Ovarian Cancer

Overview

What is ovarian cancer?

Ovarian cancer occurs when abnormal cells in your ovaries or fallopian tubes grow and multiply out of control.

Ovaries are part of the female reproductive system. These two round, walnut-sized organs make eggs during your reproductive years.

Who gets ovarian cancer?

Ovarian cancer affects women and people assigned female at birth (AFAB). 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.

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.

Symptoms and Causes

What are the symptoms of ovarian cancer?

Ovarian cancer can develop and spread throughout your abdomen before it causes any symptoms. This can make early detection difficult. Ovarian cancer symptoms may include:

  • 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.

What causes ovarian cancer?

The exact cause of ovarian cancer isn’t yet known. But some people have a slightly higher risk of developing the condition. Ovarian cancer risk factors include:

  • 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’s also an increased risk of developing ovarian cancer as you grow older.

How does ovarian cancer spread?

If ovarian cancer spreads, it usually does so from your pelvis to your lymph nodes, abdomen, intestines, stomach, chest or liver.

Diagnosis and Tests

How is ovarian cancer 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.

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.

They may recommend additional tests, including:

Imaging tests

Providers may use several imaging tests, including:

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.

Surgical evaluation

Providers can diagnose ovarian cancer during surgery. Typically, if they find abnormal growths, they’ll remove them during the same procedure.

Laparoscopy

During laparoscopic surgery, a surgeon places a thin camera (laparoscope) through a small cut (incision) made in your abdomen. Using the scope as a guide, along with additional ports to hold instruments, the surgeon can assess the cancer, perform staging biopsies and, in some circumstances, remove ovarian tumors.

What are the stages of ovarian cancer?

There are four stages of ovarian cancer. In this cancer staging system, the least severe is the lowest number. The more serious the condition, the higher the number.

  • Stage I: This stage is divided into three sub-stages (Stage IA, Stage IB and Stage IC). In the first sub-stage, cancer is only in one ovary or one fallopian tube. Stage IB has cancer in both ovaries or fallopian tubes. In Stage IC, cancer is in both ovaries or fallopian tubes and is found outside of your ovary (on the outside of the organ itself or in the space around the ovary, called the peritoneal cavity).
  • Stage II: Stage II is also divided into a few additional stages. In Stage IIA, the cancer is no longer only in your ovary, but has also spread to your uterus. In Stage IIB, the cancer has spread to other nearby structures in your pelvis.
  • Stage III: This stage includes three sub-stages. In Stage IIIA, the cancer has spread beyond your pelvis to your abdomen (microscopically) or within lymph nodes. The second sub-stage (Stage IIIB), the tumor is up to 2 centimeters in size and has spread beyond your pelvis or within your lymph nodes. In Stage IIIC, the cancer has moved outside of your pelvis area and is larger in size (more than 2 centimeters) or may be within your lymph nodes. At this point, it could impact other organs, like your liver and spleen.
  • Stage IV: Stage IV cancer is the most severe. In this stage, the cancer has spread to the inside of organs such as your liver or spleen. In Stage IVA, it’s found near your lungs, and in Stage IVB, the cancer has spread to the lymph nodes of your groin or into your chest.

Staging is important because it helps your healthcare provider design a tailored treatment plan for you. Your healthcare provider will talk with you about your treatment options.

Management and Treatment

How is ovarian cancer treated?

The goal in treating cancer is to remove as much, if not all, cancer from your body as possible. Common ovarian cancer treatments include:

  • Surgery. This typically involves the removal of your reproductive organs and any organ that has cancer on it. Your surgeon may use laparoscopy (a minimally invasive surgery) or laparotomy (open surgery that requires an abdominal incision).
  • Chemotherapy. Your provider may recommend chemotherapy either before or after surgery. Chemotherapy are drugs designed to target and kill cancerous cells. Your provider may give you chemotherapy intravenously (through a vein) or orally (in pill form).
  • Targeted therapy. This cancer treatment uses drugs to identify and attack cancer cells. Targeted therapy changes the way cancer cells grow and divide.
  • Hormone therapy. Some ovarian cancers use hormones to grow. This type of therapy blocks hormones, slowing or stopping the growth of cancer.
  • Radiation therapy. Providers rarely use radiation therapy for treatment of ovarian cancer.

