Ovarian Cancer

Ovarian cancer is cancer of the ovaries (or, closely related, the fallopian tubes or peritoneum). It is less common than breast or cervical cancer but often presents late because early symptoms are vague and there is no reliable general screening test. Knowing the early patterns saves lives.

Subtle symptoms to take seriously

• New persistent bloating — not just "gas" that comes and goes.
• Feeling full quickly, reduced appetite.
• Pelvic or abdominal pain.
• Urinary urgency or frequency.
• Change in bowel habit.
• Unexplained weight loss or fatigue.
• Back pain, painful sex.
• Post-menopausal bleeding — always needs evaluation.
• These symptoms matter when they are new, persistent (more than 2-3 weeks), and frequent — several times a week.

Who is at higher risk

• BRCA1 / BRCA2 mutations — a major cause of inherited risk.
• Lynch syndrome and other inherited conditions.
• Family history of ovarian, breast, uterine, or colorectal cancer.
• Never having been pregnant.
• Late menopause, long-term hormone therapy (selected).
• Endometriosis.
• Smoking, obesity.

Evaluation

Pelvic examination, transvaginal ultrasound, CA-125 blood test (+ sometimes HE4, ROMA score). Further imaging (CT, MRI) if abnormal. Laparoscopy or surgery usually confirms the diagnosis.

Treatment

• Surgery — usually removal of ovaries, tubes, uterus, and widespread disease where possible. The expertise of the surgeon directly affects outcome.
• Chemotherapy — essential for most cases.
• Targeted therapy — PARP inhibitors in BRCA-mutated cancers.
• Regional Cancer Centres with gynae-oncology expertise give much better outcomes than general gynaecology.
• Genetic counselling and BRCA testing — for patient and family.
• Fertility preservation in select younger women.

Prevention for high-risk women

• BRCA testing for women with strong family history.
• Risk-reducing salpingo-oophorectomy around 35-45 for BRCA carriers — substantial risk reduction.
• Combined oral contraceptive pills reduce ovarian cancer risk over years.
• Salpingectomy at the time of tubal ligation or hysterectomy — often recommended now.