Ovarian Cancer
Types, Stages, Symptoms, and More
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Ovarian cancer starts in cells on or in an ovary. Early symptoms tend to be mild, allowing it to spread to the fallopian tube or other organs within the pelvic area before it's detected.
Ovarian cancer can develop at any age. But it's most common in postmenopausal women.
This article discusses ovarian cancer's risk factors, symptoms, treatment options, and fertility.
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Types of Ovarian Cancer
The three main types of ovarian cancer are:
Epithelial ovarian carcinoma: This type represents about 90% of ovarian cancers. It starts in cells on the outer surface of the ovary.
Stromal tumors (or sex cord stromal tumors): Making up about 7% of ovarian cancers, these tumors start in cells that produce eggs.
Germ cell tumors: This rare type occurs in women under age 30.
Worldwide, ovarian cancer is the eighth most common cancer in women. New U.S. cases in 2022 were estimated at 19,880. About 1.1% of women will be diagnosed with ovarian cancer during their lifetime.
Ovarian Cancer Symptoms
About 65% of all ovarian cancers are advanced at diagnosis. One key reason is that early symptoms can be unspecific and unrecognized, earning the disease a reputation as a silent killer.
Early Signs
Ovarian cancer doesn't always cause symptoms in the early stages. The symptoms that do occur tend to be rather vague and can easily be attributed to something else. Early signs are likely to be persistent and include:
Having trouble eating or quickly feeling too full
Later Symptoms
Other symptoms of ovarian cancer can include:
Changes in bowel habits (diarrhea or constipation)
After menopause, additional symptoms may include unusual vaginal discharge or vaginal bleeding.
What Causes Ovarian Cancer?
It's not clear exactly what causes a person to develop ovarian cancer. Genetic, environmental, and lifestyle factors may all play a role.
Risk Factors for Ovarian Cancer
The risk of getting ovarian cancer increases with age. It's rare in women under age 40. More than half of all cases occur in women who are 63 or older.
Other ovarian cancer risk factors include:
Having a mother, sister, aunt, or grandmother who has had ovarian cancer
Carrying specific gene mutations, such as BRCA1, BRCA2, or one linked to Lynch syndrome
Having a personal history of breast, uterine, or colorectal cancer
Having endometriosis
Experiencing fertility problems or never having given birth
Having risk factors doesn't mean you'll get ovarian cancer. It's also possible to get ovarian cancer even without apparent risk factors.
How to Diagnose Ovarian Cancer
Coming to a diagnosis is likely to start with your healthcare provider taking your medical history and performing a complete physical examination.
Ultrasound and Imaging Tests
A transvaginal ultrasound uses sound waves to produce images of the abdominal organs, including the ovaries. Other imaging tests that can help detect ovarian cancer are:
Computed tomography (CT scan)
Magnetic resonance imaging (MRI)
Positron-emission tomography (PET scan)
Blood Tests
The cancer antigen 125 (CA-125) blood test checks for epithelial ovarian cancers. A high level of CA-125 can be an indicator of ovarian cancer.
Other blood tests help screen for other types of cancers. Inhibin and HCG screen for certain germ cell tumors (forming in the egg cells of the ovary). CEA and CA19-9 screens for rare subtypes of mucinous ovarian cancers (large fluid-filled cells).
Laparoscopy
Laparoscopy involves a small incision in your lower abdomen. Through this opening, a practitioner can view the ovaries and surrounding area using a thin, lighted tube. The small hysteroscope instrument is used to evaluate and confirm the diagnosis of ovarian cancer.
Can a Pap Smear Detect Ovarian Cancer?
You may get a Pap test and a pelvic exam as you seek a diagnosis. However, a Pap test checks for cervical cancer. It can't detect ovarian cancer.
A pelvic exam is an important part of ovarian cancer screening. A healthcare provider would perform a pelvic exam that includes a bimanual exam (in which two fingers are inserted into the vagina to feel the uterus and ovaries). Sometimes, this is one of the first ways that an ovarian mass is felt.
An ovarian cyst is a sac that forms on or in an ovary, typically filled with fluid. Most ovarian cysts are harmless, and many clear up without treatment. Ovarian cancer, however, has to do with DNA mutations. Cancer can destroy healthy tissue and spread to other body areas without treatment.
Ovarian Cancer Stages
Ovarian cancer is divided into four stages:
Stage 1: This can include cancer in one or both ovaries.
