Events

Join our ovarian cancer web chat on Tuesday 29 March at noon

Join us on Tuesday 29 March 2016 between 12.00 and 13.00 for a live web chat to mark ovarian cancer awareness month.

This is your chance to speak to Cathy Hughes, consultant nurse in gynaecology/oncology, about any ovarian cancer-related questions, including recognising signs and symptoms, what to do if you are concerned you may have ovarian cancer and current treatments.

Everyone, including patients, the public, GPs and other health workers are invited to submit questions. All questions can be submitted anonymously.

You can submit your question here from 11.30 on Tuesday 29 March. You're also welcome to email questions to web@imperial.nhs.uk or tweet your questions to @ImperialNHS.

You can also follow the chat through twitter by following our twitter handle @ImperialNHS.

Comment From Guest 
How does it affect fertility?
 
Cathy Hughes: 
Most women diagnosed with ovarian cancer are post-menopausal, where fertility is not an issue. 

In very early stage disease, it can be possible to spare fertility. Unfortunately, most ovarian cancers are found at a more advanced stage of the disease. 

While every attempt is made to spare fertility, priority will be given to treating the cancer effectively, which will often result in the removal of the uterus and both ovaries. 

However, all women will be given the option to consider any assisted conception technologies that may be available to her on an individual basis. 

There are specific guidelines available for younger women. These are in collaboration with charities including Target Ovarian Cancer (www.targetovariancancer.org.uk) and Ovacome (www.ovacome.org.uk), the Eve Appeal (www.eveappeal.org.uk) and Ovarian Cancer Action (ovarian.org.uk). 

Cathy Hughes: 
In the UK, about 7,300 women are diagnosed with ovarian every year – that works out to about 20 women each day. It is the 15th most common cancer in the UK and sixth most common in women.
 
Cathy Hughes: 
Most ovarian cancers are not linked to an inherited gene mutation. It is thought that around 15 per cent of ovarian cancers are associated with an inherited gene mutation such as the BRCA1 and BRCA2 genes.
 
Comment From Guest 
Who is at risk for it?

Cathy Hughes: 
Age is a factor – older women are more at risk of developing ovarian cancer, as well as people who carry certain genes. Around 15 to 20 per cent of cases of ovarian cancer have a genetic link, so most cases are not linked to the particular inherited genes. Women with Ashkenazi Jewish heritage are also at greater risk of developing ovarian cancer.
 
Cathy Hughes: 
The BRCA1 and BRCA2 genes can increase your risk of developing ovarian cancer. BRCA1 increases the lifetime risk of developing the disease by 40 per cent, while BRCA2 increases the risk by 10 to 15 per cent. 

If you have a strong family history of ovarian cancer, talk to your GP about the possibility of being referred for genetic assessment. 
Macmillan’s Opera Tool is a very helpful resource for people who are concerned about genetic testing. Unfortunately, this tool is currently unavailable, but keep checking this link as the tool will likely be up and running again soon: www.macmillan.org.uk... 

There are some lifestyle risks such as smoking and continuous ovulation that can increase your risk of developing ovarian cancer. Breastfeeding, pregnancy and taking contraceptives that halt ovulation can decrease your risk of developing ovarian cancer. 

Comment From Guest 
How can I minimise my chances of developing it – is there anything I can do?
 
Cathy Hughes: 
Stop smoking if you do smoke – generally to prevent the development of all cancers including ovarian cancer, we recommend people avoid smoking, eat a balanced diet and get enough exercise – 150 minutes of weekly physical activity is recommended by the NHS. That works out to about 30 minutes a day of moderate physical activity and strength exercises. NHS Choices has more information: www.nhs.uk/Livewell...
 
Comment From Guest 
What are the symptoms, when should I worry/see my doctor?
 
Cathy Hughes: 
Above all, it is important to know your body and note any changes. In the case of ovarian cancer, symptoms include persistent bloating, feeling full or loss of appetite, pelvic or abdominal pain, as well as increased urinary urgency and frequency. Unexplained weight loss and unexplained fatigue are potential signs of cancer and should be discussed with your doctor.
 
Cathy Hughes: 
The key is about persistence – if these symptoms persist consistently (more than 12 times a month according to NICE guidelines), you should see your GP. This particularly applies to women over 50, who are more likely to develop ovarian cancer. 

Irritable bowel syndrome (IBS) can present with similar symptoms, but it is rarely diagnosed for the first time in women over 50. If you are experiencing the symptoms above, it is important to discuss them with your doctor, as it is unlikely IBS if you’ve never been diagnosed with this in the past. 

Comment From Guest 
What are the treatment options for ovarian cancer?
 
