Ovarian Cancer Overview

Ovarian cancer is a disease that begins when abnormal cells in, on, or near the ovaries grow out of control, forming a mass (tumor). Researchers don’t know the exact cause of ovarian cancer, but certain risk factors, like having a family history of the condition or late-onset menopause can increase your chances of developing the condition. About 1 in 78 people with ovaries will develop ovarian cancer at some point in their lifetime.

Signs and symptoms of ovarian cancer include abdominal discomfort, bloating, feeling full quickly, and frequent urination. There is no screening test to detect ovarian cancer. Doctors usually use a combination of imaging tests, blood tests, and tissue biopsies to diagnose the disease. Treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapies. 

Types of Ovarian Cancer

There are many different types of ovarian cancer, which are grouped by the kind of cell they start in. The three main types of ovarian cancer include: 

  • Epithelial: Epithelial tumors develop from the cells that cover the outer surface of the ovaries. These tumors account for between 85 to 90% of all ovarian cancers. 
  • Germ: Germ cell tumors develop from the cells that produce ova (eggs). These tumors are more common in teenagers and people in their 20s. 
  • Stromal: Stromal cell tumors develop from the cells that form the ovarian structural tissues and produce sex hormones estrogen and progesterone. These tumors are rare, accounting for about 1% of all ovarian cancers. 

Each of these main ovarian cancer types are further divided into subtypes. Though they are all ovarian cancer, each type is a distinct disease that may have different causes, risk factors, treatment options, and prognosis.

Ovarian cancers are also classified by stage, ranging from stage 1 (early disease) to stage 4 (advanced disease). Doctors use imaging scans, lab tests, and other procedures to determine the stage of the cancer. Ovarian cancer staging is based on the TNM system, which considers three factors: 

  • T: The extent (size) of the primary tumor
  • N: Whether cancer has spread to nearby lymph nodes
  • M: Whether cancer has metastasized (spread) to other, more distant parts of the body

Ovarian Cancer Symptoms

Ovarian cancer symptoms are general and can be easily attributed to other, more benign causes. In the early stages, symptoms may be subtle and brushed off. Pay attention to your body and be aware of early warning signs of ovarian cancer, including: 

  • Abdominal discomfort or pain 
  • Bloating
  • Feeling full quickly when eating 
  • Frequent urination 
  • Pelvic pressure 

As the tumor grows and reaches an advanced stage, existing symptoms may be more intense, and new symptoms can develop. Symptoms of advanced ovarian cancer include: 

  • Abnormal vaginal discharge 
  • Back pain 
  • Constipation 
  • Fatigue 
  • Fluid build-up in the abdomen (ascites) 
  • Heavy periods or breakthrough bleeding (bleeding between menstrual cycles
  • Loss of appetite 
  • Pain during sex 
  • Post-menopausal bleeding
  • Unintentional weight loss 

It’s important to remember that not everyone who has these symptoms will be diagnosed with ovarian cancer. With ovarian cancer, symptoms are generally persistent and occur more than 12 times a month. 

What Causes Ovarian Cancer? 

Ovarian cancer begins when mutated cells in the ovary or nearby structures grow and divide out of control. These abnormal cells eventually form a mass called a tumor.

There are a number of factors that may cause normal ovary cells to mutate. In some cases, gene mutations passed down through families (inherited mutations) can lead to ovarian cancer. Research shows that about 25% of ovarian cancers are linked to inherited gene mutations. Mutations may also occur due to environmental, hormonal, or lifestyle factors.

Risk Factors

Certain risk factors can increase your chances of developing ovarian cancer. Some of these risk factors are out of your control, including: 

  • Personal or family history of breast, colon, or ovarian cancer
  • Inheriting certain genes (BRCA1 and BRCA2)
  • Being middle-aged or older
  • Having endometriosis 
  • Having Eastern European or Ashkenazi Jewish background
  • Having an early first period (before 12) or late-onset menopause (after age 55) 

Other risk factors are tied to lifestyle and may be changed to reduce your risk: 

  • Smoking
  • Eating a diet high in animal fats (e.g., red meats, dairy) 
  • Being overweight or obese 
  • Not having children
  • Not breastfeeding
  • Using hormone therapy after menopause

How Is Ovarian Cancer Diagnosed? 

There are no reliable screening tests to check for ovarian cancer. If you have symptoms of ovarian cancer, your doctor may use different tests and procedures to diagnose ovarian cancer. Common diagnostic tests for ovarian cancer include: 

  • Medical history: Your doctor will want to learn more about your personal risk factors for the disease and your family history of breast, ovarian, and colorectal cancers. 
  • Pelvic exam: Your doctor will perform a pelvic exam to look for signs of ovarian cancer, like a lump or fluid in your abdomen.
  • Imaging tests: Imaging scans, such as transvaginal ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) may be used to look inside of your abdomen and pelvis for signs of cancer. 
  • CA-125 test: This blood test measure the amount of cancer antigen 125 (CA-125)—a protein that is found in high levels in many people with ovarian cancer. 
  • Tumor marker blood tests: These may be used to look for tumor markers—proteins and other substances released by cancer cells—in the blood. 
  • Biopsy: A small tissue sample will be taken from the tumor (most likely during surgery to remove the mass) and sent to the lab, where it will be checked for cancer cells. 

