“Look. I’d had a lovely supper, and all I said to my wife was ‘That piece of halibut was good enough for Jehovah.”
“Blasphemy! He’s said it again!” 
It’s funny how some words are taboo or verboten; there may be cultural, societal, or even personal reasons why certain words are not bandied about. Few people describe their intimate body parts with clinical language – any number of nicknames and descriptions have been assigned to them. However, being embarrassed about saying a word may kill you.
According to a recent survey by Ovarian Cancer Action (OCA) ;
‘Young women are avoiding seeking help for gynaecological issues out of embarrassment and fear of intimate examination, with more than half turning to Google instead’
OCA’s survey also shows that British women aged 18-24 are four times less likely to go to a doctor with a sexual health issue than their 55-64 year old counterparts. Reasons include:
- Being scared of being intimately examined (48%)
- Being embarrassed to talk about sexual health issues (44%)
- Not knowing what words to use (26%)/ embarrassment about use of words – 66% said they’d be embarrassed to say the word ‘vagina’
Instead of seeking medical help, 57% say they would turn to Google, 17% to their mothers. A further one in six has cancelled appointments due to embarrassment.
This is unfortunate: in the UK, ovarian cancer is the leading cause of death from gynaecological cancer, the fifth most common cancer in women, and has a lifetime risk of about 2% in England and Wales . The outcome for women with ovarian cancer is generally poor, with an overall 5-year survival rate of less than 35% .
What is Ovarian Cancer?
There are three broad types of ovarian tumours, classified according to where in they originated .
- Epithelial ovarian tumours account for 85-90% of all ovarian tumours. Most are malignant and tend to affect women over the age of 50. Sub-types include serous, endometrioid, clear cell, mucinous, transitional cell and undifferentiated
- Germ cell tumours originate in egg-cells within the ovary. They account for 5-10% of ovarian tumours and tend to occur in women in their 20s. Most are non-cancerous; 90% of cases can be successfully treated
- Sex cord stromal tumours begin in the connective cells that hold the ovaries together. Most of these tumours are either benign or very slow growing, and account for 5% of all ovarian tumours
As well as being classified by type and sub-type, ovarian cancers are also staged (Box 1).
The three main risk factors are:
- Age – over 80% of cases occur in women aged over 50 
- Family history – women with a first-degree relative with ovarian cancer have 3-4 times the risk of developing the disease; presence of BRCA1 and BRCA 2 genes increases susceptibility 
- Lifestyle – an estimated that 21% of ovarian cancer can be attributable to lifestyle 
Other risk factors include being obese, not having children, having endometriosis and use of hormone replacement therapy 
Symptoms of Ovarian Cancer
The National Institute for Clinical and care Excellence suggest that in primary care, tests for ovarian cancer are undertaken if a woman (especially if 50 or over) reports any of the following symptoms on a persistent or frequent basis (more than 12 times per month) :
- persistent abdominal distension (women often refer to this as ‘bloating’)
- feeling full (early satiety) and/or loss of appetite
- pelvic or abdominal pain
- increased urinary urgency and/or frequency
- or who has experienced symptoms within the last 12 months that suggest irritable bowel syndrome (IBS) – IBS rarely presents for the first time in women of this age.
Initial tests include [3, 7]:
- Serum CA125 in primary care in women with symptoms that suggest ovarian cancer
- If 35 IU/ml or greater, arrange ultrasound scan of the abdomen and pelvis
- If normal (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound:
- assess carefully for other clinical causes of her symptoms and investigate if appropriate
- if no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent
For most women, treatment will involve surgery followed by chemotherapy although those with advanced disease may begin with chemotherapy followed by surgery and another course of chemotherapy .
Surgery for early stage ovarian cancer usually involves oophorectomy and salpingectomy. The two most common treatments for epithelial ovarian cancer at first presentation are Paclitaxel with carboplatin; or single agent carboplatin. Germ cell ovarian cancer is most commonly treated with a combination of the drugs bleomcyin, etoposide and cisplatin (referred to as BEP). Sex-cord stromal ovarian tumours are not usually treated with chemotherapy .
Seventy percent of ovarian cancer patients will experience recurrence. This can be:
- Local – recurs in the same location
- Regional – recurs near original location
- Distant – in organs or tissue elsewhere
Treating recurrent ovarian cancer is challenging; options can be limited, particularly if recurrence is due to chemotherapy resistance.
Addressing these issues is a challenge and a key part of this is ensuring that ovarian cancer is diagnosed as early as possible to improve survival rates and lessen the impact of advanced disease.
A plethora of organisations exist to provide education, advice and support to health care professionals as well as patients.
Thanks to Ovarian Cancer Action for their input into this article.
If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.
- Monty Python. Monty Python’s ‘Life of Brian’ Script Part 1. 1979. MontyPython.net. http://www.montypython.net/brianmm1.php Accessed August 2015
- Ovarian Cancer Action. Young women too self-conscious to seek medical help. Press release. 17th August 2015. http://ovarian.org.uk/news-and-campaigning/article/young-women-too-self-conscious-to-seek-medical-help/ Accessed August 2015
- National Institute for Health and care Excellence. Ovarian cancer: The recognition and initial management of ovarian cancer. NICE guidelines [CG122]. 2011. http://www.nice.org.uk/guidance/CG122/chapter/introduction Accessed August 2015.
- Ovarian Cancer Action. Ovarian cancer: what you need to know. PCNR. Issue 7. https://pcnr.co.uk/articles/207/ovarian-cancer-what-you-need-to-know
- Harding M. Ovarian Cancer. Patient. 2015. http://patient.info/doctor/ovarian-cancer-pro#ref-6 Accessed August 2015
- Parkin DM, Boyd L, Walker LC; 16. The fraction of cancer attributable to lifestyle and environmental factors in Br J Cancer. 2011 6;105 Suppl 2:S77-81. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252065/ Accessed August 2015
- National Institute for Health and care Excellence. Ovarian cancer: detection in primary care. 2012 http://pathways.nice.org.uk/pathways/ovarian-cancer#path=view%3A/pathways/ovarian-cancer/ovarian-cancer-detection-in-primary-care.xml&content=view-index Accessed August 2015