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Ovarian cancer

Cancer of the ovary affects more than 6,500 women in the UK each year. It is the fifth most common cancer among women.

Cancer of the ovary affects more than 6,500 women in the UK each year. It is the fifth most common cancer among women after breast cancer, bowel cancer, lung cancer and cancer of the uterus (womb).

Ovarian cancer is most common in women who have had the menopause (usually over the age of 50), but it can affect women of any age.

As the symptoms of ovarian cancer can be similar to those of other conditions, it can be difficult to recognise. However, there are early symptoms to look out for, such as persistent bloating, pain in the pelvis and lower stomach, and difficulty eating.

If you experience these symptoms, particularly over a long period of time, it is important to see your GP. Read more about how ovarian cancer is diagnosed.

Types of ovarian cancer

There are several types of ovarian cancer. They include:

  • epithelial ovarian cancer, which affects the surface layers of the ovary and is the most common type 
  • germ cell tumours, which originate in the cells that make the eggs
  • stromal tumours, which develop within the cells that hold the ovaries together

Epithelial ovarian cancer is by far the most common type of ovarian cancer. This information concentrates on epithelial ovarian cancer.

The exact cause of ovarian cancer is unknown, although a number of possible factors are thought to be involved, such as the number of eggs the ovaries release and whether someone in your family has had ovarian cancer in the past. However, only one in 10 cases of ovarian cancer has a genetic link.

Read more about the causes of ovarian cancer.

Treating ovarian cancer 

The best treatment for ovarian cancer depends on several things, such as the stage of your cancer and your general health. Treatment will usually involve a combination of surgery and chemotherapy.

As with most types of cancer, the outlook largely depends on how far the cancer has advanced by the time it is diagnosed and your age at diagnosis. Ninety per cent of women diagnosed with early stage one ovarian cancer will be alive in five years' time (the five-year survival rate).

Read more information about how ovarian cancer is treated.

Being diagnosed with ovarian cancer can affect daily life in many ways. However, there is support available for many aspects of living with ovarian cancer, including emotional, financial and long-term health issues.

Ovarian cancer screening

There are methods of screening for ovarian cancer but, at the moment, they are not yet fully tested. Screening is only available for women who are at high risk of developing the disease due to a strong family history or inheritance of a particular faulty gene. Clinical trials in the UK are currently assessing the effectiveness of screening in high-risk women and in the general population.

A cervical screening test (which used to be called a smear test) cannot detect ovarian cancer.

Read more information about preventing ovarian cancer.

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Ovarian cancer

The symptoms of ovarian cancer can be difficult to recognise, particularly in the early stages of the disease.

The symptoms of ovarian cancer can be difficult to recognise, particularly in early stages of the disease.

This is because they are often the same as symptoms of other less serious conditions, such as irritable bowel syndrome (IBS) or pre-menstrual syndrome (PMS).

However, three main symptoms are more frequent in women diagnosed with ovarian cancer:

  • increased abdominal size and persistent bloating (not bloating that comes and goes)
  • persistent pelvic and abdominal pain
  • difficulty eating and feeling full quickly, or feeling nauseous

Other symptoms, such as back pain and needing to pass urine more urgently and frequently than normal, may be the result of other conditions in the pelvic area. They are probably not ovarian cancer, but may be present in some women with the disease.

If you have any of these symptoms, keep a symptom diary to see how many of these symptoms you have over a longer period. Bear in mind ovarian cancer is rare in women under 40 years old. If you regularly have any of these symptoms, talk to your GP. It's unlikely they are being caused by a serious problem, but it's best to be checked.

If you've already seen your GP and the symptoms continue or get worse, it is important to go back and explain this, as you know your body better than anyone.

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Ovarian cancer

Several possible causes of ovarian cancer have been identified, along with risk factors that may make developing the condition more likely.

Several possible causes of ovarian cancer have been identified, along with risks that may make developing the condition more likely.

Our bodies are made up of billions of tiny cells. Normally, cells grow and multiply in an orderly way. New cells are only made when and where they're needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply out of control.

