MEDICAL SERVICES

OVARIAN CANCER

OVARIAN CYST

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Most ovarian cysts are small, harmless, and go away without any treatment. Many women don’t even know they have them. But if you have a bigger cyst it may cause you discomfort or pain. You may need to have the cyst removed. Your doctor will do tests to make sure the cyst is harmless and not a sign of cancer.

We've brought together the best research about ovarian cysts and weighed up the evidence about how to treat them. You can use our information to talk to your doctor and decide which treatments are best for you.

What are ovarian cysts?

Simple ovarian cysts are fluid-filled sacs within the ovaries. They are common and many women have them without even knowing about them.

But an ovarian cyst can be a sign of cancer. This is more common as women get older, and especially after the menopause. So it’s important to get any symptoms checked out.

Cysts usually form as a reaction to hormonal changes in your body. Things that can affect your hormone levels and lead to a cyst include:

• being pregnant

• having treatment for infertility

• having a medical condition such as polycystic ovary syndrome (PCOS)

• taking the drug tamoxifen.

Cysts may also come and go depending on your hormone levels during your menstrual cycle.

What are the symptoms?

Most ovarian cysts are small and go away without causing any problems. Many women who have a cyst don’t notice any symptoms. The cyst might only be noticed during an ultrasound scan for something else – for example, if you are pregnant.

If you do get symptoms, these can include:

• pain in the pelvic area, which might be to one side of the pelvis. Some women notice this more during or after sex.

• feeling bloated, needing to urinate more often, and feeling full sooner when eating.

• changes to your periods. They might get heavier or lighter, or become irregular or painful.

If you are in a lot of pain it may be that the cyst is infected or has twisted and is cutting off blood supply to the ovary. It’s important to get this checked out straight away. But all the symptoms listed above should be checked by a doctor if they persist.

If you have symptoms of an ovarian cyst you’ll probably be sent for an ultrasound scan. Depending on the results, you may need a further scan to give a more detailed picture, such as a CT, MRI, or PET. You may also need a blood test. These tests help the doctor work out whether the cyst is harmless or whether it could be a sign of cancer.

What treatments work?

The treatment you are offered will depend on whether you’ve been through the menopause, whether you have symptoms, and your test results. Many women don’t need any treatment, because the cyst will go away on its own without causing problems.

If you haven’t been through the menopause and you have a simple, fluid-filled cyst that isn’t causing problems, your doctor may suggest you simply have another ultrasound in a few months’ time. The cyst may have gone away. If it hasn’t, or if it’s causing pain or discomfort, your doctor may suggest you have it removed.

If you have been through the menopause and have a simple cyst, your doctor is likely to suggest you have an ultrasound and a blood test every two to three months, until the cyst goes. If it doesn’t go, or if it causes problems, your doctor may suggest that you have it removed. If your cyst gets bigger, or seems solid, your doctor will probably suggest you have it removed without waiting.

There are two types of operation to remove a cyst: laparoscopy and laparotomy. All operations have some risks. You can discuss these with your surgeon.

A laparoscopy is a type of keyhole surgery. You have a small cut below your belly button (navel), and a tiny camera on a tube is fed through to your ovaries to take a look. If the surgeon can see a cyst, he or she will probably remove it using small tools during the same operation. This operation takes about half an hour, and you may be able to go home from hospital the same day.

If your doctor is concerned that the cyst may be cancer, or if your cyst is very large, you may need a laparotomy. The surgeon makes a bigger cut so he or she can see your ovaries more clearly. The cyst will be removed and checked in the laboratory to make sure it doesn’t contain cancer cells. It takes longer to recover from a laparotomy. You may need to stay in hospital for a couple of days.

Ovarian cyst

What will happen to me?

Most women who have ovarian cysts recover without any problems. But it’s always possible that a cyst will come back.

If you have surgery to remove a cyst, you may be in pain for a few days afterwards.

The most alarming part of having an ovarian cyst is that your doctor will probably want to check for ovarian cancer. But simple ovarian cysts are rarely cancerous. Even for women who’ve been through the menopause, less than 1 in 1,000 simple cysts are cancerous.

