Women's Health Articles

I have endometriosis and that includes backache, irregular bleeding and chronic pain. My GP keeps telling me that the priority is managing the pain and stopping the bleeding but no tests have been done in the past 15 months. I’m worried that I have ovarian cancer. Help!

I would like to reassure you that although endometriosis can be associated with cancer, the probability of this is not high. From what you are describing, however, and because of your concerns, it seems reasonable for you to discuss these concerns directly with your doctor. Your doctor can then recommend appropriate tests or share your concerns with the local gynaecological cancer doctor to see what specific tests (if any) needs to be done to suit your particular case.

My late wife died of ovarian cancer in 2013. For most of her life, she was a very liberal user of Talcum powder and only stopped suddenly some 5/6 years before she died at 70 years of age. I have read that there is a possible connection between the use of this substance and this type of cancer. I would be interested to know if you support this point of view.

You are asking me a very difficult question that I am afraid I do not have a definitive answer to! As you say, there has been a lot of debate about this point. What I can say is that the evidence that we have comes predominantly from epidemiological studies. These are studies that look for associations between certain risk factors and a particular disease on a population scale. Such studies can be very powerful in showing that certain habits should be avoided to decrease the risk of a particular disease. An example of such studies are ones that reported the association between smoking and lung cancer. A review of four large epidemiological studies was published earlier this year in the Journal "JAMA Oncology" that showed there was no significant association between Talc powder use and ovarian cancer. However, the authors also say that it may have not been possible to detect small effects. This NHS website gives some more information about the study.

I have a 3cm ‘vascular structure’ on my right ovary. My CA125 is at 92 and an urgent referral has been put through. What is likely to happen next?

This will very much depend on the characteristics of the structure that was found and any other findings, as well as your symptoms and clinical examination. The advice could range from simply repeating the ultrasound and CA125 again if the structure was a simple ovarian cyst to recommending surgery. I am sorry that I can't be more specific but it is somewhat reassuring that the structure is not very large.

Can you explain to me what these "markers" are and what is their significance? What numbers should they ideally be? I feel very confused about this and didn't ask the oncologist the right questions when I saw her.

In relation to ovarian cancer, the marker that is commonly referred to is called CA125. The normal level of CA125 in the blood is between 0 and 35 IU/L. The idea is that ovarian cancer cells shed this "marker" into the bloodstream. The marker level goes up in the presence of ovarian cancer. However, CA125 can go up because of many other non-cancer causes. Therefore, in the absence of any ovarian tumour, one "high" reading may not be a cause for great concern. A repeat sample showing that it is going up would be more meaningful. Therefore, your doctor may sometimes recommend having the test repeated.

Please note that the interpretation of the CA125 results is very much dependent on the individual case. My answer above is a general overview about CA125. Your oncologist is best positioned to give you specific advice. It is not a problem that you do not feel that you did not ask the "right" questions. It is hard to get all the information you need in one consultation. Perhaps ask again when you meet your oncologist or see your GP to ask more questions.

I’m bloated, have indigestion, constipation, nausea and pain in the lower belly. I’ve had these symptoms every day and night for about a month. Could it be ovarian cancer?

Please note that many such symptoms may not be at all related to ovarian cancer. However, I applaud you for thinking about it as a potential cause and advise you to get in touch with your GP so that tests could be done if needed. If the GP thinks that tests are needed, they are usually done pretty quickly.

My CA125 has not gone down after the first chemo session and I'm very worried that it's not going to respond. I am stage 1c grade 1 and also have a pulmonary embolism. My stomach is also bruised from all the injections. Could this be responsible for it staying up?

I am very sorry to hear about your troubles. CA125 is a very good test for monitoring response to chemotherapy. A reduction of CA125 after the first cycle would have been nice to have, but it is not unusual for such a decline to happen only after two to three cycles. CA125 can be increased by many factors and this is probably why you are wondering whether the injections are preventing the decline. It is difficult to say for sure whether or not the effect of the injections that you are having is interfering with the decline of CA125 level. You have an early stage and early grade tumour which is reassuring in itself. I hope that your treatment will be successful.

My GP referred me to a gynaecologist to see why I’ve started spotting in between periods. My results from an ultrasound, blood test and smear were all normal. I’m still spotting but am now bloated and gaining weight - but my actual period only lasts two days (they normally last for six). Should I go back to my GP?

I am assuming that you had a blood test for ovarian cancer and not "cervical cancer". The test is called CA125. The fact that your tests have been normal is reassuring. However, since you have developed new symptoms, I would advise you to go back to your GP for further evaluation.

My mum had ovarian cancer a few years ago. How likely is it that I’ll get it?

Ovarian cancer can be hereditary but the likelihood of you getting it depends on many factors. One important factor is the number of relatives, particularly from your mother's side, who had ovarian or breast cancer in the past. If no other family members have been affected by ovarian or breast cancer then your chance of getting ovarian cancer is very low. My advice is to discuss your concerns and family history with your GP and see if referral to a geneticist for further discussion would be reasonable.

I had a hysterectomy years ago, but I'm not sure whether my ovaries were taken out or not. If they were, could I still get ovarian cancer?

If the ovaries and fallopian tubes have been removed then the possibility of having ovarian cancer is really very small. Your GP should be able to look up the histopathology report that was performed on the womb to see if the ovaries and tubes have been removed or not.

Many thanks to Professor Ahmed and WOW for taking part in the clinic. You can visit the clinic here.