Saturday, June 24, 2017 15:59

Ovarian Cancer

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Posted by on Tuesday, October 5, 2010, 2:33
This news item was posted in Cancer, Gynaecological, O, Pregnancy category and has 3 Comments so far.

Why it’s so important to be aware

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Ovarian cancer is the fifth most common cancer in women, after breast, lung bowel, and uterine cancers. Each year around 6,800 women in the UK are diagnosed with the disease.
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It is the highest gynaecological killer of women in the UK and the fourth most common cause of death from cancer in women. Around two thirds of those diagnosed will die from the disease.
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If found in the early stages, up to 90% of women will survive for more than five years. Unfortunately, most women in the UK are not diagnosed with ovarian cancer until it has already spread, making successful treatment difficult, and survival rates much lower.

Ovarian Cancer
Ovarian Cancer

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There is currently no proven screening tool for ovarian cancer but a large-scale screening trial is underway and initial results are encouraging – especially in terms of the number of cases of ovarian cancer being detected early. However, there are several years to go before the trial is completed, and the researchers will need to assess survival rates to get a clearer idea of how effectively these screening methods translate into saving lives. Improving awareness of the common symptoms of ovarian cancer and developing a better understanding of how to treat it more effectively through investment in research, will play a vital role in ensuring women are diagnosed with ovarian cancer at an earlier stage and they receive the most effective treatment.
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90% of ovarian cancers are not ‘familial’. This means that most women will not have any family history of this cancer, so they may not be aware of symptoms and risk factors.
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Awareness of the disease and its symptoms is low but there is growing evidence that suggests that greater awareness could save lives. In 2007, research commissioned by Ovarian Cancer Action on the awareness of ovarian cancer, demonstrated that only 16% of women mentioned the disease when asked to name cancers they were aware of, and 66% of women were unable to cite any of the symptoms of ovarian cancer.
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Recent research has shown that most women do experience symptoms, particularly very frequent, persistent and sudden onset ones, and these can occur in the early stages of ovarian cancer.
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The UK has poor survival rates, and is positioned seventh in the list of European Countries for high ovarian cancer incidence and mortality rates.

Signs and symptoms

Ovarian Cancer Action bases its symptoms awareness programmes on the most recent and credible research available.

Ovarian cancer used to be called ‘the silent killer’, even in medical text books, with most women not being diagnosed until the cancer had spread. But there is now growing scientific evidence that the frequency and combination of particular symptoms could alert women and their doctors to the possibility of ovarian cancer, even when it is in the early stages, when survival rates are much higher1.

In 2008, the Department of Health consulted with some of the UK’s leading cancer charities, scientists, and doctors, and agreed on a number of key symptoms, which are more common in women diagnosed with ovarian cancer.
Read the Key messages for ovarian cancer for members of the public [PDF, 99KB, new window will open].

Diagnosis can be difficult because symptoms are often similar to those caused by more common, less serious conditions. If you have any of the following symptoms, it is unlikely that they are caused by a serious problem, but it is important that you discuss them with your doctor and ask if they have considered ovarian cancer. In particular, you should ask your GP whether ovarian cancer should be considered if you experience any of these three symptoms on most days:

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Persistent pelvic and stomach pain
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Increased abdominal size / persistent bloating – not bloating that comes and goes
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Difficulty eating and feeling full quickly

Occasionally other symptoms such as urinary symptoms, 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.

Download our symptom diary to help track your symptoms [PDF, 2.18MB, new window will open] and help your doctor decide what might be causing them.

1Goff BA, Mandel LS, Drescher CW, Urban N, Gough S, Schurman KM, Patras J, Mahony BS, Andersen MR. Development of an ovarian cancer symptom index: possibilities for earlier detection. Cancer. 2006 Dec 11
Goff BA, Mandel LS, Melancon CH, Muntz HG. Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA. 2004 Jun 9;291(22):2705-12.

