Ovarian cancer

Ovarian cancer starts in the ovaries, which are part of the reproductive system. This is in the lower part of your tummy (abdomen), in the area between your hips (pelvis). Your reproductive system is made up of your vagina, and the organs involved in getting pregnant and having a baby. 

Your reproductive system  

Your reproductive system is made up of:  

• the vagina - the passage from the cervix to outside your body  
• the cervix - the opening from the womb to the vagina 
• the womb (uterus) - where a baby grows if you are pregnant 
• the fallopian tubes - which connect your ovaries to the womb  
• the ovaries - which store your eggs and release one every month.  

Facts about ovaries  

You have two ovaries, one on each side of your womb. They are about 4cm long.  

Puberty begins around the age of 11. This is when your body begins to change from a child into an adult. At this time, your ovaries start making hormones called oestrogen and progesterone. These make your breasts grow and your periods start.  

Every month after puberty, your ovaries release an egg. The egg travels down the fallopian tubes to the womb. At the same time, the womb’s lining gets thicker, ready for an egg to be fertilised by a man’s sperm. If this does not happen, the womb’s lining comes out of your vagina as blood (this is called a period).  

When a woman is about 50 years old, her periods stop. This is because her ovaries have run out of eggs, so they stop making hormones. This is called the menopause.  

We do not know what causes germ cell tumours. Research into possible causes is going on all the time.

Germ cells are a normal part of the ovary, but something causes them to change. This makes them grow too quickly and they make a tumour.

• pain or swelling in your tummy (abdomen)
• a feeling of fullness or bloating in your tummy
• irregular periods
• needing to wee more often

If you think you might have some of these symptoms, go and see your GP. They will be able to talk to you about your symptoms and may be able to reassure you. Your GP might not know what is causing your symptoms, or they may think your symptoms could be caused by cancer. If this is the case, they will arrange tests to find out more.

If you think you might have some of these symptoms, go and see your GP. They will be able to talk to you about your symptoms and may be able to reassure you. Your GP might not know what is causing your symptoms, or they may think your symptoms could be caused by cancer. If this is the case, they will arrange tests to find out more. 

These might include: 

• a blood test  
• an ultrasound of the ovaries 
• an internal (vaginal) examination, to check for any lumps or swelling.  

For an internal examination, you lie on your back with your feet drawn up and your knees apart. The doctor will gently put one or two fingers inside your vagina and press a little on your lower tummy. It should not be painful, but it can feel uncomfortable. It doesn’t take long. 

You may feel embarrassed during this examination. Let your doctor or nurse know so they can support you. Remember they are used to helping people through check-ups like this. If you have questions or worries about having an internal examination, tell the nurse or doctor. They can answer any questions you have and explain ways they can make it easier for you. 

You can have a friend or relative stay with you during the examination. Or you can ask whoever is with you to wait outside the room until it’s over. Do whatever feels right for you.  

After these tests, your GP may arrange for you to see a gynaecologist. This is a doctor who specialises in women’s health.  

At the hospital  

The gynaecologist will do an internal examination to check if there is anything unusual in your ovaries and womb. Your GP may have already done an internal examination.  

More tests  

The gynaecologist will arrange for you to have some more tests. Different tests are used to diagnose germ cell tumours of the ovary:  

Blood tests 
Blood tests check for chemicals in the blood, called tumour markers. Some germ cell tumours produce high levels of these.  

Ultrasound scans 
Ultrasound scans use sound waves to make a picture of your ovaries and the area around them on a computer screen. The person doing the scan will rub some gel on your tummy and gently move a small device over your tummy to produce the picture. You may also have an ultrasound scan done through the vagina (called a transvaginal ultrasound), to get a clearer picture. A small probe about the size of a tampon is gently put inside your vagina. It isn’t painful but it can be a bit uncomfortable. You can have someone with you during the test if you want to.  

CT scans 
CT scans take a series of x-rays, which build up a 3D picture of the area being scanned. It can show up the size and position of a tumour.  

MRI scans 
MRI scans use magnetism to build up a picture of the inside of the area being scanned. It can help doctors tell if a tumour is cancer or not. It also helps to show the size and position of a tumour. 

Laparoscopy 
Laparoscopy is a test that is sometimes done to look inside your tummy at your ovaries. It is done under a general anaesthetic. You can usually go home the same day.  

The surgeon makes 3 or 4 small cuts in the skin in your lower tummy (just above the bikini line). Then they put a thin, flexible tube with a camera on the end (called a laparoscope) through one of the cuts to look at the ovaries.  

Sometimes the surgeon will remove the ovary during the laparoscopy, but they will discuss this with you before you have the surgery. The removed ovary will be looked at under a microscope to find out what type of tumour it is.  

Having tests and waiting for the results can be an anxious time. Talking about how you feel and getting support from family, friends, your doctor or specialist nurse can help.  

Most girls and young women with germ cell tumours of the ovary can be cured. 
Your treatment will depend on the type of germ cell tumour you have and whether it has spread outside the ovaries. Treatments include: 

• surgery  
• chemotherapy
• surgery and chemotherapy  
• radiotherapy.  

Surgery and chemotherapy are the two main types of treatment. Often people have both.  
Before you have treatment, your specialist needs to know the type of germ cell tumour you have and what stage it is. The stage of a cancer describes the size of the tumour and whether it has spread outside the ovary. 

Your specialist will tell you the exact stage of the cancer after surgery. Most germ cell tumours are diagnosed early when they are in one (or sometimes both) ovaries, but have not spread anywhere else in the body. Waiting to hear about the stage of the cancer can be worrying. But this information is important, because it helps your doctors plan the right treatment.  
Another important part of planning treatment is to try to make sure you are still fertile (able to become pregnant) afterwards. Your doctors will think carefully about this when planning your treatment. We have more information about fertility after treatment for ovarian cancer.  