Stage 2: Cancer is found elsewhere in the pelvic region.
Stage 3: Cancer has spread to one or more places in the abdomen.
Stage 4: Cancer is advanced and has spread to distant parts of the body.
Ovarian Cancer Treatment
Ovarian cancer treatment depends on many factors and the stage at diagnosis. It may involve a combination of several types of therapies.
Surgery
The goal of surgery is to remove as much cancer as possible. Types of surgery for ovarian cancer include:
Salpingo-oophorectomy: Removal of one (unilateral) or both (bilateral) ovaries and fallopian tubes
Hysterectomy: Removal of the uterus and cervix
Omentectomy: Removal of tissue that lines the abdominal wall
Lymph node biopsy: Checks if cancer has spread to the lymph nodes
Surgery to remove other organs where cancer has spread, such as the bladder or spleen
Chemotherapy
Chemotherapy can shrink or destroy cancer cells throughout the body. Chemo may be recommended for cancer cells left behind after surgery, for cancer that has spread, or to help prevent a recurrence.
Some chemo drugs are available in pill form, while others require intravenous (IV) administration. Women with ovarian cancer might also have intraperitoneal (IP) chemotherapy, a treatment in which drugs are delivered directly into the abdomen through a thin tube.
Radiation Therapy
Radiation therapy uses X-rays to destroy cancer cells. Treatment for ovarian cancer may involve IP radiation therapy, so the radioactive liquid is placed into the abdomen through a catheter.
Targeted Therapy
Targeted therapies attack specific characteristics of cancer cells. In ovarian cancer, this may include:
Angiogenesis inhibitors: To prevent tumors from forming new blood vessels.
PARP inhibitors: To slow growth in ovarian cancers with BRCA gene mutations. They are generally used to treat people with advanced ovarian cancer, which relapsed after treatment.
NTRK inhibitors: Used for ovarian cancers related to changes in one of the NTRK genes when other treatments don't work when the cancer is advanced.
Hormone Therapy
Hormone therapy is used to block hormones that help cancer grow. It might treat ovarian stromal tumors but rarely is prescribed for epithelial ovarian cancer. Hormone therapy may include:
GnRH agonists
Tamoxifen
Aromatase inhibitors
Ovarian Cancer Treatments and Fertility
Surgery and other ovarian cancer treatments can affect fertility. But there are options for those who want to get pregnant in the future. These options depend on cancer's stage, type, and location. When caught early, options may include:
Fertility-preserving surgery: When cancer only affects one ovary, the other ovary and fallopian tube, as well as the uterus, may be left in place.
Egg or embryo freezing: You can freeze eggs or embryos before treatment.
It's important to discuss fertility concerns with a healthcare provider before you start treatment.
The ovaries play a key role in female fertility. These two small organs are located on either side of the uterus. They are the main producers of hormones such as estrogen and progesterone, holding the lifetime supply of eggs necessary for human reproduction.
Can You Prevent Ovarian Cancer?
There's no way to completely prevent ovarian cancer. Absent symptoms, routine screening is not recommended. Not all risk factors are modifiable, but you may be able to reduce risk by maintaining a healthy weight and meeting with a genetic counselor if you have a family history of ovarian and/or breast cancer.
If you think you may be at high risk for developing ovarian cancer, ask your provider for more information on screening and preventive treatment options.
Outlook for Ovarian Cancer
The overall five-year relative survival rate from 2012 to 2018 was 49.7%, broken down by stage as:
Localized: 93.1%
Regional: 74.2%
Distant: 30.8%
The low five-year survival rate may reflect the delay and difficulty in diagnosing ovarian cancer in the early stages.
These statistics are of women diagnosed more than five years ago and may not reflect the latest treatments. As with all cancers, there are many variables. Your individual outlook depends on factors such as stage at diagnosis, age, and overall health. Your oncologist can give you a better understanding of your own prognosis.
Living With Ovarian Cancer: Support and Resources
Living with ovarian cancer can be challenging in many ways. Your oncology team may be able to point you toward resources in your area. You can search for additional support and resources here:
American Cancer Society Cancer Survivors Network ovarian cancer discussion board
Centers for Disease Control and Prevention (CDC) video, podcast, and print materials
National Ovarian Cancer Coalition local chapters
Ovarian Cancer Foundation patient resources list
Ovarian Cancer Research Alliance (OCRA) Woman to Woman supportive services