In ovarian cancer, cells in the ovary start to change and grow abnormally. If the cancer is not identified at an early stage, it can spread to nearby parts of the body, including other parts of the female reproductive system.

Increased risk

Some of these risk factors cannot be changed, but there may be some that can. Although these factors may increase the risk of ovarian cancer, you can still contract the condition even if none of them apply to you.

Family history

If you have two or more close relatives (mother, sister or daughter) who developed ovarian cancer or breast cancer, you may be at higher risk of developing the condition.

If your relatives developed cancer before the age of 50, it may be the result of an inherited faulty gene. Faulty genes linked to ovarian cancer include BRCA1 and BRCA2. They are also known to be linked to the development of breast cancer.

Having relatives with ovarian cancer does not mean you definitely have a faulty gene in the family  the cancer could have happened by chance. About one in 10 ovarian cancers are thought to be caused by a faulty gene.

You may be at high risk of having a faulty gene if you have:

  • One close relative (such as your mother, sister or daughter) diagnosed with ovarian cancer at any age, and at least two close relatives who have breast cancer. Your relatives with breast cancer should be on the same side of your family and have an average age of less than 50 years.
  • One close relative diagnosed with ovarian cancer at any age, and at least one close relative with breast cancer diagnosed under the age of 40. These relatives should come from the same side of your family.

If you are concerned you may be at higher risk of ovarian cancer because of your family history, talk to your GP. If you are at high risk, your GP can refer you to a genetic counselling clinic. It is possible to test for the BRCA1 and BRCA2 genes.

Age

Your risk of ovarian cancer increases with age and most cases of ovarian cancer occur after the menopause. More than eight out of 10 cases of ovarian cancer are in women over the age of 50.

Fertility and egg release

Every time an egg is released into the reproductive system, the surface of the ovary has to break to let it out. As the surface of your ovary is damaged during this process, it needs to be repaired. Every time this happens, there is a greater chance of abnormal cell growth during the repair.

This may be why the risk of ovarian cancer decreases if you take the contraceptive pill, or have multiple pregnancies or periods of breastfeeding, as during this time eggs will not be released. In contrast, some research has shown there is an increased risk of ovarian cancer in women who have infertility treatment (as more eggs may be released because of the treatment). But other studies have found this is not the case.

Hormone replacement therapy (HRT)

Women who take hormone replacement therapy (HRT) have been shown to have a small increased risk of ovarian cancer. However, if HRT is stopped, after five years the risk is reduced to the same level as women who have never taken HRT.

Endometriosis

Endometriosis may increase your risk of ovarian cancer. Endometriosis is a condition where cells that usually line the womb grow elsewhere in the body. These endometrial cells behave as if they were in the womb, so thickening and bleeding that usually happens during menstruation occurs in this other part of the body. But there is no way for this endometrial tissue to leave the body and it becomes trapped, leading to pain, swelling and bleeding in that area.

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Ovarian cancer

If you have any of the symptoms of ovarian cancer, it's important to see your GP as soon as possible.

If you have any symptoms of ovarian cancer, it's important to see your GP as soon as possible.

Your GP will first ask about your symptoms, your general health and whether there is a history of ovarian or breast cancer in your family.

Your GP may also carry out a vaginal or internal examination to investigate your ovaries and womb. They may also take a blood sample or refer you for an ultrasound scan.

If necessary, your GP may then refer you to a specialist (a gynaecologist or gynaecological oncologist) at the hospital.

The specialist may carry out another internal examination. They will ask about your symptoms and general health. They may also do further tests to confirm the diagnosis of ovarian cancer, including a blood test and ultrasound.

Blood test (CA125)

You may have a blood test to look for a chemical called CA125 in the blood. This chemical is produced by some ovarian cancer cells. A very high level of CA125 in the blood may mean you have ovarian cancer.

However, this chemical is not specific to ovarian cancer and may also be raised in many benign conditions, so a raised level of CA125 does not definitely mean you have ovarian cancer.

The National Institute for Health and Care Excellence (NICE) has produced guidance that advises your GP to test for CA125 if you frequently experience: 

  • bloating
  • feeling full quickly
  • loss of appetite 
  • pelvic or abdominal pain 
  • needing to urinate urgently or frequently

Read the full NICE guidance on recognition and treatment of ovarian cancer (PDF, 302kb).

