GYNAECOLOGICAL CANCER

Ovarian Cancer

Epidemiology

Ovarian cancer is the most common gynaecological cancer in women in the UK. If affects between 4,000 and 5,000 women every year. Unfortunately many of those women present when the disease is quite advanced and therefore the prognosis from ovarian cancer is often quite poor. There is an increased chance of developing ovarian cancer in women who have had no children, a late menopause and sometimes in the event of a family history of ovarian cancer. There is a decreased chance of developing ovarian cancer in women who have been on the oral contraceptive pill and those who have already had hysterectomies with conservation of ovaries. Smoking appears to have no affect on the incidence of ovarian cancer.

Presentation

Patients with ovarian cancer tend to present in a number of different ways. Some will find a mass in the abdomen which is causing swelling. Some will find fluid in their abdomen, which is also caused swelling and many will find a decreased appetite and a change in bowel habit. Some will have their ovarian cancer discovered coincidentally. Quite a number of patients with ovarian cancer are actually referred by their GP to other specialists such as bowel surgeons and gastroenterologists because their symptoms can be so confusing. On examination a mass may be found in the abdomen, which arises from the pelvis. An ultrasound scan can usually characterise this matter and other scans such as MRI scan and CT scan may also be used to help in the diagnosis. A blood test can be done to look for a CA125 level. If this is raised it increases the suspicion of an ovarian cyst being due to an ovarian cancer.

Treatment

Most patients with ovarian cancer will require a combination of surgery and chemotherapy. It is most common to perform the surgery first to remove the cancer and to take samples from any areas inside the abdomen where the cancer may have spread. Ideally, all the areas of cancer are removed at the time of surgery, but this is not always possible. The surgical treatment is usually followed by chemotherapy. There are a combination of chemotherapeutic agents, which are used for the treatment of ovarian cancer, but the commonest is carbo platin and taxol. This is usually given on a three weekly basis for six cycles in total. The debate about which patients benefit most from which types of chemotherapy can often be quite complex and would be a discussion outside the scope of this summary.

Follow-up

Most patients with ovarian cancer will be carefully followed-up. They should see their doctor every three months for the first two years and some of those patients will benefit from having a blood test on a regular basis to look at the CA125 level. If the cancer recurs then the majority of patients would be suitable to receive a second type of chemotherapy, but this would depend on the individual circumstances.