Focus on ovarian cancer

Many people aren't aware of the symptoms of ovarian cancer, but knowing them is key to early diagnosis. "The symptoms of ovarian cancer are persistent pelvic and stomach pain, increased abdominal size, persistent bloating that comes and goes, and difficulty eating and feeling full quickly," says Tania Pearson at Ovarian Cancer Action. "Occasionally other symptoms such as urinary problems, changes in bowel habit, extreme fatigue or back pain may also be experienced on their own or at the same time as those listed above. If a woman experiences any symptoms that are unusual, she should ask her GP to investigate."

The location of the ovaries means that symptoms are often related to the menstrual cycle. "Because the ovaries are intimately associated with menstruation this type of cancer can also cause irregular periods or bleeding and possible discomfort during sex," says Bill, a nurse specialist at Macmillan. "The position of the ovaries near the pelvis also means that that they can affect other body functions if a tumour or swelling presses on the other organs nearby. That kind of pressure might show up as constipation, back pain or difficulty with passing water."

Early diagnosis is crucial when it comes to ovarian cancer. "Ovarian cancer is a very challenging disease to treat, primarily because most women (75%) are diagnosed once the disease has spread," explains Alex at Target Ovarian Cancer. "Treatment for ovarian cancer includes surgery and usually chemotherapy. In this sense it's not dissimilar to other cancers. Radiotherapy is not generally used except to relieve certain symptoms. However, whilst other cancers have seen improvements in treatments, there have been no new life-extending treatments in ovarian cancer in over 20 years."

While it's true that women who take the pill are less likely to develop ovarian cancer, there's a bigger picture to consider. "Long-term use of the oral contraceptive pill lowers the risk of a woman developing ovarian cancer, but it can increase the risk of other cancers," points out Alex at Target Ovarian Cancer. "For this reason, it's important that women discuss any concerns they have with their doctor. Taking the pill for five years or more does not necessarily stop you developing ovarian cancer, but it reduces the possibility."

It's thought that part of the reason for the high number of cases of ovarian cancer in the western world could be linked to the fact more and more women are having children later in life. "Having children has a protective effect against ovarian cancer," says Tania at Ovarian Cancer Action. "The fewer menstrual cycles a woman has, the less 'wear and tear' her ovaries receive over the course of her lifetime. In developed countries, women often postpone motherhood until later in adult life or choose not to have children."

As with other types of cancer, knowing about your family's medical history can make a huge difference. "Women who are known to be at high risk of developing the disease because of a family connection sometimes have their ovaries and fallopian tubes removed," says Alex at Target Ovarian Cancer. "This is known to reduce the risk by 90%. Women who have two or more family members on the same side who have had ovarian cancer and/or breast cancer are at increased risk. That's why it's important for women to understand their family history, and to seek advice if necessary."

Although ovarian cancer can affect women of any age, women over the age of 40 are most at risk, as are those where there's a family history of cancer. "Some ovarian cancers are caused by an inherited faulty gene that can be passed down family lines, through both women and men," explains Tania. "In particular, there are two faulty genes that have been identified as causes of ovarian cancer, named BRCA1 and BRCA2. These same genes are responsible for hereditary breast cancer. Consequently, there are families where a number of relatives may develop ovarian, breast or both breast and ovarian cancer. "

Many people underestimate how common ovarian cancer is but in the UK, around 6,500 cases are diagnosed each year, and survival rates are worringly low. "A recent international benchmarking study published in The Lancet showed that women in the UK are less likely than women in comparable countries to survive ovarian cancer longer than one year from diagnosis," says Tania. "In fact, survival rates of UK woman rank seventh in Europe. Only 41% of women diagnosed with ovarian cancer in the UK will survive five years."

However, if the cancer is detected early, the statistics are very different. "The evidence points to early diagnosis being key to improving UK women's survival rates for ovarian cancer," says Tania. "90% of women will survive longer than five years if diagnosed at the earliest stage of the disease. Unfortunately, there is very low awareness amongst UK women that ovarian cancer has symptoms and GPs may not always recognise the symptoms as indicative of the disease."

Although the link between diet and ovarian cancer isn't clear, it's common knowledge that being overweight increases your chances of developing cancers of the breast and womb, and can also increase your chances of developing a more aggressive type of ovarian cancer. "We do know that the incidence is lower in Mediterranean countries, compared with Nordic countries," says Dr Sean Kehoe, medical adviser to the ovarian cancer charity Ovacome. "This could be down to diet, genes, or the environment."

Ovarian Cancer Awareness Month last from 1 to 31 March. For more information and help visit www.ovarian.org.uk.

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