ConditionCancer
Ovarian Cancer
Ovarian cancer is cancer that starts in the ovaries, fallopian tubes or the lining of the abdomen (peritoneum), which doctors now treat as one disease. The most common type, high-grade serous carcinoma, often begins in the fallopian tube. Because early symptoms are vague, most cases are found after the cancer has spread within the abdomen. Treatment is usually surgery to remove as much cancer as possible plus chemotherapy, often followed by maintenance therapy such as PARP inhibitors, which have improved survival.
Also called: Ovarian carcinoma, ovarian malignancy, cancer of the ovary, epithelial ovarian cancer
At a glance
- What it is
- Cancer of the ovary, fallopian tube or peritoneum.
- Most common type
- High-grade serous carcinoma, often starting in the fallopian tube.
- Main risk factors
- Age over 50, BRCA1/BRCA2 mutations, Lynch syndrome, family history, endometriosis.
- Diagnosis
- CA-125, ultrasound, CT scan, and tissue from surgery or biopsy.
- Treatment
- Surgery, platinum-based chemotherapy, and maintenance with PARP inhibitors or bevacizumab.
- Outlook
- Over 90% 5-year survival when found at stage 1; lower for advanced stages.
When to get help
Call 911 or go to the ER
- Vomiting with no bowel movement or gas and a swollen, painful belly (possible bowel obstruction)
- Severe breathlessness or a rapidly swelling belly
- Fever with shivering during chemotherapy (possible neutropenic sepsis)
See a doctor within a day or two
- New, persistent bloating, pelvic pain, early fullness or urinary frequency for 2 to 3 weeks
- A pelvic mass found on examination or scan
- Bleeding after menopause
Book a routine appointment
- A personal or strong family history of ovarian or breast cancer, for genetic counseling
- Follow-up after treatment, including any new symptoms between visits
What ovarian cancer is
Doctors once thought most ovarian cancers began on the surface of the ovary. Research now shows that many of the most common and aggressive type, high-grade serous carcinoma, begin in the fimbriae, the finger-like ends of the fallopian tubes, and spread to the ovary and peritoneum. That is why ovarian, fallopian tube and primary peritoneal cancers are staged and treated together.
Ovarian cancer tends to spread by shedding cells into the abdominal fluid, seeding the surfaces of the bowel, diaphragm and the fatty apron (omentum), and causing fluid build-up (ascites).
Types of ovarian cancer
| Type | Share of cases | Features |
|---|---|---|
| High-grade serous carcinoma | About 70% of epithelial cancers | Usually advanced at diagnosis; linked to BRCA; responds to platinum chemotherapy |
| Endometrioid carcinoma | About 10% | Often earlier stage; linked to endometriosis and Lynch syndrome |
| Clear cell carcinoma | About 5 to 10% | Linked to endometriosis; less responsive to chemotherapy |
| Mucinous carcinoma | About 3% | Can be large; must be distinguished from spread from the bowel |
| Low-grade serous carcinoma | Under 5% | Slow-growing; younger women; less chemo-sensitive |
| Germ cell tumors | Rare | Teens and young women; highly curable |
| Sex cord-stromal tumors | Rare | Can produce hormones; often early stage |
Borderline (low malignant potential) tumors are a separate group with a very good outlook, usually treated with surgery alone.
Symptoms
Early ovarian cancer often causes no symptoms. When symptoms occur, they are persistent bloating, pelvic or abdominal pain, feeling full quickly and urinary frequency or urgency. See ovarian cancer symptoms for how to recognize the warning pattern and when to ask for tests.
Risk factors
- Age: most cases occur after menopause.
- Inherited gene mutations: BRCA1 and BRCA2 mutations raise the lifetime risk substantially (roughly up to 40% to 45% for BRCA1 and about 15% to 20% for BRCA2). Lynch syndrome also increases risk. About 1 in 5 ovarian cancers are linked to an inherited mutation.
- Family history of ovarian, breast, bowel or womb cancer.
- Endometriosis: linked to clear cell and endometrioid types.
- Never having been pregnant, early periods and late menopause.
- Hormone replacement therapy for several years.
- Obesity and smoking (smoking is linked to the mucinous type).
Factors that lower risk
- combined oral contraceptive pill (risk falls with longer use and lasts years after stopping)
- pregnancy and breastfeeding
- tubal ligation and removal of the fallopian tubes (salpingectomy)
Diagnosis
- Examination: abdominal and pelvic exam.
- Blood tests: CA-125; in younger women, tumor markers for germ cell tumors such as AFP, hCG and LDH.
- Transvaginal ultrasound: assesses ovarian masses using standardized risk scoring.
- CT scan of the chest, abdomen and pelvis to see how far the cancer has spread.
- Tissue diagnosis: a biopsy, often guided by CT, or analysis during surgery. Fluid drained from the abdomen or chest is also tested.
