Ep 124 – Ovarian cancer

Ovarian cancer is a common female malignancy. Patients often present with vague, non-specific symptoms such as abdominal bloating, early satiety and dyspepsia (suggestive of upper abdominal disease). Other symptoms are more suggestive of pelvic disease, such as pelvic pain, abdominal or pelvic pressure, low back pain and urinary urgency. Late diagnosis has a significantly adverse impact on survival rates, so prompt diagnosis and treatment is crucial. In this episode, Dr Roger Henderson looks at the key symptoms of ovarian cancer to be aware of in clinical practice, the NICE guidance on diagnostic tests, treatments and survival rates.

Key references

1. NICE. 2023. https://www.nice.org.uk/guidance/cg122/.
2. NICE. 2023. https://www.nice.org.uk/guidance/ng12.
3. Target Ovarian Cancer. https://targetovariancancer.org.uk/health-professionals.
4. Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/ovarian-cancer.

Key take-home points

• Ovarian cancer is the fifth most common malignancy in females in the UK, accounting for 4,275 deaths per year. Each year, 5,000 new cases are diagnosed.
• Ovarian carcinoma has a mean age of incidence of 58 years and usually occurs between the third and eighth decades.
• The outcome for women with ovarian cancer is generally poor, with an overall 5-year survival rate of less than 35%.
• Despite the relatively poor overall survival rates for ovarian cancer, there has been a two-fold increase in survival over the last 30 years.
• No screening method has been shown to affect mortality significantly.
• NICE guidance has emphasised the importance of clinicians being aware of the symptoms and signs of possible ovarian cancer.
• Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer.
• If serum CA125 is 35 IU/mL or greater, arrange an ultrasound scan of the abdomen and pelvis.
• If the ultrasound suggests ovarian cancer, refer the woman urgently for further investigation.
• For any woman who has normal serum CA125 (less than 35 IU/mL), or CA125 of 35 IU/mL or greater but a normal ultrasound, assess her carefully for other clinical causes of her symptoms and investigate if appropriate.
• The initial approach to ovarian cancer is to confirm the diagnosis by an exploratory laparotomy.
• The standard comprehensive surgical staging approach consists of a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH and BSO) along with examination of all peritoneal surfaces, biopsies of pelvic and para-aortic lymph nodes and clinically uninvolved areas and peritoneal washings.
• Further management is then determined by the stage and histology of the tumour.
• Adjuvant therapy to surgery for ovarian cancer varies according to the stage of the disease.
• Adjuvant platinum-based chemotherapy improves survival in early (Stage I/IIa) ovarian cancers.
• Chemotherapy is advised for all women with Stage II–IV disease following surgery.
• Biological therapies have been developed and continue to undergo trials as understanding of the molecular biology of the types of ovarian cancer has advanced.
• When diagnosed at its earliest stage, nine in 10 women with ovarian cancer will survive their disease for 5 years or more, compared with less than five in 100 of women when diagnosed at the latest stage.