Ovarian Cancer

Ovarian cancer is a disease where abnormal cells in the ovaries grow out of control. It often develops without obvious symptoms in the early stages, making early detection challenging. Understanding the warning signs, risk factors, and treatment options can help you take charge of your health.

What is ovarian cancer?
Where ovarian cancer develops
Types of ovarian cancer
Who gets ovarian cancer
Symptoms and warning signs
Causes and risk factors
How ovarian cancer is diagnosed
Treatment options
Living with ovarian cancer

What is ovarian cancer?

Ovarian cancer is a growth of cells that forms in the ovaries. The cells multiply quickly and can invade and destroy healthy body tissue^[1]. When abnormal cells in your ovaries or fallopian tubes (the tubes that carry eggs from the ovaries to the uterus) grow and multiply out of control, they eventually form a tumor^[3].

Ovarian cancer is a group of diseases that originates in the ovaries, or in the related areas of the fallopian tubes and the peritoneum (the tissue lining that covers the organs in the abdomen)^[2].

Ovaries
Fallopian tubes
Peritoneum

Where ovarian cancer develops

Women have two ovaries that are located in the pelvis, one on each side of the uterus. The ovaries are each about the size of an almond. They produce eggs, called ova, as well as the hormones estrogen and progesterone^[1].

The ovaries make female hormones and produce eggs for reproduction. Women have two fallopian tubes that are a pair of long, slender tubes on each side of the uterus. Eggs pass from the ovaries through the fallopian tubes to the uterus^[2].

Types of ovarian cancer

Ovarian cancers come in a variety of different tumor types and subtypes. The most common tumor type is adenocarcinoma (cancer that begins in cells that line certain organs), and the most common subtype is serous adenocarcinoma. Most serous adenocarcinomas are high-grade, meaning they are aggressively growing tumors^[2].

More than 95% of ovarian cancers are epithelial ovarian cancer, while approximately 5% are other types^[6]. Most ovarian cancers start in the cells covering the ovaries and are called epithelial ovarian cancers. Other rare types include germ cell tumors, stromal tumors and sarcomas^[5].

Epithelial ovarian malignancies are subdivided by type, including high-grade serous, low-grade serous, clear cell, endometrioid, and mucinous ovarian cancer^[6].

Who gets ovarian cancer

Ovarian cancer affects women. It’s slightly more common in Native American and white populations than in people who are Black, Hispanic or Asian. In addition, people of Ashkenazi Jewish descent are much more likely to have a BRCA gene mutation, placing them at a higher risk for breast and ovarian cancer^[3].

Ovarian cancer accounts for 1% of all new cancer cases in the U.S. The lifetime risk of developing ovarian cancer is approximately 1 in 78^[3].

Globally, ovarian cancer is diagnosed in an estimated 300,000 people each year, and causes roughly 180,000 deaths. In 2023, ovarian cancer will be diagnosed in approximately 20,000 people and cause about 13,000 deaths in the United States^[14].

Ovarian cancer is the leading cause of death in women diagnosed with gynecological cancers and the second most common gynecologic malignancy in the United States. Worldwide, ovarian malignancy ranks as the third most common gynecologic cancer^[6].

Symptoms and warning signs

When ovarian cancer first develops, it might not cause any noticeable symptoms. When ovarian cancer symptoms happen, they’re usually attributed to other, more common conditions^[1]. Ovarian cancer often causes symptoms, so it is important to pay attention to your body and know what is normal for you^[2].

Ovarian cancer can develop and spread throughout your abdomen before it causes any symptoms. This can make early detection difficult^[3].

