Ovarian Cancer

Ovarian cancer is an overgrowth of abnormal cells in the tissue in your ovaries. These cells invade and destroy healthy tissue. It’s difficult to diagnose ovarian cancer because it usually doesn’t cause symptoms until the later stages.

When symptoms appear, they’re often due to fluid buildup in your belly (ascites). This leads to pain and bloating. Ovarian cancer is serious because in two-thirds of cases, the cancer has already spread (metastasized) at diagnosis.

There are three types of ovarian cancer based on the cells affected:

• Epithelial ovarian cancer: Tumors grow from the cells that cover your ovary. It’s the most common type and accounts for about 9 in 10 cases of ovarian cancer. It has several subtypes.
• Germ cell ovarian tumors: Tumors grow from the egg-producing cells. It’s rare, but it most commonly affects children and teens.
• Stromal ovarian cancer: Tumors grow from the connective tissue in your ovary. They often make hormones. It’s the rarest type of ovarian cancer.

Surgery is usually the initial treatment for ovarian cancer, followed by other therapies, like chemotherapy. Specific treatment options vary based on the type.

Symptoms of ovarian cancer

You may have no symptoms of ovarian cancer at first. Once it spreads throughout your abdomen, you may develop symptoms. These changes can mimic other, more common conditions. It’s important to reach out to a healthcare provider if something stands out from how you normally feel.

Ovarian cancer symptoms include:

• Pelvic, back or abdominal pain
• Bloating or distension
• Feeling full soon after eating or losing your appetite
• Fatigue
• Pain during sex
• Abnormal vaginal bleeding
• Diarrhea or constipation
• Peeing more often
• Unexplained weight loss

Ovarian cancer causes

Genetic mutations (changes) cause ovarian cancer. Different types of ovarian cancer are linked to various gene mutations. The most common one is a mutation to tumor protein 53 (TP53).

DNA carries the genes that tell your cells how to function. You have genes that tell cells when to grow, multiply and die. When your DNA mutates, your cells get new instructions. Mutations that lead to cancer tell your cells to grow out of control.

Risk factors

Certain factors may make it more likely for genetic mutations to happen. For example, many ovarian cancer risk factors are linked to long-term estrogen exposure and a high number of ovulation cycles.

Ovarian cancer risk factors include:

• Age: Being over the age of 60
• Genetics: Having inherited BRCA1 and BRCA2 gene mutations (and other rarer mutations) and/or a family history of ovarian, breast, uterine or colorectal cancer
• Medical conditions: Having endometriosis and/or obesity
• Duration of your reproductive years: Getting your period early (before age 12) and/or starting menopause late (after age 50)
• Pregnancy and breastfeeding: Never being pregnant, having your first baby after age 30 and/or never breastfeeding
• Hormone-related medications: Never taking birth control pills and/or taking postmenopausal hormone replacement therapy

Having these risk factors doesn’t guarantee that you’ll get ovarian cancer. But it’s important to talk about them with a healthcare provider.

How doctors diagnose this condition

Ovarian cancer is difficult to diagnose in the early stages. This is because you may have no symptoms or vague symptoms. There’s no screening test for ovarian cancer.

If your healthcare provider suspects ovarian cancer, they’ll recommend the following tests to diagnose it:

• Pelvic exam to check for growths or enlarged organs
• Imaging tests, like pelvic or transvaginal ultrasounds, MRIs, CT scans and PET scans
• Blood tests, like CA-125 and genetic testing
• Surgical biopsies to confirm and stage ovarian cancer

Staging

There are four stages of ovarian cancer, and each stage has substages. The stages include:

• Stage I: The cancer is only in your ovary (one or both) or fallopian tubes.
• Stage II: The cancer is also in nearby structures, like your peritoneum, uterus, bladder, rectum or sigmoid colon.
• Stage III: The cancer has spread outside of your pelvis to lymph nodes in the back of your abdominal cavity and/or your upper abdomen.
• Stage IV: The cancer has spread far away from your pelvis (like your lungs, liver or intestines).

Staging is important because it helps your care team design a tailored treatment plan for you.

How is it treated?

The goal is to remove as much cancer from your body as possible, if not all of it. Your care team will tailor a treatment plan to fit your needs and the cancer type. Common ovarian cancer treatments include:

• Surgery: Removal of your reproductive organs and any organ that has cancer on it is usually the first form of treatment.
• Chemotherapy: This therapy targets and kills cancerous cells. You may get chemotherapy before or after surgery.
• Targeted therapy: This therapy identifies cancer cells and changes the way they grow and divide.
• Hormone therapy: Some ovarian cancers use hormones to grow. This type of therapy blocks hormones, slowing or stopping cancer growth.
• Immunotherapy: Immune checkpoint inhibitors may help treat certain types of advanced ovarian cancer.

Researchers are studying new treatment methods for ovarian cancer. Ask your care team if joining a clinical trial is an option.

When should I see my healthcare provider?

Once you’ve finished treatment, you’ll have routine appointments to make sure the cancer hasn’t returned. Your healthcare provider will go through any possible symptoms and do an exam.

Be mindful of any changes you feel in your body and tell your provider about them. Sometimes, your provider may suggest imaging tests.

What can I expect if I have ovarian cancer?

Ovarian cancer tends to have a poor outlook due to its late-stage diagnoses. But new treatments are in progress through clinical trials. And researchers are working on ways to detect it earlier.

Recovering from cancer treatment and managing its side effects can be hard. But your healthcare team is there to support you. Finding a support group or seeking counseling can also be an important part of your recovery. Know that you aren’t alone. Resources are available to help you.

It’s common for ovarian cancer to come back (recur). This is why it’s crucial to see your healthcare provider regularly after treatment.

Survival rate

Due to the difficulty of detecting ovarian cancer early, it’s the fifth leading cause of cancer death in females. Between 2016 and 2022, the overall five-year survival rate of ovarian cancer was 52% in the U.S. This rate is much higher (92%) if you get a diagnosis in the first stage.

Cancer survival statistics are based on large groups of people. They can’t predict how cancer will affect you. Each case is different. Lean on your care team for support and guidance. They can update you on your health as you go through treatment.