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Ovarian Cancer

Cancer of the ovary is the most common gynaecological cancer in the UK; 6,537 women were diagnosed with this disease in 2008. The lifetime risk of developing ovarian cancer is 1.3% - 1.7%. The risk increases with the number of times a woman ovulates in her lifetime and if she has a family history of breast and/or ovarian cancer.

Familial ovarian cancer - genetics

The risk of developing ovarian cancer is increased if a woman inherits a ‘faulty’ gene from either parent. A faulty gene has a ‘mutation’ or change in its structure that may have a significant effect on cell division. It may predispose to abnormal cell division, which can lead to cancer.

The sequence of many genes has now been identified and mutations of two genes, BRCA1 and BRCA2, have been shown to increase the risk of developing cancer of the ovary and breast. Mutations of BRCA1 and BRCA2 may be passed on to offspring of the affected person, resulting in an increased risk of cancer in that family. Often no gene mutation can be identified in an affected family, which is likely to mean that there are other gene mutations yet to be discovered.

Risk assessment

Risk assessment and testing for mutations of BRCA 1 & 2 is performed by clinical geneticists, who are doctors and nurses with training in measuring risk factors for an individual and for the whole family. Important factors include: the exact type of cancer, the number of cancers and the age at which cancer is diagnosed. Currently genetic testing for any individual is only possible if there has been a mutation identified in a family member affected by a relevant cancer.

Management of the at risk patient

Once a risk assessment has been performed, the individual will be advised to consider risk-reducing surgery. There have been large national clinical trials conducted to assess the efficacy of screening tests for women with an increased risk of developing ovarian cancer. The results of the most recently completed trial are awaited, but currently there is no definite evidence that ovarian cancer screening detects ovarian cancer at an early stage so that treatment improves the chance of cure. The only intervention of proven benefit is surgery to remove the ovaries. Given that the menopause is caused by ovarian failure (i.e. the ovaries cease to function) and occurs at the average age of 51 years in the UK, it seems reasonable to offer at risk women this operation around this time of their lives, especially as the peak age of incidence of ovarian cancer is 55-65 years. Oophorectomy is also shown to reduce the risk of breast cancer in pre-menopausal women and can be effective treatment for oestrogen receptor positive breast cancer.

Prophylactic Oophorectomy

It is always more difficult to recommend an operation for a healthy woman and it is important that every patient is aware of possible complications. Every effort will be made to minimise complications and enhance recovery from the procedure. The ovaries can be removed via the vaginal route (transvaginal endoscopic oophorectomy). Pain is significantly less with this procedure than with conventional ‘keyhole’ surgery and the operation may be performed as a day case.