Ovarian Cancer

Ovarian cancer forms in the tissues of the ovary, one of a pair of female reproductive glands where eggs are made. Some cancers that are grouped with ovarian cancer may begin in the far end of the fallopian tube or in the lining of the pelvis and abdomen, called the peritoneum.

Ovarian cancer can be hard to find early because symptoms may be mild, vague or similar to other common conditions. Learning the possible signs, risk factors and treatment options can help you know when to talk with a healthcare provider.

Types & Stages

Types of ovarian cancer include:

• Epithelial ovarian cancer begins in the cells that cover the outer surface of the ovary. This is the most common type of ovarian cancer. Epithelial ovarian cancers may include serous, mucinous, endometrioid, clear cell, transitional and undifferentiated types.
   
• Malignant germ cell ovarian cancer begins in the egg-producing cells of the ovary. These cancers are less common and are more often diagnosed in younger women. Subtypes may include teratoma, dysgerminoma, endodermal sinus tumor and choriocarcinoma.
   
• Stromal ovarian cancer begins in the connective tissue cells that hold the ovary together and make hormones such as estrogen and progesterone. Subtypes may include granulosa, granulosa-theca and Sertoli-Leydig cell tumors.

Two rare related cancers are often treated in a similar way to epithelial ovarian cancer:

• Primary peritoneal cancer starts in the lining of the pelvis and abdomen. It can look and act much like ovarian cancer, even when the ovaries are not the main site where the cancer began.
   
• Fallopian tube cancer starts in the fallopian tube, often near the ovary. Many cancers once thought to begin in the ovary may actually start in the far end of the fallopian tube.

Ovarian cancer stages describe how far the cancer has spread:

• Stage I means the cancer is found in one or both ovaries or fallopian tubes and has not spread to distant areas.
• Stage II means the cancer has spread to nearby pelvic organs, such as the uterus, bladder or rectum.
• Stage III means the cancer has spread to the lining of the abdomen or nearby lymph nodes.
• Stage IV means the cancer has spread to distant parts of the body, such as the liver, lungs or fluid around the lungs.

Your care team will use the type, stage, tumor grade and your overall health to recommend a treatment plan.

Signs & Symptoms

Visit a doctor if you are experiencing symptoms that are new, unusual for you or last for two weeks or longer.

Symptoms of ovarian cancer may include:

• Bloating
• Pelvic or abdominal pain or pressure
• Feeling full quickly or having trouble eating
• Urinary urgency or needing to urinate more often
• Constipation or other changes in bowel habits
• Abdominal or back pain
• Vaginal bleeding, especially after menopause
• Vaginal discharge that is not normal for you
• Unexplained fatigue
• Unexplained weight loss or weight gain
• Swelling in the abdomen

Many of these symptoms can be caused by conditions that are not cancer. However, it is important to pay attention to your body and talk with a healthcare provider if something does not feel normal.

Diagnosis

Tests and procedures used to diagnose ovarian cancer may include:

• Pelvic exam. During a pelvic exam, your doctor inserts gloved fingers into your vagina while pressing on your abdomen with the other hand to feel your pelvic organs. The doctor may also visually examine your external genital area, vagina and cervix.
   
• Imaging tests. Imaging tests, such as ultrasound or CT scans of the abdomen and pelvis, may help determine the size, shape and structure of the ovaries and nearby organs. A transvaginal ultrasound uses a small probe placed in the vagina to create images of the uterus, fallopian tubes and ovaries.
   
• Blood tests. Blood tests may be used to check your overall health and organ function. Your doctor may also test for tumor markers, such as CA-125, a protein that can be higher in some people with ovarian cancer. CA-125 can support diagnosis and help monitor treatment, but it cannot confirm ovarian cancer by itself.
   
• Additional tumor marker tests. If a germ cell tumor is suspected, your doctor may test for markers such as HCG, AFP or LDH. If a stromal tumor is suspected, hormone levels or markers such as inhibin may be checked.
   
• Surgery or biopsy. Sometimes ovarian cancer cannot be confirmed until surgery is performed to remove an ovary, tumor or tissue sample for testing. A pathologist then examines the tissue under a microscope to determine whether cancer is present and what type it is.
   
• Laparoscopy. Laparoscopy uses a thin, lighted tube with a camera inserted through a small incision in the abdomen. It can help doctors view the ovaries and nearby organs, collect tissue and plan treatment.
   
• Genetic testing. Your doctor may recommend genetic counseling and testing to look for inherited gene changes that can increase ovarian cancer risk, such as BRCA1, BRCA2 or genes linked to Lynch syndrome. This information may help guide treatment and may also be important for family members.

Treatment

Treatment for ovarian cancer depends on the type and stage of cancer, whether it has spread, your overall health and your personal goals. Your care team can help explain the benefits and risks of each option.

