Ovarian Cancer
Often presents late with vague abdominal symptoms — early recognition saves lives.
Overview
Ovarian cancer is the leading cause of gynaecological cancer death. Most are high-grade serous carcinomas, often originating in the fallopian tube. Symptoms (bloating, early satiety, urinary urgency, pelvic pain) are non-specific and frequently attributed to IBS or menopause, delaying diagnosis.
Symptoms
- • Persistent abdominal bloating
- • Early satiety or loss of appetite
- • Pelvic or abdominal pain
- • Urinary urgency or frequency
- • Change in bowel habit, fatigue, unexplained weight loss
Risk factors
- • Age >50
- • Family history of ovarian, breast, colorectal cancer
- • BRCA mutation, Lynch syndrome
- • Obesity, HRT (small increase)
Causes
- • BRCA1/2 (~15%), Lynch syndrome, RAD51, BRIP1, PALB2
- • Lifelong number of ovulations (nulliparity, early menarche, late menopause increase risk)
- • Endometriosis (clear cell, endometrioid subtypes)
🚨 Red flags — seek urgent care
- • New persistent bloating > 12 times/month in a woman over 50
- • Ascites or palpable pelvic/abdominal mass
- • Postmenopausal bleeding with bloating
- • Bowel obstruction in a woman with vague abdominal symptoms
When to seek care
- • Any new persistent (>3 weeks) bloating, pelvic pain or urinary symptoms in women over 50
- • Family history meeting genetic referral criteria
- • Sudden severe abdominal pain — exclude ovarian torsion
Diagnosis
- • CA-125 and pelvic ultrasound as first-line in women >50 with symptoms
- • Risk of Malignancy Index (RMI) or ROMA to triage
- • CT chest/abdomen/pelvis for staging
- • Histological confirmation: laparoscopic or image-guided biopsy
- • BRCA and somatic tumour testing in all epithelial ovarian cancers
Treatment
- • Primary cytoreductive surgery aiming for no macroscopic residual disease
- • Carboplatin + paclitaxel chemotherapy (neoadjuvant or adjuvant)
- • Maintenance PARP inhibitor (olaparib, niraparib) for BRCA-mutated or HRD-positive disease
- • Bevacizumab maintenance in selected high-risk disease
- • Hormonal therapy for low-grade serous; targeted/immunotherapy in clinical trials
Prevention
- • Combined oral contraceptive reduces risk by ~50% with 5 years' use
- • Bilateral salpingo-oophorectomy for BRCA carriers after childbearing
- • Opportunistic salpingectomy at other pelvic surgery may reduce risk
Complications
- • Bowel obstruction, ascites, pleural effusion
- • VTE (high risk in advanced ovarian cancer)
- • Chemotherapy: neuropathy, neutropenia, alopecia
- • Recurrence — usually within 2 years for advanced disease
Prognosis
5-year survival ~93% stage I but ~13% stage IV; PARP inhibitor maintenance has substantially improved outcomes in BRCA-mutated and HRD-positive disease.
Education & self-care
Ovarian cancer's symptoms are vague but recognisable when persistent. Acting on them early — and engaging with genetic services when relevant — saves lives.
Frequently asked questions
Is bloating always serious?
Usually not — but persistent daily bloating in women over 50 deserves CA-125 and ultrasound.
Should I have BRCA testing?
Offered when family or personal history meets NICE criteria, or at any ovarian cancer diagnosis.
Does HRT cause ovarian cancer?
There is a small increased risk with long-term use — discuss benefits and risks individually.