Ovarian cancer: symptoms, diagnosis, treatment and survival

The NHS lists four main symptoms of ovarian cancer. They count when they happen frequently, which the NHS describes as roughly 12 or more times a month. Many people notice them together, and they tend to be persistent rather than coming and going once or twice.

Other symptoms the NHS lists are indigestion, constipation or diarrhoea, back pain, feeling tired all the time, losing weight without trying, and unusual bleeding from the vagina, including between periods, heavier periods or bleeding after the menopause.

The NHS stresses that these symptoms are very common and can be caused by many different conditions, such as irritable bowel syndrome, but that it is still important to get them checked by a GP because finding cancer early can mean it is more treatable.

• A swollen tummy or feeling bloated.

• Pain or tenderness in your tummy or the area between your hips (pelvic pain).

• No appetite, or feeling full quickly after eating.

• An urgent need to pee, or needing to pee more often.

The NHS advises seeing a GP if you have any symptoms of ovarian cancer, or if you have seen a GP before and your symptoms have not gone away, are worse or are more frequent. This is non-urgent advice in the sense that you do not need A&E, but you should not wait for the symptoms to settle on their own.

At the appointment you will be asked about your health and symptoms. The NHS asks you to tell the GP if anyone in your family has or had ovarian or breast cancer. The GP may arrange a blood test for a protein sometimes linked to ovarian cancer, and if the level is high you will have an ultrasound scan of your abdomen and pelvis.

The GP or practice nurse may offer an examination, which can involve pressing on your tummy and a check inside the vagina. The NHS says you can ask for a female doctor or nurse, can have a friend, family member or staff member in the room, and can ask them to stop at any time.

The NHS says treatment depends on the size and type of cancer, where it is, whether it has spread and your general health. The main treatments are surgery and chemotherapy. Your specialist team will explain the benefits and side effects and work with you on a plan.

Surgery: if the cancer is at an early stage and has not spread outside the ovaries, the operation may remove one or both ovaries and the fallopian tubes, or the womb including the cervix. If it has spread, more surgery may be needed to remove as much as possible, which may include fatty tissue in the abdomen, lymph nodes and sometimes parts of the bowel or other organs.

Chemotherapy is medicine that kills cancer cells. The NHS says it may be given before and after surgery, on its own, or when ovarian cancer has come back. Radiotherapy may treat advanced cancer when other treatments are not right for you, or help with symptoms such as bleeding, pain or discomfort.

Targeted therapies only target things that help cancer cells grow or survive and may be an option for some types of advanced ovarian cancer, or cancer that has come back. Hormone treatments, used when a cancer needs oestrogen to grow, are rarely used.

The NHS notes that treatment in younger women can affect periods and fertility, and that there may be options to preserve fertility which the specialist team will advise about. If the cancer cannot be cured, the aim becomes limiting the cancer and its symptoms and helping you live longer, with support from a palliative care or symptom control team.

The NHS says the risk increases with age and that most UK cases are in women over 50. It lists factors that may give a higher chance of developing it. Having one or more of them does not mean you will get ovarian cancer, and many people with ovarian cancer have none of them.

• Inheriting a faulty gene, such as the BRCA genes or those linked to Lynch syndrome.

• Having had breast cancer or bowel cancer.

• Having had radiotherapy for a previous cancer.

• Having endometriosis or diabetes.

• Starting periods young, going through the menopause late (over 55), or not having had a baby, because these may mean more eggs have been released.

• Never having used hormonal contraception such as the pill or an implant.

• Taking hormone replacement therapy (HRT).

• Being overweight, or smoking.

The NHS says you cannot always prevent ovarian cancer, but you can help lower your chances by stopping smoking, staying a healthy weight and talking to a GP if ovarian cancer runs in your family, since they may refer you to a specialist for genetic testing.

The NHS ovarian cancer pages emphasise getting symptoms checked early rather than describing a screening test. Ovarian Cancer Action discusses the challenges in screening for ovarian cancer on its information hub.