Signs and symptoms of ovarian cancer may include^[1]:

Abdominal bloating or swelling
Quickly feeling full when eating
Weight loss
Discomfort in the pelvic area
Fatigue
Back pain
Changes in bowel habits, such as constipation
A frequent need to urinate

Other symptoms may include^[3]:

Pelvic or abdominal pain, discomfort or bloating
Changes in your eating habits, getting full early and losing your appetite
Vaginal discharge or abnormal bleeding, especially if the bleeding occurs outside of your typical menstrual cycle or after you’ve gone through menopause
Bowel changes, such as diarrhea or constipation
An increase in the size of your abdomen
Peeing more often (frequent urination)

If you develop any of the symptoms listed above, schedule a visit with a healthcare provider^[3].

Causes and risk factors

The exact cause of ovarian cancer isn’t yet known^[3]. Ovarian cancer happens when there are changes (mutations) in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown. Most ovarian cancers are caused by genetic changes that happen during your lifetime. But sometimes these genetic changes are inherited, meaning that you are born with them. Ovarian cancer that is caused by inherited genetic changes is called hereditary ovarian cancer^[7].

Some people have a slightly higher risk of developing the condition. Ovarian cancer risk factors include^[3]:

Being over the age of 60
Obesity
A family history of ovarian cancer (others in your biological family have had the disease) or have inherited a gene mutation (BRCA1 or BRCA2) or Lynch syndrome
Never being pregnant or having children later in life
Endometriosis

There are certain genetic changes that can raise your risk of ovarian cancer, including changes called BRCA1 and BRCA2. These two changes also raise your risk of breast and other cancers^[7]. Some mutations (changes in genes) can raise your risk for ovarian cancer. Mutations in the breast cancer susceptibility genes 1 and 2 (BRCA1 and BRCA2), and those associated with Lynch syndrome, are the most common mutations that raise ovarian cancer risk^[2].

There’s also an increased risk of developing ovarian cancer as you grow older^[3].

How ovarian cancer is diagnosed

Despite years of research, experts haven’t yet developed a successful ovarian cancer screening test. For this reason, the condition is often difficult to diagnose in the early stages^[3].

If your healthcare provider suspects ovarian cancer, they’ll ask about your symptoms and perform a pelvic exam. During the exam, they’ll check for any abnormal growths or enlarged organs^[3].

Tests and procedures used to diagnose ovarian cancer include^[8]:

Pelvic exam: During a pelvic exam, your doctor inserts gloved fingers into your vagina and simultaneously presses a hand on your abdomen in order to feel your pelvic organs. The doctor also visually examines your external genitalia, vagina and cervix.

Imaging tests: Providers may use several imaging tests, including pelvic ultrasound, MRI (magnetic resonance imaging), CT scan (computed tomography), and PET scan (positron emission tomography)^[3].

Blood tests: Blood tests look for a substance called CA-125. High levels of CA-125 in your blood can be a sign of cancer. However, CA-125 levels can be normal, even when cancer is present, and higher in many conditions that aren’t cancer. Because of this, providers use blood tests in combination with other tests to diagnose ovarian cancer^[3]. Blood tests might include organ function tests that can help determine your overall health. Your doctor might also test your blood for tumor markers that indicate ovarian cancer^[8].

Surgical evaluation: Providers can diagnose ovarian cancer during surgery. Typically, if they find abnormal growths, they’ll remove them during the same procedure^[3]. Sometimes your doctor can’t be certain of your diagnosis until you undergo surgery to remove an ovary and have it tested for signs of cancer^[8].

Genetic testing: Your doctor may recommend testing a sample of your blood to look for gene changes that increase the risk of ovarian cancer. Knowing you have an inherited change in your DNA helps your doctor make decisions about your treatment plan. You may wish to share the information with your blood relatives, such as your siblings and your children, since they also may have a risk of having those same gene changes^[8].

Treatment options

Ovarian cancer treatment usually involves surgery and chemotherapy^[1]. If your doctor says that you have ovarian or fallopian tube cancer, ask to be referred to a gynecologic oncologist, which is a doctor who has been trained to treat gynecologic cancers, including ovarian cancer. This doctor will work with you to create a treatment plan^[12].

Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy^[12]:

Surgery: An operation in which doctors cut out the cancer. The type of operation you have depends on your cancer and if it’s spread. If your cancer is in the early stages (has not spread outside of your ovaries), you may have surgery to remove both ovaries and the fallopian tubes, the opening to your womb from your vagina (cervix) and your womb. If the cancer has spread to other parts of your body, you may need more surgery to remove as much of it as possible^[11].

Chemotherapy: Use of special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both. Chemotherapy is medicine that kills cancer cells. It may be given before and after surgery, or it may be used on its own. It may also be used for ovarian cancer that has come back^[11].

Targeted therapy: Use of drugs to block the growth and spread of cancer cells. The drugs can be pills you take or medicines given in your veins. You will get tests to see if targeted therapy is right for your cancer type before this treatment is used^[12]. Targeted therapies are medicines that only target things that help cancer cells to grow or survive. They may be an option for some types of advanced ovarian cancer^[11].

Other treatments may include^[1]:

Radiation therapy: Radiotherapy uses high-energy rays of radiation to kill cancer cells. You may have radiotherapy for ovarian cancer to treat advanced cancer if other treatments are not right for you, or to help with symptoms, such as bleeding, pain or discomfort^[11].

Hormone therapy: Some ovarian cancers need the hormone estrogen to grow. Hormone treatments can block the production of estrogen to stop some cancers from growing. These medicines are rarely used^[11].

Living with ovarian cancer

The time after an ovarian cancer diagnosis, whether during treatment or in remission, can be challenging. It’s natural to feel uncertain about what comes next, but there are steps you can take to bring more brightness to your days. Identifying your strengths, recognizing your needs, and setting small, achievable goals can help you maintain a sense of control^[20].

A diagnosis of ovarian cancer may bring on overwhelming emotions, ranging from fear to confusion to grief. Talking about these emotions and the issues you face, such as body image and sexuality, can be helpful. Your doctor can recommend support groups or counselors to help guide you through this challenging time^[19].

Make healthy choices: Moving your body, maintaining a healthy diet, staying hydrated, and getting rest is important. Work with your doctor to determine what’s appropriate for you^[20]. Cancer treatment is an intensive process, so it is important to take care of your body with proper diet and exercise. Eating well and moving your body will help you regain your energy and strength, rebuild tissue, and feel better overall^[21].

Reach out: You don’t have to go through this experience alone. Develop a support team that can help you along the way by reaching out to professional help (such as a counselor or therapist), family and friends, other people with cancer through online forums, gynecologic cancer events, and ovarian or gynecologic cancer advocacy groups, which can provide emotional support, education for you and your care partner, financial assistance, and connection to other women living with gynecologic cancer^[20].

Follow-up care: You will likely be asked to schedule frequent follow-up visits with your gynecologic oncologist. During these visits, your doctor may ask questions about your general health and recommend further examinations or scans to screen for signs of recurring cancer or treatment side effects. Your specialist will likely recommend follow-up examinations every 2-4 months for the first few years after completing ovarian cancer treatment. After the first few years you will likely be asked to return for follow-up appointments every 3-6 months^[23].

Managing stress: Stress related to a cancer diagnosis and subsequent treatment is a common experience. It is important to find ways to manage your stress so it does not further affect your quality of life. Some women have found that talking to a friend or family member helps to allay some of their stress. In addition, many women have found comfort by joining an ovarian cancer support group and connecting with other women who are facing the same diagnosis^[21].

Understanding recurrence: Ovarian cancer may respond well to initial treatment and go into remission. However, for some individuals, the cancer may return, either in the same area or elsewhere in the body. This is known as recurrence. Recurrence occurs in more than 80% of patients with advanced ovarian cancer, so knowing what to look for may better help you prepare with your healthcare team^[20].

Finding out that you can’t be cured is distressing and can be a shock. It’s common to feel uncertain and anxious. It’s normal to not be able to think about anything else. Lots of information and support is available to you, your family and friends. Some people find it helpful to find out more about their cancer and the treatments they might have^[16].