The CA125 test is particularly important if you are 50 or over, or have these symptoms more than 12 times each month.

If you experience unexplained weight loss, fatigue or changes in your bowel habits such as diarrhoea or constipation, your GP may also test for CA125.

If you are 50 or over and have experienced symptoms that could suggest irritable bowel syndrome (IBS) in the last 12 months, such as bloating, abdominal pain or changes in your bowel habits, your GP should test your CA125 level.

A significant proportion of women with early stage ovarian cancers have a normal CA125 level.

If you do have a raised CA125 level, your GP will arrange for you to have an ultrasound scan.

Ultrasound

Ultrasound uses high frequency sound waves to produce an image of your ovaries. You may have an internal ultrasound (known as a transvaginal ultrasound), where the ultrasound probe is inserted into your vagina, or you may have an external ultrasound, where the probe is put next to your stomach. The image produced can show the size and texture of your ovaries, as well as any cysts that may be present.

Further tests

If you've been diagnosed with ovarian cancer, you may have further tests to see how large the cancer is and whether it has spread. This is called staging.

These other tests may include:

  • chest X-ray – this can see if the ovarian cancer has spread to your lungs or caused a build-up of fluid around the lungs (called a pleural effusion).
  • CT scan or MRI scan these imaging techniques are used to look for signs of cancer elsewhere in your chest, abdomen and pelvis.
  • abdominal fluid aspiration – if there is a build-up of fluid in your abdomen and it looks swollen, it could mean your ovarian cancer has spread. To find out, a thin needle is passed into your abdomen to take a sample of fluid to be tested for cancer cells. 
  • laparoscopy this small operation may be performed if the gynaecologist wants to take a better look at the ovaries. A thin tube with a camera on the end (a laparoscope) is inserted through a small cut in your lower abdomen (stomach) in order to examine your ovaries. A small sample of tissue may be taken from your ovaries for testing (this is known as a biopsy).

Staging helps your doctors decide on the best kind of treatment for your condition. However, it is important to remember that the stage of your ovarian cancer alone cannot predict how your condition will progress.

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Stages and grades of ovarian cancer

Staging

When your ovarian cancer is diagnosed, the doctors will give it a stage. This is often based on surgical findings. The stage describes the size of the cancer and how far it has spread. Ovarian cancer has four commonly used stages:

  • stage 1 – the cancer only affects one or both of the ovaries
  • stage 2 – the cancer has spread from the ovary and into the pelvis or uterus
  • stage 3 – the cancer has spread to the lining of the abdomen, the surface of the bowel and the lymph nodes in the pelvis
  • stage 4 – the cancer has spread to other parts of the body such as the liver, spleen or lungs 

This is a simplified guide – each stage is divided into further categories called A, B and C. If you're not sure what stage you have, ask your doctor.

Grading

The grade of cancer refers to the appearance of cells under a microscope.

  • low grade – although abnormal, cells appear to be slow-growing
  • moderate grade – cells look more abnormal than low-grade cells
  • high grade – cells look very abnormal and are likely to be fast-growing

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Ovarian cancer

People with cancer should be cared for by a team of specialists who work together to provide the best treatment and care. This is called a multidisciplinary team.

Surgery

The majority of women who have ovarian cancer will be considered for surgery. Sometimes, it is not possible to confirm the stage of the cancer until the surgery.

Your doctor will discuss with you what will happen during the surgery. The surgery will probably involve removing:

  • both ovaries and the fallopian tubes (called a bilateral salpingo-oophorectomy)
  • the uterus (called a total abdominal hysterectomy)
  • the omentum, a fatty layer of tissue within the abdomen (called an omentectomy)

The surgeon may also remove the lymph nodes from the pelvis and abdomen. They may also take samples of nearby tissue and send it to the laboratory to see if the cancer has spread.

If the cancer has spread, the surgeon will try to remove as much of it as possible. This is known as debulking surgery.