The ovaries are 2 small organs that store the eggs needed to make babies and produce female sex hormones. Cancer Research UK describes ovarian cancer as abnormal cells in the ovary, fallopian tube or peritoneum growing and dividing in an uncontrolled way to form a tumour.

The NHS notes that cancers of the ovary, fallopian tubes and peritoneum (the lining inside the tummy) are often grouped together because they are similar and treated in the same way. This is also why you can still get ovarian cancer after your ovaries have been removed.

It can affect women, some transgender men and non-binary people assigned female at birth, according to Cancer Research UK.

Cancer Research UK says epithelial ovarian cancer, which starts in the cells covering the ovaries, is the most common type. Fallopian tube cancer and primary peritoneal cancer are forms of epithelial ovarian cancer. The rarer types are listed below.

A pathology report after surgery gives the type, stage and grade, which guide the next steps. Stage describes how big the cancer is and whether it has spread; grade describes how abnormal the cells look under the microscope.

The NHS says you will usually have a blood test and a scan if a GP thinks you may have ovarian cancer, and that other tests are then needed to confirm the diagnosis. The scan may be done with a smooth, tube-shaped device inserted into the vagina (transvaginal scan) or externally over the tummy. Sometimes the ovaries are too small to show up on a scan, especially after the menopause.

If the scan is normal, the NHS says the GP should check whether anything else may be causing your symptoms, and should advise you to come back if the symptoms continue or become more frequent. If the blood test and scan suggest ovarian cancer, the GP should refer you to a gynaecological cancer service in hospital.

A specialist may then arrange further tests and procedures to confirm the diagnosis: a CT scan, a needle biopsy, a camera test through a small cut in the tummy (laparoscopy), or surgery to remove tissue or possibly the ovaries (laparotomy). The NHS says you should get your results within a few weeks, and that you can call the hospital or GP if you are worried.

NICE guideline NG12 sets out how CA125 is used in primary care. For people aged 39 or under with persistent symptoms, CA125 should not be used in isolation, and an urgent direct-access ultrasound can be considered. For people aged 40 or over, CA125 is measured in primary care and an urgent ultrasound is arranged according to age-specific thresholds.

Cancer Research UK says survival depends on factors such as the stage, type and grade of the cancer, whether the surgeon can remove all of it in the first operation, your general health and fitness, and your age. It stresses that no one can say exactly how long an individual will live and that statistics are only a general guide.

For all stages in the UK, it reports that almost 80 in 100 women survive their cancer for 1 year or more, more than 50 in 100 for 5 years or more and around 40 in 100 for 10 years or more. For women in England who survive 1 year, around 65 in 100 survive 5 years or more.

Ovarian cancer symptoms are usually not an emergency, but they should not be left. Book a GP appointment if you have any of the symptoms above, especially if they are frequent, new for you or getting worse. Say clearly that you are worried about ovarian cancer and mention any family history of ovarian or breast cancer.

If you have already seen a GP and the symptoms have not gone away, are worse or are more frequent, go back. The NHS specifically advises this. The NHS also says an urgent referral, usually within 2 weeks, may be made if the GP thinks symptoms could be cancer.

The NHS ovarian cancer pages do not describe an emergency route, because the symptoms usually build gradually. As with any health problem, if you develop sudden severe pain or feel very unwell, use NHS 111 or your GP surgery for same-day advice, and call 999 or go to A&E if you think it is an emergency.

In the NHS, the route starts with your GP, who can arrange blood tests and a scan and, if cancer is suspected, an urgent referral to a gynaecological cancer service. Your team will include a clinical nurse specialist, the NHS says, who is your main point of contact during and after treatment.

Some people also choose to see a private gynaecologist or arrange scans privately. If you do, keep copies of your results and tell your NHS GP, so that your records stay joined up. Private tests do not replace the need to follow up persistent symptoms.

Support is available whichever route you take. The NHS signposts Macmillan Cancer Support, which has a free helpline open every day from 8am to 8pm, and Cancer Research UK has a nurse helpline for questions about cancer.