Around 1.5 percent of women are likely to develop ovarian cancer at some stage of their life. It is less common than breast cancer but is considered as the most serious and fatal of all gynecological cancers.

The reason for this is that the cancer is usually advanced before it is diagnosed, making treatment difficult. The ovaries cannot be easily examined and, because the warning signs are unclear, late diagnosis is common.

Because of the lack of screening tests available, it is imperative to know the early symptoms and the possible risk factors.

Understanding ovarian cancer

The ovaries are two small organs that are a part of the female reproductive system and they are situated each side of the uterus. These ovaries contain germ cells that become eggs which are released when the woman menstruates.

They also produce estrogen and progesterone, the hormones that adjust the menstrual cycle and have an effect on the growth of breasts and body hair as well as affecting the development of the female body shape.

What types of tumors are there?

This normally happens in an organised manner but occasionally they grow abnormally and form a growth that we know as a tumor.

This tumor may be benign or it may be malignant. If it is benign, it is not cancerous and does not spread to other parts of the body. A malignant tumor, on the other hand, is cancerous and will often spread, making mestastases or secondary cancers.

Ovarian cancer is malignant and can occur in either one or both of the ovaries. There are three main groups that are related to the cells where the cancer starts.

Epithelial ovarian cancer, as its name implies, grows in the epithelium which is the surface of the ovary. It is the most common and accounts for around 90 percent of ovarian cancer. It mainly affects post menopausal women.

Another kind of epithelial tumor is a borderline tumor which grows much more slowly than its regular counterpart. These can normally be removed successfully even if diagnosed at an advanced stage.

There is a very rare form of ovarian cancer called germ cell ovarian cancer that starts in the cells that develop into eggs. This only accounts for about 5 percent of ovarian cancers and usually occurs only in women under 30.

The other five percent of ovarian cancers are generally sex-chord stromal cell ovarian cancer that affects the ovary cells responsible for female hormones. It can affect women of all ages.

Who is at risk of getting ovarian cancer?

The cause of ovarian cancer is unknown but there are some risk factors that have been identified through research. Although having these risk factors may increase your chances of developing ovarian cancer, they do not mean that you will necessarily get the disease. However, knowledge of these risk factors can be helpful. If you are concerned by having any of these risk factors, it is important to talk to your healthcare professional.

Factors that may increase your risk of ovarian cancer include:

• Age- Around 90 percent of ovarian cancers affect women over 40.
• Cultural background - Caucasian women in western society have higher rates of ovarian cancer than African or Asian women.
• Number of pregnancies - Women who have never been pregnant appear to have a higher risk of ovarian cancer.
• Family history - Between 5 and 10% of ovarian cancers are genetic. Researchers believe that the genes responsible for breast cancer (BRCA1 and BRCA2) are involved in almost all cases of familial ovarian cancer as well as familial breast cancer. It is also thought that these same damaged genes may be responsible for some endometrial and colon cancers. If you are genetically predisposed to any ovarian, breast, endometrial or colon cancers, you may have an increased risk of getting ovarian cancer.
• Infertility and taking fertility drugs - Women who have had fertility drugs may be at a higher risk although infertility itself is a risk factor so this cannot be taken as a clear indication.
• Hormone Replacement Therapy - The use of estrogen only HRT which is usually when you have had a hysterectomy, has been identified as a possible risk factor for ovarian cancer, particularly if you have been on this therapy for over ten years.
• Lifestyle factors - Obesity is a risk factor associated with ovarian cancer as is a diet that is high in fat.
• Can I reduce the risk of ovarian cancer?

Currently, there are no known procedures to prevent or detect early ovarian cancer but there are ways to reduce the risks. Some of these are:

• Oral contraceptives - Research has found that the use of oral contraceptives can cut the risk of ovarian cancer by up to 60 percent if taken for a period of five years during your life.
• Pregnancy and breastfeeding - Breastfeeding delays ovulation after childbirth and therefore decreases your risk of ovarian cancer. However, there is no guarantee that breastfeeding will stop you from developing ovarian cancer.
• Enjoy a low fat diet - A high fat diet has been identified as a risk factor in ovarian cancer. Therefore, it makes sense to stick to a low fat diet with lots of fresh fruit and vegetables.
• Tubal ligation or hysterectomy - These operations are only performed with a valid medical reason but it is believed that they both reduce the risk of ovarian cancer.

People with a strong family history of ovarian cancer may opt to speak to a genetic counselor that can assess whether you are at risk of developing the disease. If your family history suggests the damaged genes associated with ovarian, breast, endometrial, or colon cancer, it may be wise to have genetic testing. If these tests show the damaged BRCA1 or BRCA2 genes, you may be refe. rred to a gynecological oncologist to consider ways to reduce your risk.

Early symptoms of ovarian cancer

Because there is no screening test available for ovarian cancer, it is recommended that you have a regular pelvic vaginal checkup to see if there are any changes in your ovaries. It is also vital that you consult your healthcare specialist if you notice any possible signs of this illness. Because the symptoms are often common to many other medical conditions, diagnosis of ovarian cancer can be difficult.

However, if you have any of the following symptoms that are unusual for you and that persist for more than a week, see your doctor without delay.

Some symptoms of ovarian cancer may include:

• Stomach discomfort of pain in the pelvic area.
• Persistent nausea or wind.
• Feeling constantly bloated or 'full'.
• Unexplained weight gain.
• Loss of appetite or unexplained weight loss.
• Bowel changes.
• Frequency or urgency in urination.
• Lethargy.
• Pain during intercourse.
• Unexplained vaginal bleeding.

Sometimes, ovarian cancers are wrongly diagnosed as irritable bowel syndrome or menopause so if you are concerned, ask to be referred to a gynecological oncologist who can order tests to rule out ovarian cancer. It is rare that these symptoms will be ovarian cancer but if it is, early detection gives an excellent chance of survival.

Diagnosing ovarian cancer

If your doctor suspects ovarian cancer, you will be referred to a gynecological oncologist who will organize tests which may include any or all of the following:

• An internal pelvic examination.
• Blood tests.
• Chest and stomach x-rays.
• A barium enema to rule out bowel problems.
• Ultrasound scans.

If the results show a likelihood of ovarian cancer, you will be recommended to have an operation to confirm the diagnosis (none of the abovementioned tests can be sure). During the operation, if the surgeon finds ovarian cancer, they will normally remove the cancer as well as the ovaries.

It is important to understand before the surgery that this may happen so learn all you can about your illness and the outcomes before the operation.