Treatment may include:

• Debulking surgery is a procedure used to remove as much visible cancer as possible. This may be done through a laparotomy, which is a surgical incision in the abdominal wall. In many cases, removing as much tumor as safely possible can help other treatments, such as chemotherapy, work better.
   
• Minimally invasive laparoscopy is surgery done through smaller incisions. A small video camera is inserted into the abdominal area through an endoscope, which is a thin device with a light at the end. The surgical team uses the camera to guide the procedure inside the body.
   
• Robotic-assisted surgery is a type of minimally invasive surgery that may be used to biopsy or treat early-stage ovarian cancer and, in some cases, recurrent ovarian cancer. During robotic surgery, the surgeon uses hand and foot controls, and the robotic system precisely follows the surgeon’s movements. The surgical team remains at the bedside and monitors you throughout the procedure.
   
• Removal of the ovaries, fallopian tubes and nearby tissue may be recommended depending on the cancer’s stage and location. Some surgeries may also include removal of the uterus, cervix, omentum, lymph nodes or other areas where cancer has spread.
   
• Chemotherapy uses medicines to kill cancer cells or slow their growth. It may be given before surgery to shrink tumors, after surgery to treat remaining cancer cells or as part of treatment if cancer returns. Chemotherapy may be given through a vein or, in select cases, directly into the abdomen.
   
• Targeted therapy uses medicines that focus on specific features of cancer cells. Some targeted therapies may be used for cancers with BRCA gene changes or other tumor features. Your doctor may order tumor testing to see whether targeted therapy may be an option.
   
• Hormone therapy may be used for some ovarian stromal tumors or certain recurrent cancers. It works by blocking hormones or lowering hormone levels that may help some cancer cells grow.
   
• Immunotherapy may be an option for a small number of ovarian cancers with certain genetic or protein changes. Tumor testing can help determine whether this treatment may be appropriate.
   
• Radiation therapy is not commonly used as the main treatment for ovarian cancer, but it may be used in certain situations to treat symptoms or specific areas of cancer.

Clinical trials may also be available. These research studies test new treatments or new ways to use current treatments. Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

The exact cause of ovarian cancer is not always known. Ovarian cancer begins when cells develop changes in their DNA that cause them to grow and divide in an uncontrolled way.

Factors that may increase ovarian cancer risk include:

• Age. Ovarian cancer can occur at any age, but risk increases as you get older. It is more common after menopause.
   
• Family history. Having a mother, sister, daughter or other close blood relative with ovarian, fallopian tube, primary peritoneal, breast, pancreatic or prostate cancer may increase risk.
   
• Inherited gene changes. Changes in genes such as BRCA1 and BRCA2 can increase ovarian cancer risk. Lynch syndrome and other inherited conditions may also raise risk.
   
• Personal history of cancer. A personal history of breast, colorectal or uterine cancer may be linked with a higher risk of ovarian cancer in some people.
   
• Endometriosis. Endometriosis, a condition in which tissue similar to the lining of the uterus grows outside the uterus, may increase the risk of certain ovarian cancer types.
   
• Reproductive history. People who have never been pregnant or who had a first full-term pregnancy later in life may have a higher risk.
   
• Hormone therapy after menopause. Some forms of hormone therapy used after menopause may increase risk, especially when used for a long time.
   
• Weight. Having obesity may increase the risk of developing ovarian cancer and can affect overall health.

Factors that may lower risk for some people include pregnancy, breastfeeding, use of birth control pills for several years and certain risk-reducing surgeries. These options are not right for everyone, so talk with your healthcare provider about your personal risk and choices.

Screening

There is no recommended routine screening test for ovarian cancer for people at average risk who do not have symptoms.

A Pap test screens for cervical cancer, not ovarian cancer. HPV testing also helps screen for cervical cancer, but it does not screen for ovarian, fallopian tube or primary peritoneal cancer.

Tests that may be used in certain situations include:

• Pelvic exam. A pelvic exam can help your provider check the uterus, ovaries and other pelvic organs, but it often cannot find early ovarian cancer.
   
• Transvaginal ultrasound. This imaging test uses sound waves to look at the ovaries, fallopian tubes and uterus. It may find a mass, but it cannot always tell whether a mass is cancer or a noncancerous cyst.
   
• CA-125 blood test. This test measures a protein that can be higher in some people with ovarian cancer. It is not reliable as a routine screening test because CA-125 can be normal in some ovarian cancers and can be high due to noncancerous conditions.

People at higher risk, such as those with BRCA gene changes, Lynch syndrome or a strong family history, should talk with a healthcare provider or genetic counselor. In some high-risk cases, doctors may discuss closer monitoring, genetic testing or risk-reducing surgery.

If you have symptoms that are new, persistent or unusual for you, do not wait for a screening test. Talk with a healthcare provider about your symptoms and whether further evaluation is needed.

This information is for general education only and is not a substitute for medical advice. Please consult a qualified healthcare provider for diagnosis, treatment recommendations and guidance based on your personal health history.