Risk factors

There are a number of factors which can affect your risk of getting ovarian cancer:

Family history: If you have two or more relatives from the same side of your family (ie from either your mother’s OR father’s side), affected by ovarian, or ovarian and breast cancer, your risk may be increased. For full details see below.

Age: The majority of cases occur in women over the age of 40. However some types of ovarian cancer do appear in women from the age of 20 onwards.

Childbirth: There is a slightly increased risk to women who have not had children, or breastfed.

Weight: Being overweight may also increase risk.

Ethnicity: Women of a Jewish, Polish, Icelandic and Pakistani population are at an increased risk of developing ovarian cancer. Research has shown that these women have a higher incidence of carrying a faulty gene, responsible for inherited risk of developing ovarian cancer.

Other factors: Outside of the risk factors mentioned above, very little is currently known about the causes of ovarian cancer. This is why research into the disease is so important. Alongside raising awareness of the symptoms of ovarian cancer, Ovarian Cancer Action is undertaking vital work at the Ovarian Cancer Action Research Centre to gain a greater understanding of the disease, improve a woman’s chances of receiving a prompter diagnosis and receiving more effective treatment.

Areas of research into risk factors to be aware of are:

HRT: Questions have been raised about whether women taking HRT are at a higher risk of developing ovarian cancer. Research has shown that the different types of HRT have varying levels of risk. The Millennium Study 2007, found that women who take the combined HRT for longer than five years are at an increased risk. Following termination of HRT use, this risk returns to a normal level.

Factors that may help reduce your risk

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Childbirth: the more children you have, the less likely you are to have ovarian cancer.
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Taking the contraceptive pill: A 2008 study indicated that if women take the contraceptive pill over a prolonged time period, there is a lesser risk of developing ovarian cancer. This reduction in risk continued 30 years after women ceased taking the contraceptive pill.
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Breast feeding: research suggests that breastfeeding could provide a preventative effect for ovarian cancer.
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Having a hysterectomy or having your tubes tied.
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There is some evidence that some painkillers may reduce your risk but further research is needed on this subject.

Should I be concerned?

If you recognise any of the following information, then it is important to let your doctor know, discuss your history, and if you are still not reassured, seek a second opinion:

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develop a number of symptoms suddenly
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experience the three key symptoms on most days (persistent pelvic and stomach pain; increased abdominal size/persistent bloating – not bloating that comes and goes; and difficulty eating and feeling full quickly).
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are being treated unsuccessfully for conditions such as irritable bowel syndrome or urine infections, or experience persistent back pain and/or feel extremely fatigued, or
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have a family history (2 or more close relatives) of ovarian, breast, lung, stomach, womb lining (endometrium), lymphona or prostate cancer.

Family history

Knowing your family’s health history is important. Having just one relative with the disease does not usually mean you are at increased risk. Only around 10% of ovarian cancers are due to an inherited faulty gene. Women who may be at higher risk (relative to the general population) of developing ovarian cancer, are those who have on one side of their family (either father’s or mother’s)

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A first generation relative (mother, sister, daughter) who has had ovarian cancer and also have a second generation relative (aunt, grandmother) who has suffered from ovarian cancer, or
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A first generation relative with ovarian cancer and a second generation relative (male or female) with breast cancer under the age of 50, or
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A first generation relative with ovarian cancer and two or more second generation relatives with breast cancer over the age of 60, or
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Known BRCA1 or BRCA2 gene carriers, or
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Three or more relatives in total with either colon, stomach, ovarian, endometrial or small bowel cancer, or
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A first generation relative of an individual with both breast and ovarian cancer.

If there does appear to be a strong familial connection, then you should make this known to your doctor. You may be eligible to join a major screening trial (see UKFOCS below ).

Screening

Currently a CA125 blood test, plus transvaginal ultrasound scan is used to screen women who are deemed to be high risk. However CA125 levels can be affected by a number of less serious conditions, and whilst being good at indicating a recurrence of ovarian cancer, may not be as reliable at diagnosing the disease at an early stage. There are approximately twenty-five other markers of ovarian cancer currently being tested around the world. A smear test will not detect ovarian cancer.