Solid cysts are more likely to be cancerous, especially when they occur in women who’ve been through the menopause. Although ovarian cancer can happen to women of any age, it’s unusual before the age of 60.

If your cyst proves to be cancerous you will need treatment for ovarian cancer.

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OVARIAN CANCER

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Ovarian cancer: what is it?

Ovarian cancer is cancer that affects women's ovaries and that can affect other organs and tissues near to the ovaries like the urinary bladder and rectum or intestine. It is a serious disease, but if it is diagnosed at an early stage it can usually be cured. And even cancers that are more advanced can be treated and their progress slowed.

What is ovarian cancer?

Not all ovarian growths are dangerous. For example, many women have growths on their ovaries called cysts. These cysts aren’t usually cancer and they often go away by themselves.

But if they cause symptoms, or if your doctor is worried that they could be cancer, you might be advised to have surgery to remove them.

Cancerous ovarian tumours are serious. This is partly because pieces of the tumour can break off and spread to other parts of the body.

Most ovarian cancers start in cells on the outside of an ovary. When they spread it tends to be to nearby organs such as the womb, bladder, and bowels, causing new spots of cancer in these areas.

Ovarian cancer is most common in women over 50. Having a close family member with the disease can also slightly increase your chance of getting it.

What are the symptoms?

Most women with ovarian cancer get some symptoms in the early stages. But they are not always recognised as being caused by ovarian cancer. This is because the symptoms of ovarian cancer are similar to those of other, less-serious, conditions such as indigestion or an irritable bowel.

The symptoms of ovarian cancer can include:

• pain in your pelvis (your lower abdomen)

• constipation

• diarrhoea

• feeling bloated or full after eating very little

• losing weight without trying

• having to urinate more often

• persistent bloating or swelling, where your abdomen gets bigger and doesn't get smaller again

• bleeding from your vagina between your periods

• swollen ankles

• back pain

• a lump in your abdomen.

Your doctor will probably ask you about your symptoms and how long you have had them, and about your general health and any illnesses in your family.

He or she will also do a physical examination. This might involve feeling your abdomen and examining inside your vagina to check your ovaries and fallopian tubes.

You might have some tests, such as a blood test and an ultrasound scan, and maybe an MRI scan, to look at the organs inside your abdomen.

An experienced doctor can usually tell you whether you need treatment in the form of surgery or upfront chemotherapy. However a sure diagnoses of ovarian cancer can only be done with a sample of the tumour tissue or fluid in the abdomen. This maybe done via a CT scan.

The most common procedure is a laparotomy, where the surgeon makes a cut in the abdomen. But sometimes the surgeon is able to do a laparoscopy, which requires a much smaller cut. During the procedure the surgeon will remove samples of tissue from your ovary and from other parts of your abdomen.

What will happen to me?

Ovarian cancer is considered to be an aggressive cancer. The treatment involves surgery as well as chemotherapy. It is very important that surgery for ovarian cancer be done by an experienced surgical oncologist with skill of gastrointestinal surgery and not by a gynaecologist or even a gynaec-oncologist. Many patients with the right treatment survive for five to ten years. Your survival will depend on the adequacy of surgery (that means whether all the cancer has appropriately been removed from your abdomen) and the sensitivity of your tumour cells to chemotherapy. But, as with most cancers, the less advanced your cancer the less it has spread when you are diagnosed, the better your chance of being cured.

What happens to you also depends on how much cancer doctors can remove during surgery and how well you respond to chemotherapy. Remember that figures from research studies tell us how well a lot of women do on average. But they don't predict how well you or your cancer will respond to treatments.

There are many types of ovarian cancers, some do not need chemotherapy and can be treated by surgery alone.

We can’t tell for sure what course your cancer will take. For this reason you need to be watchful and have regular check-ups for many years after your treatment has finished.

Future pregnancy

If both of your ovaries are taken out during surgery you won't be able to become pregnant naturally. But if you are younger and you have not been through the menopause you might be able to become pregnant with fertility treatments that you have planned before your surgery.