After you’ve completed ovarian cancer treatment, your healthcare provider will want to see you regularly for observation. You may have routine appointments to check and make sure the cancer hasn’t returned over time. During these appointments, your provider may go through any possible symptoms and do an exam. Be mindful of any symptoms you may be having and tell your provider about them. Sometimes, your provider may order imaging tests, typically a CT scan.

Prevention

Can I prevent ovarian cancer?

There’s no way to prevent ovarian cancer completely. But knowing your biological family history can help you prepare for any heightened risk of developing ovarian cancer.

If you have a genetic mutation such as BRCA mutation, your healthcare provider may recommend risk-reducing surgery to remove your ovaries and tubes before they become cancerous. If you’re not sure if you have a BRCA or another mutation, ask your healthcare provider about genetic testing.

Outlook / Prognosis

What can I expect if I have ovarian cancer?

After you’ve received ovarian cancer treatment, your healthcare provider will still see you for regular appointments. During these visits, they’ll check on any symptoms you may have and discuss any concerns. It’s important to pay close attention to your body and let your provider know if anything unusual is happening. Observation is key after ovarian cancer treatment.

What’s the ovarian cancer survival rate?

The overall five-year survival rate for ovarian cancer is 49%. That means that approximately 49% of people diagnosed with ovarian cancer are alive five years from diagnosis.

It’s important to understand that survival rates are just estimates. They can’t tell you how long you’ll survive or predict the success of your treatment. If you have specific questions about ovarian cancer survival rates, talk with your healthcare provider.

Living With

When should I see my healthcare provider?

If you develop signs of ovarian cancer, such as unusual lumps, pain or bloating in your abdomen, schedule a visit with a healthcare provider.

What questions should I ask my healthcare provider?

If you’ve received an ovarian cancer diagnosis, you may want to ask your healthcare provider questions such as:

  • What’s the location of the tumor?
  • Has the cancer spread? If so, how far?
  • What treatments do you recommend?
  • How long will my treatment take?
  • Will I be able to work during my treatment?
  • Are there ovarian cancer resources available?

A note from Cleveland Clinic

A cancer diagnosis is scary, no matter the type. If you or a loved one has ovarian cancer, you may also feel sad, frustrated or hopeless. Your healthcare provider can help you during this trying time. Ask about resources or support groups (local or online). Getting in touch with others who are going through the same thing can help you process the difficult emotions that often come with a cancer diagnosis.

Last reviewed by a Cleveland Clinic medical professional on 11/14/2022.

References

  • American Cancer Society. Key Statistics for Ovarian Cancer. (https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html#:~:text=Ovarian%20cancer%20ranks%20fifth%20in,is%20about%201%20in%20108.) 11/14/2022.
  • Centers for Disease Control and Prevention. Basic Information About Ovarian Cancer. (https://www.cdc.gov/cancer/ovarian/basic_info/index.htm) Accessed 11/14/2022.
  • National Cancer Institute. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®) — Patient Version. (https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq) Accessed 11/14/2022.
  • The American College of Obstetricians and Gynecologists. Ovarian Cancer. (https://www.acog.org/Patients/FAQs/Ovarian-Cancer?IsMobileSet=false) Accessed 11/14/2022.
  • U.S. Department of Health and Human Services, Office on Women's Health. Ovarian cancer risk factors. (https://www.womenshealth.gov/cancer/ovarian-cancer/ovarian-cancer-risk-factors) Accessed 11/14/2022.
  • U.S. National Library of Medicine, Genetics Home Reference. Ovarian cancer. (https://ghr.nlm.nih.gov/condition/ovarian-cancer#inheritance) Accessed 11/14/2022.

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