You may have an operation to remove the affected ovary and the fallopian tube. If it is an early germ cell tumour, this may be the only treatment you need. After surgery, you will come back to the clinic for regular checks. If there are any signs of the cancer coming back, it will be treated straight away.  

Having the affected ovary and fallopian tube removed should not stop you from having a baby in the future. You can still get pregnant with only one ovary.  

Before surgery, you will have a general anaesthetic. During the operation, the surgeon will make a cut in the lower tummy (laparotomy). They will remove the ovary through this cut.  

If the cancer has spread, the surgeon may still do an operation to try to remove as much of the tumour as they can. If possible, they will try to leave the other ovary and the womb. You will have chemotherapy after your operation to treat any cancer that the surgeon could not remove.  

The surgeon will only remove both ovaries and the womb if there is no other way of successfully treating the cancer. Unfortunately, this means you will not be able to get pregnant in the future. This can be upsetting news. You may not have thought about having children yet, so it may be difficult to take in. If this happens, there will be lots of support to help you.  

Chemotherapy can be given to:  

• get rid of any cancer cells that were not removed with surgery 
• stop the cancer from coming back after surgery 
• treat cancer that has spread or that has come back after previous treatment.  

If it is an early germ cell tumour, you might not need chemotherapy. 

Your specialist will explain more about this to you. Germ cell tumours are very sensitive to chemotherapy and this treatment cures most of these tumours.  

Germ cell tumours are often treated with the drugs bleomycin, etoposide and cisplatin. When these are given together, it’s called BEP for short. You usually have BEP in the chemotherapy day unit or during a short stay in hospital.  

We have more information about chemotherapy.  

Different chemotherapy drugs cause different side effects. Some people have just a few side effects, and others have more. Some side effects can be controlled with medicine.  

Most side effects are temporary and gradually disappear once treatment stops. The most common side effects are: 

• losing your hair 
• feeling tired 
• feeling sick or being sick  
• being more likely to get an infection.  

Doctors cannot be sure whether you will be able to get pregnant in the future after you have had chemotherapy. They may talk to you about storing your eggs before chemotherapy starts. Stored eggs can be used with fertility treatments if you want to get pregnant. You can read more in our section on fertility.  

You will usually have chemotherapy after your surgery. You might have more surgery after you have finished chemotherapy, if there is still some tumour left behind. If the cancer has spread, you may have chemotherapy before an operation. This can make it easier to remove the cancer by shrinking it. 

Radiotherapy treats cancer by using high-energy x-rays to destroy cancer cells. Some types of germ cell tumour are sensitive to radiotherapy, but it is rarely used.  

Once you have finished your treatment, you will have regular follow-up appointments at the hospital. You will have blood tests and sometimes other scans or x-rays. This is to see if the cancer has come back. It is important to go to these appointments. You could make a note of them in your phone or diary. 

You might find it embarrassing to talk about your body and how the cancer or treatment has affected you. It can feel awkward talking to doctors or family about this. Try not to let this stop you talking about things. It can be helpful to let someone know how you are feeling.  

After treatment support is still available. Your hospital team includes people you can talk to about how you are feeling. Ask your doctor or specialist nurse for advice if you need more support. They understand what you are going through and are there to help.  

You might worry about sex and relationships as soon as you find out you have cancer. Or you may only notice changes to your sex life as you have treatment, or after finishing. We have information about possible physical and emotional effects that cancer can have on your sex life and relationships. 

If you have sex during cancer treatment, it is important to protect yourself and your partner. It is also important to prevent a pregnancy. If you have any questions about this, ask your doctor or nurse for advice. We say more about this in our information about sex and relationships. 

Some cancer treatments can affect your fertility. For women, fertility means being able to get pregnant and have a baby.  

Your doctors will always think carefully about this when planning your treatment. If doctors only need to remove one ovary, the other one will keep releasing eggs. If they need to remove both of your ovaries or your womb, you cannot get pregnant or have a baby naturally. This can be very upsetting, especially as you are already dealing with having cancer. Many hospitals have doctors or counsellors to help and support you.

Our section on fertility gives you more information about preserving fertility and treatments.  
It might also be helpful to talk to other young people who are going through something similar. You could see if your hospital has a support group. 

Having chemotherapy can make your periods become irregular or stop. After chemotherapy, your periods should get back to normal. But this could take a few months.

Remember, this is a side effect of your treatment. This does not mean you are going to be infertile (can’t have children).  

Sometimes, doctors recommend you take tablets during chemo to stop your periods. This is so you do not have any blood loss.  

The menopause happens when the ovaries stop producing hormones. This means a woman’s periods stop and she can no longer have children. It usually happens when women are about 50. Sometimes, cancer treatments make this happen earlier. 

An operation to remove both ovaries will cause the menopause to start straight away. This will happen whatever age you are.  

Radiotherapy to the ovaries will also cause infertility. But this will happen more gradually, over a few months.  

Chemotherapy can also cause the menopause to start earlier than usual. This can be many years after your treatment has finished. It can even happen after your periods have come back. This is because chemotherapy can reduce the number of eggs you have.  

Going into the menopause because of your treatment can be upsetting. Your doctors will explain more about what it means and what they can do to help. They may give you hormones to replace the ones your ovaries are no longer producing. This is called hormone replacement therapy (HRT). Your doctor can tell you more about this. 

An early menopause can be a difficult thing to cope with at a young age. But there is a lot of support available. We have more information about this in the sex and relationships and fertility sections.