March is Ovarian Cancer Awareness Month in the UK. Dr Suzanne Brunt, Medical Writer at Porterhouse Medical Group, shares why she is so passionate about improving awareness of the symptoms of the disease.
‘Seven years ago, my mum died at the age of 63 from ovarian cancer, only three years after she was diagnosed. Unfortunately, neither of us recognised that her persistent abdominal bloating in the months prior to her eventual diagnosis was a red flag for ovarian cancer. Along with her GP, we all assumed it was irritable bowel syndrome (IBS). When she finally had a CT scan, she was diagnosed with Stage 3 ovarian cancer meaning it had already spread from her pelvis into her abdomen.’
Ovarian cancer is the biggest gynaecological cause of cancer death in women in the UK and the fourth most common cause of cancer death overall in women, ranking after breast, lung and bowel cancer .
UK ovarian cancer statistics [1-3]
- 7,400 cases of ovarian cancer are diagnosed annually – the equivalent of 20 each day 
- 75% of women are diagnosed after the cancer has already spread, making treatment more difficult 
- 41% of patients with ovarian cancer visited their GP three or more times before being referred for diagnostic testing 
- Research has shown that just 4% of women in the UK are very confident about recognising the symptoms of ovarian cancer 
- 46% of women survive for 5 years after diagnosis, but with earlier diagnosis this figure has the potential to increase to 90% [1,4]
Common symptoms of ovarian cancer 
- Persistent abdominal bloating
- Pain or discomfort in the stomach and/or pelvic area
- Feeling full quickly when eating
- Needing to urinate frequently or more urgently
Factors affecting risk of developing ovarian cancer 
Most (80%–85%) cases of ovarian cancer are sporadic, meaning that they are not caused by inheriting a particular genetic mutation (e.g. in BRCA) that confers a predisposition to developing cancer. Although this means that 15%–20% of cases are believed to have a genetic basis, other factors are also known to affect the risk of developing the disease.
- Hormone replacement therapy
- The contraceptive pill
- Pregnancy and breastfeeding
- Hysterectomy and sterilisation
When symptoms are unlikely to be IBS 
- A new presentation of IBS over the age of 50 (when ovarian cancer commonly presents) is veryrare
- The symptoms of ovarian cancer are more frequent and persistent than in IBS
The evolving treatment landscape
Typically, ovarian cancer is treated with ‘debulking’ surgery; this involves removing as much of the tumour as possible, which can then be staged and graded. Platinum-based chemotherapy is often used to target the remaining cancer cells. In 70% of high-grade ovarian cancer cases the disease will return, often leading to more rounds of debilitating chemotherapy [1, 8].
Recently, the focus of research has been on cancer drugs with targeted activity, such as the ability to inhibit cancer cell growth factors or the blood supply to the tumour . Cell repair inhibitors are another example of targeted cancer therapy; these inhibit proteins that are involved in repairing cancer cells. One such protein, which is found in all human cells, is poly(ADP-ribose) polymerase (PARP) .
PARP helps repair cell DNA, including cancer cell DNA, when it becomes damaged. By inhibiting this repair process in cancer cells, PARP inhibitors result in cancer cell death. Drugs in this class were approved by the European Medicines Agency (EMA) in 2014 for use in BRCA-positive women with platinum-sensitive disease who have already been treated with several rounds of chemotherapy .
After more research was conducted into the beneficial effects of the use of PARP inhibitors earlier in the treatment pathway, the EMA granted approval in 2018 for the use of maintenance treatment with PARP inhibitors in women with BRCA-positive tumours from their first round of treatment . This was closely followed by similar approval by the National Institute for Health and Care Excellence (NICE) in 2019 .
Most recently, it has been shown for the first time that giving PARP inhibitors considerably lengthens progression-free survival compared with placebo (in newly diagnosed women with Stage III or IV ovarian cancer who have responded to platinum-based chemotherapy) . PARP inhibitors are considered by some to have the future potential to cure ovarian cancer if given before the first recurrence of the disease .
PARP inhibitors represent a long overdue improvement in the therapy options available for ovarian cancer. These drugs, along with ongoing research to investigate other treatment possibilities, provide tangible hope for many women diagnosed with ovarian cancer of a longer future that is free of disease progression .
Awareness remains key
The recent game-changing developments in treatment options are, without doubt, hugely significant in the fight against ovarian cancer, but the fact remains that the earlier symptoms are recognised, the longer women are likely to survive.
So, during Ovarian Cancer Awareness Month 2020, please share this story and the four key warning signs that could help save or lengthen your life or the life of a loved one .
- Ovarian Cancer Awareness Month. Facts and figures. Available at: http://ocam.org.uk/ovarian-cancer-facts-and-figures/. Accessed March 2020.
- Ovarian cancer statistics. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/ovarian-cancer#heading-Zero. Accessed March 2020.
- Ovarian cancer in elderly women. Standard management of ovarian cancer. Available at: https://www.cancernetwork.com/. Accessed March 2020.
- Ovarian cancer: the statistics. Available at: https://ovarian.org.uk/ovarian-cancer/ovarian-cancer-statistics. Accessed March 2020.
- National Health Service. Symptoms: Ovarian cancer. Available at: https://www.nhs.uk/conditions/ovarian-cancer/symptoms/. Accessed March 2020.
- Target Ovarian Cancer. Risk and protection factors of ovarian cancer. Available at: https://www.targetovariancancer.org.uk/information-and-support/what-ovarian-cancer/risk-and-protection-factors-ovarian-cancer. Accessed March 2020.
- Is it ovarian cancer or IBS? Available at: https://www.everydayhealth.com/ovarian-cancer/is-it-ovarian-cancer-or-ibs.aspx. Accessed March 2020.
- Target Ovarian Cancer. Treatment: Surgery, chemotherapy, other drugs. Available at: https://www.targetovariancancer.org.uk/information-and-support/i-have-just-been-diagnosed-ovarian-cancer/treatment/treatment-surgery. Accessed March 2020.
- Targeted cancer drug types. Available at: https://cancerresearchuk.org/about-cancer. Accessed March 2020.
- European Medicines Agency. Available at: www.ema.europa.eu/en/medicines/human/EPAR/lynparza. Accessed March 2020
- NICE pathway for ovarian cancer. Available at: https://pathways.nice.org.uk/pathways/ovarian-cancer/managing-advanced-stage-ii-iv-ovarian-cancer#content=view-node%3Anodes-maintenance-treatment-after-second-line-and-subsequent-chemotherapy. Accessed March 2020.
- González-Martín A, Pothuri B, Vergote I et al. Niraparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2019; 381 (25): 2391–2402.
- National Institute for Health and Care Excellence. Innovative treatment for gynaecological cancers approved for Cancer Drugs Fund. Available at: https://www.nice.org.uk/news/article/innovative-treatment-for-gynaecological-cancers-approved-for-cancer-drugs-fund. Accessed March 2020.
- New research to create better ovarian cancer treatments. Available at: https://ovarian.org.uk/news-and-blog/news/900000-invested-in-new-research-to-create-better-ovarian-cancer-treatments/ Accessed March 2020.