If the cancer is confined to one or both ovaries, you may only need to have the ovary or ovaries removed, leaving your uterus (womb) intact. This means you may still be able to carry a pregnancy. For most women, however, pregnancy is not an issue and the normal procedure is to remove both ovaries and the uterus.

You will probably be ready to go home three to seven days after your operation, but it can take many weeks to fully recover. After your operation you will be encouraged to start moving about as soon as possible. This is very important. Even if you have to stay in bed you must keep doing regular leg movements to help your circulation and prevent blood clots. A physiotherapist will show you exercises to help prevent complications.

When you go home, you will need to exercise gently to build up your strength and fitness. Walking and swimming are good exercises that are suitable for most people after treatment for ovarian cancer. Discuss with your doctor or physiotherapist which types of exercise would be suitable for you.

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Chemotherapy

Chemotherapy involves using anti-cancer (cytotoxic) drugs to kill cancer cells. It is often given after surgery for ovarian cancer. In some cases, it can be given before surgery as it may help shrink the tumour and make it easier to remove. This is called neoadjuvant chemotherapy.

Several different drugs can be used in chemotherapy. Often, a combination is given. The choice of drug and how and when it is given depends on the stage of your cancer and how much it has spread. The most common treatment for ovarian cancer is a platinum-containing drug (carboplatin), which is used alone or in combination with another drug, paclitaxel.

Chemotherapy is usually given as a drip into the vein, but is sometimes given as tablets. Some studies have looked at giving chemotherapy directly into the abdomen, called intraperitoneal chemotherapy. This is not established routine practice in the UK at the moment, but it is being assessed in clinical trials.

Most often, you will have chemotherapy as an outpatient, but sometimes you may need a short stay in hospital. It is usually given in cycles, with a period of treatment followed by a period of rest to allow the body to recover. Most women have six cycles of chemotherapy.

How will I know if the chemotherapy is working?

Over the course of your chemotherapy, you will have tests to monitor how the ovarian cancer is responding to treatment. This can be done in a number of ways.

  • if you had higher than normal levels of the cancer chemical CA125 in your blood when diagnosed, you may have blood tests to see whether the levels are falling
  • if you had a tumour visible on a CT or ultrasound scan when diagnosed, you may have repeated scans to see whether it has shrunk
  • you may have another small operation, known as 'second-look surgery', which is carried out in the same way as a laparoscopy

If, after your chemotherapy treatment, all of your tests are clear of cancer, you will be in remission. This means the cancer is under control.

Side effects of chemotherapy

The main side effects of chemotherapy are caused by its influence on normal, healthy cells, such as immune cells. Side effects include:

  • infections
  • loss of appetite
  • nausea and vomiting
  • tiredness
  • hair loss
  • sore mouth

Many side effects can be prevented or controlled with medicines your doctor can prescribe.

Chemotherapy for cancer that has come back

Ovarian cancer can come back (relapse) after treatment. If this happens, you may have another course of chemotherapy. This may be the same drugs again or a different combination of chemotherapy drugs. This is called second-line treatment. The choice of drugs will take into account which drugs were used in previous treatments, and the side effects and benefits of the drugs. Your doctor will discuss this with you.

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Radiotherapy

Radiotherapy uses high energy X-rays. Like chemotherapy, it works by targeting rapidly growing cancer cells. Radiotherapy is not often used to treat ovarian cancer. But occasionally, the multidisciplinary team may recommend it for ovarian cancer treatment under very specific circumstances, such as treating pain and bleeding from a localised tumour mass.

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Clinical trials

A great deal of progress has been made in ovarian cancer treatment. More women are living longer and having fewer side effects. These advances were discovered through clinical trials where new drugs and combinations of drugs are compared with standard treatment.

All cancer trials in this country are subject to careful oversight to ensure the trial is worthwhile and safely conducted. Participants in clinical trials can often do better overall than in routine care.

If you are approached about taking part in a trial, you will be offered an information sheet. If you wish to take part, you will be asked to sign your consent. You are always free to refuse or withdraw from a clinical trial without it affecting your care.

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Psychological help

Dealing with cancer can be a huge challenge for patients and their families. It can bring emotional and practical difficulties.