Cathy Hughes: 
Most women will have a combination of surgery and chemotherapy to treat ovarian cancer. 
 
Comment From Anon 
What are the chances the cancer will recur?
 
Cathy Hughes: 
Thirty-five per cent of women diagnosed with ovarian cancer will survive 10 years or more from diagnosis. However, much depends on the stage of the disease at the time of diagnosis. 

Women with stage 1 ovarian cancer have a much higher chance of being cured from the disease. However, the vast majority of women will be diagnosed at stage 3, when the disease is more advanced. For these women, the cancer may be more controlled than cured, with additional courses of chemotherapy months, even years after initial treatment. 

Comment From Anon 
I've had ovarian cancer, should other women in my family be tested regularly for it?
 
Cathy Hughes: 
The women in your family are not at increased risk of developing ovarian cancer unless there is a genetic link within your family – e.g. if you have a strong family history of ovarian cancer. In that case talk to your GP about the possibility of being referred for genetic assessment. 

Where there is not an identified genetic link (BRCA1 or BRCA2), we currently do not screen for ovarian cancer on the NHS. A large study has recently closed to recruitment that investigates the possibility of using a blood test and ultrasound scan to screen for the disease. It is probably too early to confidently assess the overall benefits and risks of national screening.

Comment From Anon 
How can I keep myself as healthy as possible during treatment?
 
Cathy Hughes: 
It is important to eat as well as you can and although rest is always good to heal the body, we now know that physical exercise is also important for optimising your treatment and even reducing the risk of some cancers coming back. It is more likely that you’ll be encouraged to be as active as is possible. 

This may be as simple as joining a Walking for Health group, or even making sure you get up regularly to make a cup of tea – whatever activity you feel you can handle will be beneficial. 

Cathy Hughes: 
The Walking for Health website may be a helpful resource during and after your treatment: www.walkingforhealth...

Cathy Hughes: 
There are also specific guidelines on symptoms to be concerned about during your treatment and contact numbers you may use should you be concerned. Following your surgery and during your chemotherapy, please contact your clinical nurse specialist or chemotherapy team for more information.
 
Comment From Anon 
What long-term side effects or late effects are possible based on the cancer treatment I received?
 
Cathy Hughes: 
The National Cancer Survivorship Initiative was set up to enable people to live as well as possible for as long as possible following cancer diagnosis. As part of this programme, a significant amount of work was done looking at the consequences of cancer treatment. Many of the side effects can be predicted and prevented. Also, patients should be made aware of what to look for and where to go for help. 

Across England, all cancer centres are trying to improve their survivorship services and offering patients access to the Recovery Package (holistic needs assessment, health and well-being event, treatment summary and cancer care review), which should include recognising long-term effects of cancer treatments. 

At the end of cancer treatment, your GP should also have all the appropriate information and do a cancer care review in the community. The GP should also be made aware of all the side effects and any signs of potential recurrence. 

The most common side effects associated with the treatment for ovarian cancer are around loss of fertility, the menopause and menopausal symptoms, as well as specific side effects associated with the various chemotherapy agents used, such as hair loss and the sensation of pins and needles in fingers and toes. People also find the emotional and financial impact of cancer can be more significant than they anticipated, and patients should be able to access support through their clinical nurse specialist or cancer teams. 

Comment From Anon 
How do you test for ovarian cancer?
 
Cathy Hughes: 
If you present to your GP with the symptoms of ovarian cancer, your GP may carry out a blood test looking for a tumour marker called Ca125, which can be raised in the presence of ovarian cancer. However, it can also be raised in the presence of other conditions. If the Ca125 is raised, your GP may request an ultrasound.

If your GP is concerned about the presence of cancer, you will be referred to a specialist centre under what is called an urgent suspected cancer referral, commonly referred to as the ‘’two-week wait’’ to ensure that you are seen within two weeks. 
 
Comment From Anon 
Perhaps we need a greater drive towards education and prevention (diet, lifestyle etc.) instead of reactive messaging?
 
Cathy Hughes: 
I agree – the key messages around cancer prevention are about maintaining a healthy diet and lifestyle. However, only around 21 per cent of ovarian cancers are thought to be linked to lifestyle, so currently, key messages to improve outcomes for ovarian cancer are around earlier diagnosis. We will hopefully have a better idea in the future as to whether screening is a valuable tool for this disease.
 
Cathy Hughes: 
Dr Hughes is ready to sign off - thanks so much for participating in our chat! If you have any additional questions, please feel free to email them to web@imperial.nhs.uk or tweet them @ImperialNHS and we will pass them along to Dr Hughes. Thanks again!