I went to a public seminar last night at the Queen’s Medical Research Institute given by  Dr Scott Fegan, one of the surgeons who took me apart just over a year ago, and Prof. Steve Hillier, an eminent research scientist.  They were presenting some of their current knowledge and research into aspects of ovarian cancer.  Very interesting, very disturbing.

Did you know that ovarian cancer is the fourth most common cancer amongst women in the UK but that, amongst the gynaecological cancers it is first in terms of deaths?   Only 40% of women diagnosed with ovarian cancer survive for 5 years after diagnosis and Scotland has the worst survival rate in Europe for the disease.  Survival rates for breast cancer have improved significantly over the last 20 years but those for ovarian cancer have remained virtually unchanged in that period.  Fun, huh?

The reasons for such poor survival are buried in a mixture of reasons.  High on the list is the non specific  nature of the symptoms so that the disease often goes unnoticed and undiagnosed until it is well advanced and has spread from the ovaries into other parts of the abdomen.  There is no reliable screening test for ovarian cancer so it is difficult to identify in the absence of symptoms.  And, although this is an area of active research, the causes of ovarian cancer are still very poorly understood which means, for example, there is no prospect yet of a vaccine such as that for cervical cancer. 

It seems that symptoms, although vague are becoming better understood  and the following are ones that are generally agreed:-

• Persistent abdominal pain
• Increased abdominal size / persistent bloating – not bloating that comes and goes
• Difficulty eating and feeling full quickly

There can be other symptoms such as urinary symptoms, from a cyst pressing on the bladder, changes in bowel habit, fatigue, back pain, weight loss, weight gain.   Any or none of these may be experienced alone or in combination.  You have to bear in mind that GPs see on average one case every 5 years and that these symptoms could have a number of causes.  However, if you have any of these, ladies, please insist that your GP gets you thoroughly checked out.

I had none, although I had had persistent indigestion which I had attributed to my coeliac disease and the GP had pretty much dismissed – fair enough, it wasn’t severe –  and I had been getting very frequent colds coinciding with my menstrual cycle.  The indigestion and the colds both disappeared with the hysterectomy as, of course, did the menstrual cycle.   Some things you don’t miss.  I’m not sure that I appreciated the significance, if any, of those colds until recently: I have only had one cold in the 16 months since my hysterectomy and I figure my immune system was compromised in some way by the cyst.

Although there is no reliable test for ovarian cancer, there is a blood marker CA125 which is elevated in about 80% of cases.  Unfortunately this can also be elevated for a number of other reasons and so can give false positives.  Not good to have major surgery on the basis of a false positive.

Whilst the medical profession still doesn’t fully understand the origins of ovarian cancer, there is increasing evidence that it is in some way associated with uninterrupted ovulation and we were shown some eye watering (if you’re a woman) slides on the process of ovulation.  No wonder that time of the month is so uncomfortable! I hadn’t realised that, at each ovulation, the egg breaks through the surface of the ovary causing damage and inflammation.  So, on each cycle, the ovary is damaged and then repaired and, as this can happen over 400 times during a woman’s life, it’s not surprising it occasionally goes wrong.  An enzyme (11bHSD) involved in producing natural anti-inflammatories throughout the body is implicated in repairing the ovarian damage and this mechanism is the focus of much of the research. 

So what can interrupt ovulation and do these offer protection against the development of ovarian cancer?  Pregnancy and breast feeding of course – I’m one of those older mothers so I had a lot of years of uninterrupted ovulation before the children put in an appearance.  And the combined pill is another; Dr Fegan pointed out, in answer to a question, that this gets a lot of bad press because of an increased risk of DVT.  Women know that there can be issues of weight gain and personality changes associated with the pill. However, Dr Fegan suggested that the benefits of the pill almost certainly outweigh some of the risk, pointing out that there are side effects to any medication.  I have to say that I never took the pill as I didn’t like the idea of taking medicines that weren’t strictly necesary.  With the benefit of hindsight, though, if I were in my twenties with no intention of getting pregnant, I’d be straight down to the GP.  No guarantees, of course, but it sounds like the benefits might outweigh the risks.  Alternatively, perhaps I’d start early and have six children.  Hmmm. 

So, Ladies, the message is – pay attention to your bodies and make the GP pay attention to you.  And do consider taking the pill if you’re not already on it.  And perhaps, if more women were aware of the symptoms and acted on them promptly, ovarian cancer would lose its tag of a silent killer.

Photo credit: tanuschka