It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support:

  • Your hospital doctor, specialist nurse or GP can refer you to a counsellor. If you are feeling depressed, talk to your GP. A course of antidepressant drugs may help, or your GP can arrange for you to see a counsellor or psychotherapist.
  • It can help to talk to someone who has been through the same thing as you. Many organisations have helplines and online forums. They can also put you in touch with other people who have had cancer treatment.

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Ovarian cancer

How ovarian cancer will affect your daily life depends on what stage your disease is at and what treatment you are having.

Recovery and follow-up

Recovering from treatment

Many women with ovarian cancer have a hysterectomy. This is a major operation, and takes around six to 12 weeks to recover from. During this time you will have to avoid lifting things (such as children, heavy shopping bags) and doing heavy housework. You will not be able to drive for three to eight weeks after the operation. Most women need four to 12 weeks off work after a hysterectomy. The recovery time will depend on the type of surgery, whether or not postoperative problems develop, and what type of work you will return to.

If your ovaries have been removed and you have not already had the menopause, you will enter menopause after your treatment. You may decide to take hormone replacement therapy (HRT) to control your symptoms. There is no reason why you cannot take HRT after your ovarian cancer treatment. Your GP will help you decide what's best for you.

Some treatments for ovarian cancer, particularly chemotherapy, can make you very tired. You may need a break from your normal activities for a while. Do not be afraid to ask for practical help from family and friends if you need it.

Practical help may also be available from your local authority. Ask your doctor or nurse who to contact.

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Follow-up after treatment

After your treatment has finished you will be invited for regular check-ups, usually every two to three months to begin with. At the check-up your doctor will examine you. They may do blood tests or scans to see how your cancer is responding to treatment.

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Sex and relationships

Relationships with friends and family

Having cancer is not always easy to talk about, either for you or your family and friends. You may sense some people avoid you or feel awkward around you. Being open about how you feel and what your family and friends can do to help may put them at ease. But don't feel shy about telling them you need some time to yourself.

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Your sex life

Ovarian cancer and its treatment can affect your sex life. This can happen in several ways:

  • early menopause – if you have not already been through the menopause, removing the ovaries means you will have an early menopause. You are likely to have symptoms of the menopause, which can include vaginal dryness and loss of sexual desire. 
  • not feeling like sex – it is common for women to lose interest in sex after treatment for ovarian cancer. Your treatment may leave you feeling very tired. You may feel shocked, confused or depressed about being diagnosed with cancer. You may also feel grief about the loss of your fertility. It is understandable you may not feel like having sex while coping with all this. Try to share your feelings with your partner. If your sex problems are not getting better with time, speak to a counsellor or sex therapist.

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Money and benefits

If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you are caring for someone with cancer, you may be entitled to financial support.

  • if you have a job but cannot work because of your illness, you are entitled to statutory sick pay from your employer 
  • if you do not have a job and cannot work because of your illness, you may be entitled to employment and support allowance
  • if you are caring for someone with cancer, you may be entitled to carer's allowance  
  • you may be eligible for other benefits if you have children living at home or have a low household income

It is a good idea to find out early on what help is available to you. You could ask to speak to the social worker at your hospital, who can give you the information you need.

Free prescriptions

Cancer patients are entitled to apply for an exemption certificate. This gives them free prescriptions for all medication, including medication for unrelated conditions.

The certificate is valid for five years. You can apply for it by speaking to your GP or cancer specialist.

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Talk to others

If you have questions, your GP or nurse may be able to reassure you. You may also find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these. Some people find it helpful to talk to others with ovarian cancer, either at a local support group or through an internet chatroom.

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Dealing with dying

If you are told nothing more can be done to treat your ovarian cancer, care will focus on controlling your symptoms and helping you feel as comfortable as possible. This is called palliative care. Palliative care also includes psychological, social and spiritual support for you and your family or carers.

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Ovarian cancer

Currently, there is no reliable screening test for ovarian cancer. However, there are several factors which may help to prevent ovarian cancer.

