Ovarian cancer is a serious disease that forms when abnormal cells in the ovaries, fallopian tubes, or nearby tissue begin growing out of control. Because symptoms often don’t appear until the cancer has already spread, early detection remains challenging, making it one of the most difficult gynecologic cancers to catch in time.
Understanding Ovarian Cancer
Ovarian cancer begins in the ovaries, which are two small, almond-shaped organs located on either side of the uterus in the female reproductive system. These organs produce eggs and make hormones like estrogen and progesterone that regulate the menstrual cycle and pregnancy. When cells in or around the ovaries start to multiply uncontrollably, they form a growth called a tumor, which is an abnormal mass of tissue that can invade and damage healthy parts of the body.[1]
This disease doesn’t always start in the ovaries themselves. It can also begin in the fallopian tubes, the slender tubes that carry eggs from the ovaries to the uterus, or in the peritoneum, the tissue lining that covers organs in the abdomen. Because these three types of cancer share similar characteristics and are treated in much the same way, doctors often group them together under the term “ovarian cancer.”[2]
The most common form is called epithelial ovarian cancer, which accounts for more than 95% of all cases. This type develops from the cells that cover the surface of the ovary. There are also rarer forms, including germ cell tumors, which start in the cells that produce eggs, and stromal tumors, which develop in the cells that make hormones.[6]
Who Gets Ovarian Cancer
Ovarian cancer affects women, including some transgender men and non-binary people who were assigned female at birth. It is slightly more common among Native American and white populations compared to those who are Black, Hispanic, or Asian. People of Ashkenazi Jewish descent face a particularly elevated risk because they are much more likely to carry certain inherited gene changes that increase the chance of developing the disease.[3]
This cancer represents about 1% of all new cancer diagnoses in the United States. A woman’s lifetime risk of developing ovarian cancer is approximately 1 in 78. Worldwide, an estimated 300,000 people are diagnosed with ovarian cancer each year, and the disease causes roughly 180,000 deaths. In 2023, about 20,000 people in the United States were diagnosed with ovarian cancer, and around 13,000 died from the disease.[3][14]
Ovarian cancer is the leading cause of death among women diagnosed with gynecologic cancers and ranks as the second most common gynecologic cancer in the United States. Globally, it is the third most common gynecologic cancer. Its high death rate is largely due to the fact that most cases are not found until the disease has already spread beyond the ovaries.[6]
What Causes Ovarian Cancer
The exact cause of ovarian cancer is not yet fully understood. What is known is that the disease happens when there are changes, called mutations, in the genetic material known as DNA. These mutations can cause cells to grow out of control and form tumors. Most ovarian cancers are caused by genetic changes that happen during a person’s lifetime, but some are inherited, meaning they are passed down from parents to their children.[7]
When ovarian cancer is caused by inherited genetic changes, it is called hereditary ovarian cancer. The most well-known inherited mutations are in genes called BRCA1 and BRCA2. Women who test positive for these mutations have a significantly higher risk of developing both breast and ovarian cancer. Specifically, those with BRCA mutations face a 45% to 65% risk of developing breast cancer and a 10% to 20% risk of developing ovarian cancer by age 70.[2][14]
Another inherited condition that raises ovarian cancer risk is Lynch syndrome, a genetic disorder that also increases the likelihood of other cancers, particularly colorectal cancer. These inherited mutations account for a notable portion of ovarian cancer cases, making family history an important factor in assessing risk.[2]
Risk Factors for Ovarian Cancer
Certain factors make some people more likely to develop ovarian cancer than others. Age is one of the most significant risk factors. The disease is more common in people over the age of 60, and risk increases as a person grows older. Most cases are diagnosed after menopause, when the ovaries have stopped releasing eggs.[3]
Family history plays a major role. If a mother, sister, aunt, or grandmother has had ovarian cancer, a person’s own risk increases. This is especially true if multiple family members have been affected or if breast cancer has also occurred in the family. Having inherited mutations in the BRCA1 or BRCA2 genes or carrying Lynch syndrome significantly raises the risk.[3]
Women who have never been pregnant or who had children later in life are at higher risk. Conversely, factors that reduce the number of times a woman ovulates—such as pregnancy, breastfeeding, and use of oral contraceptives—appear to lower the risk. Interestingly, having a tubal ligation, a surgical procedure to close the fallopian tubes, also reduces ovarian cancer risk, though the reasons are not fully understood.[7][19]
Certain medical conditions also increase risk. Women with endometriosis, a condition where tissue similar to the lining of the uterus grows outside it, have a higher chance of developing ovarian cancer. Obesity and being tall are also associated with increased risk. Additionally, women who took hormone replacement therapy, particularly estrogen-only formulations, may have a slightly higher risk.[3]
Symptoms of Ovarian Cancer
One of the most challenging aspects of ovarian cancer is that it often does not cause noticeable symptoms in its early stages. When symptoms do appear, they are frequently vague and can easily be mistaken for less serious digestive or abdominal problems. This lack of clear early warning signs is a major reason why the disease is often not detected until it has already advanced.[1]
