• What are the symptoms of ovarian cancer?
• Ovarian screening
• Can I keep my nipples?
• Ovarian cancer in BRCA carriers
On average, women have about a 2% chance of developing ovarian cancer in their lifetime. Women with a close relative affected with ovarian cancer may have a slightly increased risk of around 4-5%.
Women who have a faulty BRCA1 the ovarian cancer risk to age 80 years is 44% and 17% for BRCA2 carriers.
The risk of developing ovarian cancer starts to increase in the late 30s for BRCA1 carriers and from 45 for BRCA2 carriers.
What are the symptoms of ovarian cancer?
Ovarian cancer was once known as a “silent” disease, because its symptoms can be vague. Ovarian cancer does not occur before age 35 in women with BRCA1 mutations and not before age 40 in women with BRCA2 mutations
Evidence now shows that any of the following three symptoms, if they occur on most days may suggest ovarian cancer:
- persistent pelvic and abdominal pain
- increased abdominal size or persistent bloating (not bloating that comes and goes)
- difficulty eating, and feeling full quickly
Occasionally, women may also experience other symptoms, such as urinary symptoms, changes in bowel habit, extreme fatigue or back pain, on their own or at the same time as those listed above. These symptoms are unlikely to be ovarian cancer, but may be present in some women with the disease. If you regularly experience any of these symptoms and they’re not normal for you, see your GP.
Is ovarian screening available?
Currently there is no proven test or group of tests , which will reliably diagnose ovarian cancer at an early stage.
CA125 is produced by some ovarian cancer cells. A very high level of CA125 may indicate that you have ovarian cancer. CA125 isn’t specific to ovarian cancer and it can be raised in conditions including endometriosis and pelvic inflammatory disease, so a raised CA125 level doesn’t definitely mean you have ovarian cancer. However, around half of all women with early stage ovarian cancer have a raised level of CA125 in their blood. If your CA125 level is raised, you’ll be referred for an ultrasound scan.
The UK Familial Ovarian Cancer Screening Study (UKFOCSS) recently concluded for women with a BRCA1 or BRCA2 mutation, that a blood test to measure CA125 protein levels every four months would identify 9 out of 10 ovarian cancers before the woman had any symptoms. The study showed that women taking part in the study were less likely to be diagnosed with more advanced stages of disease but we cannot be certain that this will provide a survival benefit. The study also showed that annual ultrasound scans were not a useful screening tool to identify tumours at an early stage. Blood tests for CA125 can be performed by your GP and should be regarded as a form of surveillance rather than screening .
How does the oral contraceptive pill affect risk of cancer.
The combined contraceptive pill (containing oestrogen and progesterone) is associated with a small increase in the risk of breast cancer. For every 10,000 women per year using the OCP there are 1.3 extra cases of breast cancer. The risk is greater for women taking the OCP in their forties rather than in their 20s or 30s. But this is counterbalanced by the reduced risk of other cancers including a one third reduction in the risk of ovarian and endometrial cancer, and it may also reduce the risk of bowel cancer. Overall there is no increase in the total number of cancers or deaths in woman taking the OCP. For women with BRCA mutations who have an increased risk of ovarian cancer it could be argued that this outweighs the increased risk of breast cancer.
Ovarian cancer in BRCA carriers
If a woman is diagnosed with ovarian cancer and it is known that she carries a BRCA mutation, targeted chemotherapy can improve the outcome. There are clinical trials of newer drugs which are open to women known to carry BRCA mutations. Often
following diagnosis of a serous ovarian cancer in women under 60, genetic testing identifies a BRCA mutation and woman are concerned about how to manage the risk of breast cancer. They will be offered annual breast screening but it is recommended that they wait until they have had two years without any evidence of ovarian cancer before proceeding with breast risk-reducing surgery.