For example, it might be possible to remove and freeze some eggs from your ovary, or some embryos, before surgery. Or you might be able to have surgery that doesn't remove all of your reproductive organs. You can talk to your doctor about the options available to you before you have surgery.

Ovarian cancer: what treatments work?

Some people have complications after surgery that mean they need more time in hospital. These complications include a lot of bleeding straight after your operation, blood clots in your legs, or just taking longer than usual to heal.

But once you've recovered from the operation you should be able to do all the things that you did before.

If you haven't already gone through the menopause you might get some of the symptoms of it after surgery, such as hot flushes, sweating at night, and a dry vagina, as well as thinning of your bones (osteoporosis). You can talk to your doctor about treatments for these problems.

Having ovarian cancer is a worrying time and you might need time to adjust to what is happening. You might not feel like having sex for some time. Let your partner know that you need support and understanding. It might help to talk to a counsellor about this.

Chemotherapy

Women whose cancer is at an early stage might not need chemotherapy after surgery. But many women need this treatment, which is intended to kill off any cancer cells left behind after surgery.

If you have chemotherapy you usually start the treatment about four weeks after your operation. You’ll usually have between three and six treatments.

The chemotherapy is given through a tube that’s inserted into a vein (an IV or intravenous drip). It’s usually given during the day and you won’t have to stay in hospital overnight for this treatment.

All chemotherapy can cause side effects in some women. Different cancer drugs can cause different side effects. But common ones include:

• anaemia (a reduction in the number of red blood cells you have, which can make you feel tired)

• temporary hair loss

• nausea and vomiting. You can have medicines to try and prevent this

• numbness and tingling in your hands and feet

• hearing problems

• tiredness

• being more prone to infections

• mouth sores

• loss of appetite.

In some women the cancer comes back after surgery and chemotherapy. It might be possible to have more chemotherapy. Some women with cancer at an advanced stage need to have chemotherapy injected directly into the abdomen as well as through an IV.

Ovarian cancer: what treatments work?

The type and amount of treatment you need will depend on how advanced your cancer is, or what 'stage' it's at.

When your surgeon operates, he or she might try to remove all problem tissue at the same time as the stage is being determined.

If your cancer is at an early stage this might be the only treatment you need.

If your cancer is at a more advanced stage you will probably also need treatment with drugs (chemotherapy) after surgery, to kill off any cancer cells that might have been left behind.

Some women have treatment the other way around - with chemotherapy first, followed by surgery. This is usually because they are not well enough to have surgery straight away.

This might be because they have another medical condition that is making them ill. These women will usually have chemotherapy to shrink their tumour as much as possible before surgery.

Surgery

There are two types of operation to check for and remove ovarian cancer. Whichever kind you have, you'll be given a general anaesthetic so that you'll sleep through it.

If you have laparoscopic surgery your surgeon makes two small cuts in your abdomen.

Tiny instruments and a camera are put through the cuts to get a close look at your ovaries, take samples of tissue (biopsies), and remove a cyst or other tissue or organ.

You should recover quicker from this surgery than from standard surgery. But if your surgeon finds cancer he or she might need to do a laparotomy (standard surgery).

During standard surgery your surgeon makes a large cut in your abdomen to look at your ovaries.

If your surgeon finds a tumour on your ovary that could be cancer he or she will probably remove your whole ovary. Surgeons do this because cutting away just a piece of the ovary could let cancer cells get out.

Your surgeon will send the tumour to the laboratory immediately to check if it is cancer. This is sometimes done during the operation.

If the laboratory finds that you have ovarian cancer your surgeon will try to remove as much of the cancer as possible to give you the best chance of staying well.

If your cancer has spread and is at an advanced stage, your surgeon might need to remove other affected organs, such as your womb (an operation to remove the womb, or uterus, is called a hysterectomy), your other ovary, and fallopian tubes. You might also need to have surgery on your bowel if it has been affected.

You'll probably need to stay in hospital for about one week after your operation.