When ovarian cancer does cause symptoms, they may include a feeling of bloating or swelling in the abdomen or pelvis. Many women report feeling full very quickly when eating, even after consuming only a small amount of food. Unexplained weight loss, discomfort or pain in the pelvic area, and persistent fatigue are also common.[1]
Changes in bowel habits, such as constipation or diarrhea, may occur. Some women experience a frequent or sudden urge to urinate. Back pain, abnormal vaginal discharge, or bleeding outside of the normal menstrual cycle—or after menopause—can also be warning signs. As the disease progresses, the abdomen may visibly increase in size due to fluid buildup or tumor growth.[3][7]
Because these symptoms can easily be confused with conditions like gas, bloating, irritable bowel syndrome, or urinary tract infections, many people do not realize they might have ovarian cancer. It is important to pay attention to your body and notice what is normal for you. If symptoms persist for more than a few weeks or worsen over time, it is crucial to see a healthcare provider for evaluation.[2]
How Ovarian Cancer is Diagnosed
Despite years of research, there is still no reliable screening test that can detect ovarian cancer early in people without symptoms. This makes diagnosing the disease in its initial stages particularly difficult. If a healthcare provider suspects ovarian cancer based on symptoms or findings during a routine exam, they will recommend further testing.[3]
The diagnostic process usually begins with a detailed medical history and a pelvic exam. During this exam, the doctor inserts gloved fingers into the vagina while pressing down on the abdomen to feel the ovaries and other pelvic organs for any abnormal growths or enlargement.[8]
Imaging tests are often the next step. A pelvic ultrasound uses sound waves to create pictures of the ovaries and surrounding structures. Other imaging tests, such as CT scans (computed tomography), MRI scans (magnetic resonance imaging), and PET scans (positron emission tomography), may be used to determine the size, shape, and spread of any suspicious growths.[3][8]
Blood tests can provide additional clues. One common test measures a substance called CA-125, a protein that is often found at higher levels in the blood of women with ovarian cancer. However, CA-125 levels can also be elevated in non-cancerous conditions, and they can be normal even when cancer is present. For this reason, doctors use CA-125 results in combination with other tests rather than relying on them alone.[8][9]
The only definitive way to diagnose ovarian cancer is through a biopsy, where a sample of tissue is removed and examined under a microscope. In most cases, this is done during surgery. If abnormal growths are found during the operation, they are typically removed and tested at the same time. A procedure called laparoscopy, which uses a thin, lighted tube inserted through a small incision in the abdomen, may also be used to examine the ovaries and collect tissue samples.[3][9]
Genetic testing may also be recommended, especially if there is a family history of ovarian or breast cancer. Testing a blood sample can reveal whether a person carries mutations in the BRCA1 or BRCA2 genes or has Lynch syndrome. This information not only helps doctors understand a person’s risk but also guides treatment decisions and may be useful for family members who might share the same genetic changes.[8]
Treatment of Ovarian Cancer
The main treatments for ovarian cancer are surgery and chemotherapy. In some cases, additional treatments such as targeted therapy, hormone therapy, or radiation therapy may also be used. The specific treatment plan depends on the type and stage of the cancer, the person’s overall health, and their preferences.[1][10]
Surgery is usually the first step. The goal is to remove as much of the cancer as possible. This may involve removing both ovaries, the fallopian tubes, the uterus, and the cervix. If the cancer has spread, surgeons may also need to remove parts of the bowel or other affected tissues. In younger women who wish to preserve fertility, it may sometimes be possible to remove only one ovary, but this depends on the stage and type of cancer.[10][11]
Chemotherapy is often given after surgery to kill any remaining cancer cells. It uses powerful medicines that target and destroy cancer cells throughout the body. Chemotherapy is typically administered through an IV (into a vein) or sometimes directly into the abdomen. The most common regimen combines a platinum-based drug, usually carboplatin, with a taxane-based drug, usually paclitaxel. This combination leads to a complete response in about 80% of patients, meaning no visible signs of disease on imaging scans and normal blood tests.[12][14]
After initial chemotherapy, some patients may be eligible for maintenance therapy. This involves taking medications for a period of time—often about two years—to help keep the cancer from coming back. One class of drugs used for maintenance therapy is called PARP inhibitors. These drugs work particularly well in patients whose tumors carry mutations in the BRCA1 or BRCA2 genes.[10][14]
Targeted therapy uses drugs that specifically attack cancer cells while causing less harm to normal cells. For ovarian cancer, targeted therapies may include drugs that block the growth of blood vessels that feed tumors or drugs that target specific proteins on cancer cells. One example is bevacizumab, a drug that stops tumors from forming new blood vessels.[10][14]
Hormone therapy may be used for certain types of ovarian cancer, particularly stromal tumors that are fueled by estrogen. These treatments work by blocking the production or effects of estrogen to slow or stop cancer growth.[10]
Radiation therapy, which uses high-energy rays to destroy cancer cells, is rarely used for ovarian cancer but may be helpful in specific situations, such as treating areas where the cancer has spread or relieving symptoms.[10][11]
Cancer Recurrence