Currently, there is no reliable screening test for ovarian cancer. However, there are a number of things that may help prevent ovarian cancer.

Stopping ovulation and the contraceptive pill

Each time you ovulate, your ovaries are damaged by an egg breaking through and being released into your reproductive system. The cells that make up the surface of your ovaries divide and multiply rapidly in order to repair the damage caused by the egg. It is this rapid cell growth that can occasionally go wrong and result in ovarian cancer.

Therefore, anything that stops the process of ovulation can help minimise your chances of developing ovarian cancer. Factors that stop ovulation temporarily or altogether include:

Diet and lifestyle

Research into ovarian cancer has found the condition may be linked to being overweight or obese. Losing weight through exercise and having a balanced diet may help lower your risk of ovarian cancer. Aside from this, it is known that regular exercise and a healthy, low-fat diet are extremely beneficial to your overall health, and can help prevent all forms of cancer and heart disease.

Read more information about:

Screening for ovarian cancer

At present, there is no screening method for ovarian cancer reliable enough to be used by all women in the UK. Clinical trials into this are continuing.

Women may be eligible for screening if they are at high risk of developing the disease because of a strong family history or they have inherited a specific abnormal gene.

If you are at high risk, your GP can refer you to your local genetics service or family cancer clinic. You may be screened for ovarian cancer once you are over the age of 35, or once you are five years away from the age at which your youngest relative was diagnosed with the condition. From this point, you will be screened again once a year.

The screening tests for ovarian cancer are the same as those routinely used to diagnose it. The tests are:

  • blood test for higher-than-normal levels of CA125 (a chemical produced by cancer cells)
  • a transvaginal ultrasound, where an ultrasound probe is inserted into your vagina to show the size and texture of your ovaries, as well as any cysts that may be present

The tests are used together to produce results that are as accurate as possible. However, as these screening methods are still in the process of being tested, they cannot guarantee they will identify every case of ovarian cancer.

A cervical screening test (smear test) cannot detect ovarian cancer.

Online personal education and risk assessment (OPERA)

If you are concerned about your risk of developing inherited ovarian cancer, you can use Macmillan's online interactive assessment tool, OPERA.

It is designed to be used by patients and health professionals to assess a person's risk of developing the condition based on their family history of breast cancer and ovarian cancer. This is because the genes mainly responsible for ovarian cancer are also linked to breast cancer.

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Ovarian cancer

My problems started in 2003. I’d been having a difficult year, as both my father and brother died within three months of each other.

"My problems started in 2003. I'd been having a difficult year, as both my father and brother died within three months of each other. I noticed my abdomen was expanding, even though I was eating less. I also had lower back pain and constipation. A lot of these symptoms at that time were attributed to stress because of my bereavement.

"I was initially diagnosed with irritable bowel syndrome. I had a colonoscopy, which was negative, then an ultrasound scan, which showed I had a large mass in my abdomen. My diagnosis was a complete shock.

"I had surgery to remove the mass, and all my 'female bits' removed. But unfortunately the cancer had spread to my spleen and I had to have that removed as well. It was a big operation and I'm now on antibiotics for the rest of my life.

"I had six sessions of chemotherapy after surgery, which was quite aggressive. I was warned there would be possibly long-term side effects. I lost the feeling in my toes and my fingers. The feeling in my fingers has come back now, but my toes are still fairly numb.

"Apart from the sense of loss I had already suffered with my bereavements, there was also the loss of my job, identity, femininity and body image. Financially it's been difficult, as I had to give up my job. I'm only able to go back to a part-time job.

"I feel fortunate that I'm still here after three years. I'm looking ahead, although I don't know what the long-term outlook will be. I try not to be neurotic, but it's easy to worry about anything that's unusual or different. If I have pain that's not normal for me, I always get it checked out.

"It's difficult to give advice. I think everyone's experience is different. Everyone has different ways of coping with things. My way was to try to keep busy, manically busy. I still try to cram as much into every day and week as possible.

"It's difficult to think long term, but it's important to just hold on to the fact that the treatment now is wonderful, the support you'll have is wonderful, and we don't know what's just around the corner.

