How to spot the signs of ovarian cancer

Twenty-two years after his first wife, actress Cassandra Harris, died from ovarian cancer, film star Pierce Brosnan has lost his daughter Charlotte to the same disease. The mother-of-two was just 41, two years younger than her mother, whose own mother also died of the disease.

Ovarian cancer is diagnosed annually in nearly a quarter of a million women globally, according to figures from Ovariancancerday.org, and is responsible for 140,000 deaths each year. Although there are sparse statistics on ovarian cancer in the UAE, Dr Mia Branch, obstetrician/gynaecologist at American Hospital Dubai, says that according to her sources, “Ovarian cancer is the fourth most common and the third leading cause of cancer-caused deaths in women in the UAE.”

The disease is known as the ‘silent killer’, because early symptoms can easily be missed or passed off as something minor. “The use of the term ‘silent killer’ is a succinct way of conveying the fact that, when it’s confined to the ovary in its early stages, this cancer doesn’t cause many symptoms, and those that it does cause – like bloating and feeling full – are hard to distinguish from symptoms that women get every day,” says Professor Ian Jacobs, a professor of Women’s Health and Cancer at the University of Manchester in the UK. “The key is when symptoms persist, and there’s no obvious reason, to get them checked by a doctor.”

Professor Jacobs, who is also medical adviser to The Eve Appeal, a UK-registered charity that funds research into gynaecological cancers, says that while more than 80 per cent of women with breast cancer will be alive five years after diagnosis, only 30-40 per cent of those diagnosed with ovarian cancer survive that long. The disease is often seen as hereditary, as two specific genes – BRCA1 and BRCA2 – are known to increase the risk of both ovarian and breast cancer (see ‘Should you get tested for the cancer gene?’, Friday, July 19).

But in the majority of cases, no genetic link is found. For the most common form of ovarian cancer (epithelial – on the surface of the ovary), the BRCA1 or BRCA2 gene mutation is only actually found around 10-13 per cent of the time. Although age is the biggest risk factor – it generally only occurs in older women – most ovarian cancers develop for unknown reasons.

It’s unclear whether Charlotte Brosnan had been tested for the gene mutations, and her mother and grandmother died before such testing was available.

However, BRCA1 or 2 aside, ovarian cancer can still strike repeatedly in families that aren’t carriers. Helen Kay’s mother, Ann, and aunt Christine died within months of each other, Christine first in July 2009 and Ann in March 2010, from ovarian cancer, yet neither were BRCA1 or BRCA2 carriers. Helen, 42, and her sister Lynn, 45, from the UK, felt they could take no chances that an as-yet-undiscovered gene was lurking within them so last year Helen had her ovaries and Fallopian tubes removed, and Lynn had a hysterectomy. “We were told that although we weren’t BRCA1 or 2 carriers, there could still be a genetic link and we might want to have surgery,” explains Helen. “We chose that option so we’ll be around for our children – we saw how our mum and aunt died and didn’t want to go through what they went through.”

The sisters each have two daughters, and Helen says that when the girls grow up, they’ll have to decide if they want to undergo genetic testing – by then, other cancer genes may have been identified. “It’s a shadow that you just can’t get away from, and we’ve still got this nagging doubt that there’s something genetic somewhere,” she says. “It’s too much of a coincidence for two sisters to be diagnosed with it and there not to be a link.”

Helen adds, “If women have the symptoms, get them checked out and be persistent – sometimes it can be an uphill battle because it can be hard to detect.”

It’s a sentiment echoed by Robert Marsh, chief executive of The Eve Appeal, who points out that while ovarian cancer usually strikes women over the age of 50, some are diagnosed in their 30s and, for many, there’ll be no family history. “If there’s any family history, you need to be on heightened awareness of both breast and ovarian cancer, but if you don’t have it in your family it doesn’t mean you’re predominantly in the clear either,” he says.

Marsh admits that symptoms can often be dismissed by doctors as something far less serious. “Doctors don’t see it on a regular basis and probably don’t think symptoms might be cancer. We have a lot of anecdotal evidence from survivors that they’ve really had to battle with their GP to get referred.” He adds that most women aren’t diagnosed until stage three or four (four is the last stage), when the prognosis is not good, whereas 90 per cent of those diagnosed at stage one survive more than five years.

However, there is hope on the horizon. Clinical trials are ongoing across the US and in the UK Professor Jacobs is leading a research team funded by The Eve Appeal and Cancer Research UK to try to find ways of identifying women at risk of ovarian cancer, and of early detection by screening. “The hope is that screening to pick it up earlier will result in fewer women dying from the cancer,” he says.

The first trial will be completed in 2015 and evidence so far suggests ovarian cancer can be picked up in 85-90 per cent of affected women before any symptoms occur, and potentially around two years before signs start appearing. If introduced, screening would target post-menopausal women, plus younger women who have a family history of the disease or a genetic predisposition.

For the time being, awareness of the symptoms and a readiness to raise them with your doctor is the best way forward. “It’s sad when anyone dies of ovarian cancer, but hopefully the death of Pierce Brosnan’s daughter will bring ovarian cancer more attention,” says Helen.

“Women need to be more aware of this disease.”