Ovarian Cancer

Ovarian cancer is can happen in adult women of any age, although it is most common in those in their late 60s and older.

Ovarian cancer can happen when abnormal cells on the surface of the ovary start to divide uncontrollably. This growth of cells forms a tumour that can spread to nearby structures such as the uterus and fallopian tubes, and beyond that to the abdominal cavity and associated lymph nodes where it can commonly involve the surface of the bowel and lead to bowel obstruction or even bowel perforation. Uncommonly, if left unchecked, ovarian cancer can spread to vital organs by spread through the blood stream such as the liver, lungs, spleen, brain and very rarely the bones.

Unlike ovarian cancer, many ovarian tumours are benign or of a kind called borderline, meaning that they do not spread or do not spread easily, so they do not usually lead to serious illness. In contrast, ovarian cancer is capable of invading surrounding tissues and spreading rapidly.

Ovarian cancer is best treated using a combination of surgery and chemotherapy. Although we usually begin treatment by offering surgery before chemotherapy (primary debulking surgery), sometimes we may reverse the sequence and give chemotherapy first (neoadjuvant chemotherapy) with surgery performed later in order to make it safer (delayed primary surgery).

Chemotherapy currently typically consists of two drugs, paclitaxel and carboplatin given every three weeks, however recent advances are causing us to look more carefully at changing the schedule of paclitaxel such that it is given every week, or alternatively considering a new targeted treatment directed against the blood vessels that feed the cancer (Bevacizumab or Avastin), and careful selection of patients that would benefit from these approaches whilst avoiding unacceptable side effects is required. Following concurrent Bevacizumab and chemotherapy, the Bevacizumab usually continues to be given for up to a year.

If ovarian cancer comes back after the first treatment, there are many opportunities and approaches possible to controlling the disease, which usually involve more chemotherapy but may involve surgery or radiotherapy.

Active ovarian cancer research has resulted in new drug treatments approaches and there increasing information on the different kinds of ovarian cancer, based on the understanding of what drives the formation and growth of ovarian cancer (the so-called molecular understanding of the disease). The hope is that understanding the molecular profile of the ovarian cancer cells from patients genes (DNA, RNA) and cell proteins will allow us to personalise treatments to individual patients by giving us insights into assessing risk of cancer returning, prognosis for the patient and the choice of the best treatment.

Further information on ovarian cancer and its research to improve chances of cure can be obtained from the national ovarian cancer charity Ovarian Cancer Action:

http://www.ovarian.org.uk/