High-grade serous ovarian cancer

"Serous" describes how the cells look under the microscope, resembling the lining of the fallopian tube. "High grade" describes how different those cells are from normal ones: they are very abnormal and multiply fast. The two words together name a specific disease that behaves differently from the slower low-grade serous type or from mucinous and clear cell cancers.

Because the same cancer can be found in the ovary, the tube or the peritoneum at the same time, pathologists and surgeons often describe it as a tubo-ovarian or pelvic serous cancer. NHS and charity pages treat ovarian, fallopian tube and primary peritoneal cancer together because the symptoms, tests and treatment are shared.

Early symptoms are easy to put down to something harmless. The ones that matter are those that are new, frequent and persistent rather than occasional.

• Bloating that does not come and go, or a swollen tummy

• Feeling full quickly or loss of appetite

• Pain or pressure in the lower tummy or pelvis

• Needing to pass urine more urgently or more often than usual

• Changes in bowel habit, or unexplained weight change and tiredness

The NHS describes a first step of a CA125 blood test and an ultrasound scan arranged by the GP. If these suggest ovarian cancer, the GP should refer you to the gynaecological cancer service at a hospital. CA125 can be raised by many non-cancer conditions, so it is a prompt for further tests and not a diagnosis on its own.

A CT scan maps the spread. Tissue is needed to confirm the cell type, taken by needle biopsy, by a camera operation (laparoscopy) or at surgery. Fluid from the abdomen may also be sampled. A multidisciplinary team, which includes a clinical nurse specialist, then agrees a plan. Results typically take a few weeks.

Cancer Research UK describes carboplatin, often with paclitaxel, given every three weeks, usually for around six cycles. Depending on how fit you are and how far the cancer has spread, chemotherapy can be given after surgery, or before and after it (the surgery in the middle is sometimes called interval debulking), or on its own if an operation is not suitable.

The surgical aim is to remove all visible cancer. The operation can include both ovaries and tubes, the womb, the omentum (a fatty apron in the abdomen), lymph nodes and sometimes part of the bowel. It is major surgery, with recovery in a high dependency or intensive care setting sometimes needed.

Testing the tumour for homologous recombination deficiency, and the blood for inherited BRCA variants, helps teams decide on maintenance after chemotherapy. NHS England genomics teaching material states that PARP inhibitors are approved as first-line maintenance for ovarian cancer whatever the BRCA status; Cancer Research UK adds that the choice of drug depends on BRCA and HRD results. Bevacizumab, a drip-given targeted medicine, is another option for stage 3 or 4 high-grade disease.

A positive BRCA result in the blood also has meaning for relatives, so referral to clinical genetics is usual.

High-grade serous cancer commonly responds well to first-line chemotherapy, but it can come back, often months or years later. CA125 and scans after chemotherapy track the response. If it returns, further chemotherapy, targeted drugs or occasionally surgery may be offered, depending on the earlier treatment and the time since it finished.

Individual outlook depends mainly on stage, how much cancer could be removed, general health and genetic profile, which is why your specialist team is the right source for personal figures. Palliative care teams support symptom control at any stage and are not only for the end of life.