"Sheer self-determination helped me get over it. In our family we just get on with things. We don't dwell on things and we keep busy. 'Mind over matter' is how I've been brought up and I think that really helped me.

"The most important thing is to try not to be afraid. Don't feel stupid or that you're making a fuss about nothing. I think you know your own body and you know when something's different or unusual, so get it checked out."

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Ovarian cancer

Practice nurse Ruth Payne, 53, was diagnosed with ovarian cancer 11 years ago. She describes her treatment and how she coped with the side effects.

Practice nurse Ruth Payne, 53, was diagnosed with ovarian cancer 11 years ago.

"I went to my GP because I had a number of minor symptoms," says Ruth. "I had irritable bowel-type symptoms and went through a period of being very depressed, which I now think may have been related to the cancer. But I also had bloating, which is why I went to the doctors. I looked seven months pregnant."

Ruth's GP thought she was pregnant. "She put me on the couch, held a sonicaid to my stomach and said, 'There's a very rapid heartbeat'. But then she realised it was my heartbeat."

Ruth was then sent to her local hospital for a scan. "The radiographer took a long time. She'd obviously seen something that wasn't right." The results indicated a 'suspicious lump'. The next morning, the GP referred Ruth to the hospital.

At her first appointment with her consultant, he seemed fairly convinced that it was ovarian cancer. Various tests were organised to help them find out what the problem was. These included blood tests, a CT scan and a kidney function X-ray.

"As a nurse, I knew quite a lot about women's health issues, but I didn't know much about ovarian cancer," says Ruth. "It wasn't talked about much in the study days on women's cancers I attended. I just knew it as the 'silent killer'. By the time I was admitted for surgery, I was so large that I could hardly walk. Whatever it was obviously needed removing. The day before surgery one of the scans suggested there could be a problem with my liver, which meant having a liver scan done just before my operation. Fortunately, the scan revealed no problem."

During the surgery, doctors performed a frozen section biopsy to give them some idea of whether Ruth had cancer. This type of biopsy is not always possible and isn't 100% reliable. In Ruth's case, however, results showed that it was cancer. The ovaries were removed and a hysterectomy was performed, and other tissues were sampled to check that the cancer had not spread to other parts of her body.

Ruth says, "The oncologist came to see me several days later. He said that although the cancer was at an early stage, I needed chemotherapy as well because it was an aggressive tumour. He gave me the option of having standard chemotherapy, or participating in a trial of another kind of chemotherapy as well. I decided to go for the standard treatment."

The doctor told Ruth the worst side effect she would feel from the chemotherapy was tiredness. "I don't think 'tired' is quite the word!" she says. "I know it varies from person to person, but some days I felt like I'd been poleaxed. I even found it difficult to walk."

Ruth also cut her hours as a practice nurse as she was concerned about picking up an infection. She had six cycles of chemotherapy, one every three weeks. Her chemotherapy treatment lasted 18 weeks.

After the chemotherapy, Ruth didn't need any more treatment. She is still cancer-free, although she has only just been discharged. It took Ruth a long time to recover fully from the chemotherapy. "I got tired very easily and I was infected by any bug going around. For a long time it was easy to think any ache or pain was the cancer returning, but this gradually got less as time went on."

She advises women diagnosed with ovarian cancer to take things one day at a time. "It's natural to want to know what's going to happen in a year's time. But if you think about all the things that might happen, you can't cope. Make the most of your friends. If they offer help, give them specific things to do, like taking you to hospital, cooking meals when you might be feeling sick, collecting the children from school, and just being there if you need to talk.

"Don't be surprised if you don't feel on top of the world when you get to the end of treatment: it can often feel like an anti-climax. After all the medical attention you have received, you might feel very vulnerable without all the checks you've had at the hospital. Sometimes it is at this stage that the enormity of all that has happened suddenly hits you.

"You might find it helpful to speak to others who have been in a similar position. Ask if there are any support groups, but this might not be for everyone. Be careful about searching on the internet as there can be a lot of information, which can be quite overwhelming and a bit scary. It sometimes helps if you can get a friend to look for you. Some information may be out-of-date and it won't all apply to you."

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