In the UK the UKCTOCS (UK Clinical trial for ovarian cancer screening) has just finished recruiting 200,000 randomly selected post menopausal women to complete its study into the potential effects of screening. Its results will not be published until 2014. Find out more by about the UKCTOCS trials [new window will open].

A very recent US study has just reported interim results declaring that whilst the screening methods did detect ovarian cancer both in the early and late stages, there were unacceptably high levels of surgery performed on women who ultimately did not have the disease. View the US National Institute of Health article [new window will open].

There is a UK trial for women with a strong familial history of the disease (UKFOCCS). Recruitment for this study ended in March 2010. For further information please call the UKFOCCS team on 020 7380 6916.

Reducing risk

It is important to develop and maintain a healthy lifestyle, by eating plenty of fresh fruit and vegetables, and taking regular exercise. Suppressing ovulation can reduce risk, but must be discussed with a doctor. Methods can include long term use of the contraceptive pill, several pregnancies and breast feeding, or removal of the ovaries (oopherectomy).

Information for GPs

Important new development in the diagnosis of ovarian cancer

In 2008 the Department of Health consulted UK leading cancer charities, scientists and doctors, and identified a set of key symptoms which occur on most days in women who may be diagnosed with ovarian cancer.

Most women are diagnosed at advanced stages of the disease, which is associated with poor survival rates. When diagnosed in earlier stages of the disease, the survival rates are as high as 90%.

The three key symptoms are:

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Persistent pelvic and abdominal pain
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Increased abdominal size / persistent bloating – not bloating that comes and goes
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Difficulty eating and feeling full quickly

Other symptoms such as urinary symptoms, 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.

In most cases it is unlikely that these symptoms are ovarian cancer, but they may be present in some women with the disease.

Ovarian Cancer Action has been awarded a grant from the John Ellerman Foundation to develop its work with health service professionals and other providers of cancer care through the appointment of a Healthcare Project Manager, Dr Sarah Blacklidge.

By consulting with primary care services we aim to impact on clinical practice through innovation and help improve early detection rates.

We hope to contribute to your continuing professional development by alerting you to the latest research on the symptoms of ovarian cancer. The evidence base is growing fast to demonstrate that ovarian cancer can no longer be described as the “silent killer”.

Our symptom diary will help you learn more about the specificity and frequency of a woman’s symptoms and thereby assist in appropriate referral for diagnostic tests.

The diaries are branded with our logo for this site, however, if you would like to use them in general practice unbranded please contact us as below and we will be happy to supply them to you directly.

Download the symptom diary [PDF, 2.18MB, new window will open]. It is based on research by Professor Barbara Goff and includes accompanying guidance notes

We are contributing to strategies for developing clinical governance and are working nationally with the cancer networks to improve the patient pathway for women at risk of having or developing the disease.

Latest news

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Ovarian Cancer Action was one of the leading ovarian cancer charities that the Department of Health consulted, in its development of the key messages for ovarian cancer for members of the public, and health professionals, as part of the National Awareness and Early Diagnosis Initiative (NAEDI), as identified in the Cancer Reform Strategy.
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In October 2008, Ovarian Cancer Action sponsored a reception at the House of Lords alongside Ovacome and the Eve Appeal to launch the key messages on ovarian cancer symptoms to women. David Lammy, MP, and Baroness Morgan of Drefelin hosted the event.
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As part of our continued programme of awareness, we will be distributing a symptoms awareness leaflet for patients to over 10,000 GP practices in England and Wales ahead of Ovarian Cancer Awareness Month in March. This follows a distribution of leaflets to over 1,000 GP practices in Scotland in October 2008.
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We are always delighted to get your feedback on our work and we are currently building a panel of GPs interested in collaborating with us on our healthcare initiatives.

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