- Genetic and tumor testing: all people with epithelial ovarian cancer should be offered germline genetic testing for BRCA and other genes, and tumor testing (including homologous recombination deficiency) to guide treatment.
Stages of ovarian cancer
| FIGO stage | Extent |
|---|---|
| Stage 1 | Confined to one or both ovaries or fallopian tubes |
| Stage 2 | Spread to other pelvic organs such as the uterus or bladder |
| Stage 3 | Spread to the lining of the abdomen beyond the pelvis and/or to lymph nodes in the back of the abdomen |
| Stage 4 | Spread to distant organs, such as inside the liver, lungs or fluid around the lungs |
Most high-grade serous cancers are stage 3 or 4 at diagnosis.
Treatment
Treatment should be led by a gynecologic oncologist, because outcomes are better in specialist centers.
Surgery
The aim is to remove all visible cancer (complete cytoreduction). Surgery usually includes removing both ovaries and tubes, the uterus, the omentum, and any other visible disease, sometimes including parts of the bowel. For early-stage cancer in young women wanting children, fertility-sparing surgery may be possible.
Chemotherapy
- Carboplatin and paclitaxel given every 3 weeks for 6 cycles is the standard.
- Chemotherapy may be given before surgery (neoadjuvant) to shrink widespread disease, then surgery, then more chemotherapy.
- Heated chemotherapy into the abdomen during surgery (HIPEC) is used in some centers for selected patients.
Maintenance therapy
After chemotherapy, many people with advanced cancer receive:
- PARP inhibitors (such as olaparib or niraparib): tablets that are particularly effective in BRCA-mutated or homologous recombination-deficient cancers, and have substantially lengthened the time before relapse.
- Bevacizumab: an antibody that blocks blood vessel growth.
Recurrent ovarian cancer
Many advanced ovarian cancers come back. Treatment depends on how long after platinum chemotherapy the relapse happens, and may include more chemotherapy, targeted drugs such as antibody-drug conjugates for tumors with specific markers, surgery in selected cases, and clinical trials.
Complications
- bowel obstruction from cancer in the abdomen
- ascites and pleural effusion (fluid in the chest)
- blood clots
- side effects of treatment: nerve damage (neuropathy), tiredness, low blood counts, early menopause
Outlook
Five-year relative survival for all ovarian cancers in the US is about 50%. It depends heavily on stage and type: over 90% for localized disease, around 70% for regional spread, and about 30% for distant spread. Survival for advanced disease has improved with PARP inhibitors and better surgery. Germ cell tumors and borderline tumors have an excellent outlook.
Prevention for high-risk women
Women with BRCA1/BRCA2 mutations are usually advised to have their ovaries and fallopian tubes removed (risk-reducing salpingo-oophorectomy) once childbearing is complete, typically between ages 35 and 45, depending on the gene. This greatly reduces risk. Women having pelvic surgery for other reasons may be offered removal of the fallopian tubes to reduce risk.
Frequently asked questions
What are the main types of ovarian cancer?
Most ovarian cancers are epithelial, and high-grade serous carcinoma is the most common and aggressive type. Others include endometrioid, clear cell, mucinous and low-grade serous carcinomas. Rarer types are germ cell tumors, which affect young women, and sex cord-stromal tumors.
What is the survival rate for ovarian cancer?
Overall 5-year relative survival is about 50% in the US. When found at stage 1, survival exceeds 90%. For cancer that has spread to distant organs, it is around 30%. Newer maintenance treatments have improved outcomes for advanced disease.
Is ovarian cancer hereditary?
About 1 in 5 cases is linked to an inherited mutation, most often in BRCA1 or BRCA2, or in Lynch syndrome genes. Everyone diagnosed with epithelial ovarian cancer should be offered genetic testing, because results guide treatment and can help relatives reduce their risk.
How is ovarian cancer treated?
Treatment usually combines surgery to remove as much cancer as possible with carboplatin and paclitaxel chemotherapy. Many people then take maintenance therapy, such as a PARP inhibitor or bevacizumab, to delay the cancer returning. Early-stage, low-risk cancers may need surgery only.
Can ovarian cancer be cured?
Yes, many early-stage ovarian cancers are cured with surgery and chemotherapy. Advanced cancer often responds well to initial treatment, but frequently returns. Even then, it can often be controlled for years with further treatments.
Sources
This guide was written from current patient and clinical guidance, including:
- National Cancer Institute: Ovarian epithelial, fallopian tube, and primary peritoneal cancer treatment (PDQ)
- American Cancer Society: Ovarian cancer
- NCCN Guidelines for Patients: Ovarian cancer
- FIGO: Staging classification for cancer of the ovary, fallopian tube, and peritoneum
- Society of Gynecologic Oncology: Genetic testing for women with ovarian cancer