of the 'silent killer'

Ovarian cancer has been called the ‘silent killer’ because of how hard it is to detect and its poor survival rate.

It’s the fifth most common cancer among women (after breast, bowel, lung and womb) and affects about 7,100 women per year, the majority of whom are over 55.

As March is Ovarian Cancer Awareness month, here’s everything you need to know about the types, symptoms, how it's diagnosed, the risk factors and what kinds of treatment are available.

What is it?

Like any cancer, ovarian cancer happens when a cell goes rogue. Consultant gynaecologist Rob Woolas explains: "You get a cell mutation, the body fails to deal with it and the “deranged” cell reproduces itself faster than the surrounding tissue."

What forms is a malignant tumour, in this case in the ovaries or fallopian tubes, which link the ovaries to the womb.

Types of ovarian cancer

Nine out of ten cases of ovarian cancer are the ‘epithelial’ type, starting in the surface lining of the ovary or in the fallopian tube. Mr Woolas says: “Many lethal ovarian cancers actually arise from cells in the fallopian tube,” so ‘ovarian’ cancer may be slightly misleading.

Rare types include primary peritoneal carcinoma, which starts in the

lining of the abdomen – the peritoneum; and germ cell cancer, which starts in the egg-making cells.

What are the symptoms?

Ovarian cancer is notoriously hard to diagnose; because it grows deep in the pelvis, symptoms are often only felt once it has spread beyond the ovaries and fallopian tubes.

Consultant gynaecologist Mourad Seif says, "In early, intermediate and even advanced stages there can be no symptoms. When there are symptoms such as indigestion or swelling in the tummy, it usually means advanced cancer."

The NHS recommends seeing your doctor if you are over 50 and feel any of the following symptoms frequently, especially more than 12 times a month:

? tummy or pelvic pain

? a long-lasting feeling of being bloated

? needing to pass urine frequently or suddenly

? loss of appetite or feeling full quickly

You should also see your GP if you are over 50 and think you have developed Irritable Bowel Syndrome – with symptoms such as tummy pain, bloating, diarrhoea or constipation – as it is unusual to suddenly develop IBS when you are older.

How is it diagnosed?

At the moment, there is no routine screening for ovarian cancer, partly because no test has yet proved accurate enough.

Blood test or ultrasound

If your GP suspects it, they may send you for a blood test to measure the level of cancer-indicating protein CA125 in your blood, or send you for a transvaginal ultrasound. If your CA125 reading is below a certain ‘cut off’ level, you will be deemed healthy.

But, as consultant gynaecologist John Murdoch explains, "The problem with the “cut off” test is that normal women can have higher levels of CA125 because of arthritis or inflammatory conditions, for example, giving a false positive result. Also, ovarian cancer can be present within the normal range, giving a false negative. So normal may not be “normal”."

Ultrasounds can also lead to a false positive, as cysts visible on the ovaries can turn out to be benign.

ROCA test

There is hope in the results of a large-scale clinical trial, part funded by the NHS, which is testing a new screening method for ovarian cancer, called the ROCA (Risk of Ovarian Cancer Algorithm) Test.

The blood test measures the changes in a woman’s CA125 levels over time. The results showed the test saved 20% of lives and was 86% accurate, picking up twice as many women with cancer as the simple CA125 test.

Dr Mourad Seif, one of the first consultants to offer it, says, "The value of the ROCA is in the detection of ovarian cancer in women with no symptoms. If we can detect it earlier, it will save lives."

What are the risk factors?

1. Genes

One in 10 cases of ovarian cancer happen in ‘high risk’ women who have inherited a faulty gene from their mum or dad, usually BRCA1 or 2, like Angelina Jolie.

Professor of women’s cancers, Ian Jacobs, says, "High risk is if two or more members of the family linked by first degree, for example mother and aunt or mother and grandmother, have had ovarian cancer OR one has had ovarian and one breast cancer aged under 50 OR one has had ovarian and two have had breast cancers at over 50."

2. Age

As with most cancers, the older you are, the more risk there is.

"Cancer is an accumulation of genetic damage," explains Mr Woolas. So the more your cells reproduce, as they all do over time, the more chance there is that one will mutate into a wild, cancer cell. "It’s not necessarily hormonal, it’s related to time," he says.

3. Hormones

There is a link between ovarian cancer and reproduction but Mr Woolas says it is not yet fully understood. "Breast cancer is always hormone dependent and ovarian cancer is associated with the total number of monthly cycles.

"You have a higher risk of ovarian cancer if you have never been pregnant or breastfed because you will have ovulated more times; the combined contraceptive pill has been shown to offer protection against ovarian cancer because it suppresses egg release."

What does treatment involve?

? Surgery or chemotherapy – or both. It depends on the type of cancer, the stage it’s at and its grade. If you are diagnosed at stage 1, before the cancer has spread, it might be possible to remove just one ovary and fallopian tube.

? Stages 2 to 4, however, mean the cancer has spread, and you will usually need surgery to remove both ovaries, fallopian tubes and maybe even the womb; plus chemotherapy. Having your ovaries removed brings on menopause if you haven’t already had it. Recovery rates after surgery are quite quick, around six weeks, but the cancer may have spread unpredictably elsewhere in the body.

? Currently, survival rates for ovarian cancer are relatively poor. Statistics show 70% survive for more than one year after diagnosis, 50% for more than five years and 33% more than 10 years. But it depends what stage the cancer is at when diagnosed; the earlier it is detected, the longer ovarian cancer sufferers should live.