Ovarian cancer has a high rate of recurrence, meaning it often comes back after initial treatment. More than 80% of patients with advanced ovarian cancer experience recurrence. The cancer may return in the same area or appear elsewhere in the body. Knowing the signs of recurrence and staying vigilant can help patients and their healthcare teams respond quickly.[20]
Symptoms of recurrence may include abdominal pain, swelling, or bloating; changes in bowel movements; fatigue; elevated CA-125 levels in blood tests; pelvic or lower back pain; and urinary problems. Regular follow-up appointments are essential to monitor for recurrence. These typically include physical exams, blood tests to check CA-125 levels, and imaging scans like CT or PET scans.[20]
If ovarian cancer recurs within six months of completing initial treatment, it is usually considered resistant to platinum-based chemotherapy. In these cases, doctors may recommend different chemotherapy drugs or other treatment options. If the cancer returns after six months or more, the same chemotherapy regimen may still be effective.[6]
The possibility of recurrence can cause significant anxiety and worry. Understanding what recurrence means, staying informed about treatment options, and maintaining open communication with the healthcare team are important steps in managing these emotions and making informed decisions about care.[20]
Living with Ovarian Cancer
Life during and after ovarian cancer treatment can be challenging, both physically and emotionally. Treatment often comes with side effects that can affect daily life and overall well-being. Common short-term side effects of chemotherapy include muscle and joint aches, weakness in the legs, peripheral neuropathy (numbness and tingling in the fingers and toes), nausea, vomiting, fatigue, and loss of appetite. Bowel problems such as constipation, diarrhea, or even bowel obstruction (a serious condition where the bowel becomes blocked) are also common.[18]
Some side effects can last for months or even become permanent. For example, peripheral neuropathy can persist long after chemotherapy ends, and it may take up to a year for the bowels and bladder to return to normal function. Fatigue and “chemo brain”—a term used to describe problems with memory and concentration—can also linger.[18]
Taking care of physical health is important during this time. Eating a balanced diet rich in fruits, vegetables, whole grains, and low-fat proteins can help the body heal and rebuild strength. Staying physically active, even with light exercise like walking, can improve mood, reduce stress, and prevent muscle wasting. It is important to talk to a doctor before starting any exercise program to ensure it is safe and appropriate.[21]
Managing stress is equally important. Many women find it helpful to talk to friends, family, or a counselor about their feelings. Joining a support group, either in person or online, can provide a sense of community and connection with others who understand what it’s like to live with ovarian cancer. Organizations like the American Cancer Society and the National Ovarian Cancer Coalition offer resources for finding support groups and other assistance.[21]
Women who have had their ovaries removed as part of treatment will enter menopause if they have not already gone through it. This can cause symptoms like hot flashes, night sweats, mood changes, and vaginal dryness. Hormone replacement therapy can help manage these symptoms and does not increase the risk of cancer recurrence.[19]
For younger women, concerns about fertility may arise. If both ovaries are removed, pregnancy will no longer be possible without the use of assisted reproductive technologies like surrogacy or egg donation. Some women may be able to preserve fertility by freezing eggs or embryos before treatment, but this depends on the stage and urgency of the cancer.[17]
Follow-Up Care
After completing treatment, regular follow-up appointments are essential to monitor for recurrence and manage any long-term side effects. During the first few years after treatment, doctors typically recommend check-ups every two to four months. These visits may include physical exams, blood tests to measure CA-125 levels, and imaging scans to check for signs of cancer returning. After a few years, the frequency of visits may decrease to every three to six months.[23]
It is important to attend all scheduled follow-up appointments, even if you feel well. Early detection of recurrence can improve treatment outcomes. If you notice any new or worsening symptoms between appointments, do not wait—contact your healthcare team right away.[23]
Coping with Advanced or Incurable Cancer
In some cases, ovarian cancer may be advanced at the time of diagnosis or may not respond to treatment. When cancer cannot be cured, the focus shifts to controlling the disease and managing symptoms to maintain the best possible quality of life for as long as possible. This is known as palliative care or symptom management.[16]
Palliative care teams include doctors, nurses, social workers, and other specialists who work together to help patients manage pain, nausea, fatigue, and other symptoms. They also provide emotional support and help patients and their families navigate difficult decisions about care.[11]
Learning that cancer cannot be cured can be devastating. It is normal to feel a wide range of emotions, including fear, anger, sadness, and uncertainty. Talking openly with loved ones, counselors, or support groups can help. Some people find it helpful to focus on what they can control, such as how they spend their time and what brings them comfort and meaning.[16]
Many women with advanced ovarian cancer live for months or even years with treatment that controls the disease and relieves symptoms. The length of time depends on many factors, including the type and stage of cancer, how well treatment works, and overall health. Open and honest conversations with the healthcare team can help set realistic expectations and make informed choices about care.[16]