Once a diagnosis is confirmed, an oncologist (a medical doctor who specializes in cancer) may order additional tests and procedures to determine the type of ovarian cancer as well as the stage and grade of the tumor. This helps your cancer care team find the best treatment plan for your particular cancer. These tests include: 

  • Additional imaging scans: These may be ordered to get a better view of the tumor or to check other areas of the body for signs of cancer. 
  • Blood tests: Your doctor will order blood tests to check on your overall health and get an idea of how your liver and kidneys are functioning. 
  • Genetic testing: Multigene testing is used to look for certain gene mutations that may have led to the development of ovarian cancer. 

Treatments

Ovarian cancer treatment differs by the type of cancer, stage of the disease, a person’s overall health, and other factors. The goals of ovarian cancer treatments are to eliminate all cancer in the body to achieve remission (the tumor is either gone or has stopped growing). Some treatments are administered after the cancer is removed to prevent a recurrence.

If remission is not achievable, people with advanced ovarian cancers may receive treatments to slow the growth of cancer, manage symptoms, and prolong their life. 

If you have ovarian cancer, you may receive one or more of the following treatments: 

Surgery

Surgery is the standard treatment for most people with ovarian cancer. Surgery is used to remove the tumor—or as much of it as possible. Oncologists will look for signs of cancer in other areas of the abdomen and pelvis. They will take tissue samples from nearby lymph nodes and other soft tissues to check for cancer cells to determine if the cancer has spread. 

Depending on the stage of the disease, surgery may involve removing one or both ovaries and fallopian tubes and the uterus. Doctors may remove small pieces of other abdominal organs, such as the colon or bladder, in order to access and remove the tumor. 

Chemotherapy 

Chemotherapy (chemo) uses anti-cancer drugs to destroy cancer cells. Chemo is almost always used to treat ovarian cancer unless the disease is diagnosed in its earliest stages, or a person is not healthy enough to tolerate the drugs. 

Chemotherapy may be used before surgery to shrink a tumor before it is removed, or after surgery to kill off any remaining cancer cells in the body. People who have achieved remission after initial treatments (surgery and chemotherapy) may be given maintenance chemotherapy in order to reduce the chances of the cancer cells coming back (recurrence). 

If you have ovarian cancer, you may be treated with one chemotherapy drug on its own or a combination of:

  • Platinum compounds: Platinol (cisplatin) or Paraplatin (carboplatin) 
  • Taxanes: Abraxane (paclitaxel) or Taxotere (docetaxel) 

You will receive 3 to 6 cycles of chemotherapy, which will be administered in one of two ways: 

  • Intravenously (IV): The medicine is delivered through a needle or tube into a vein.
  • Intraperitoneal (IP): The medicine is placed directly into the abdominal cavity through a catheter.

Targeted Therapies 

Targeted cancer drugs are used to slow or stop the growth of cancer cells. These therapies can’t cure ovarian cancer, but they may be used in combination with chemotherapy to prevent tumors from growing and spreading. 

Targeted therapies used to treat ovarian cancer include: 

  • PARP (poly ADP ribose polymerase) inhibitors: These drugs prevent cancer cells from repairing DNA damage, with the aim of making the cancer cells die. PARP inhibitors may be used to reduce the chance of recurrence. 
  • Monoclonal antibodies: Avastin (bevacizumab) is a monoclonal antibody that cuts off a tumor’s blood supply, essentially ‘starving’ the tumor so it does not grow. This drug may be given in combination with chemotherapy and/or after chemo is finished to prevent a recurrence. 
  • Folate-receptor alpha targeted drugs: Elahere (mirvetuximab soravtansine) is a drug that attaches itself to folate receptor alpha—a protein found in many ovarian tumors. The drug attaches itself to the surface of cancer cells to deliver chemo drugs directly into the cells. It is sometimes used in people whose tumors did not respond to previous chemotherapy treatments. 

Other Treatments 

In some cases, oncologists may recommend additional therapies to treat ovarian cancer. These treatments are used less frequently but may be effective for some people: 

  • Radiation therapy: Intense energy beams (radiation) may be used to target tumors in specific areas of the body to kill off cancer cells. Radiation therapy is rarely used to treat ovarian cancer alone, but may be recommended if cancer has spread to other, more distant areas of the body. 
  • Hormone therapy: Drugs that block hormones are sometimes used to lower estrogen levels or block estrogen-producing enzymes in order to stop cancer growth. These medicines are sometimes used to treat stromal cell tumors (tumors that develop on the tissue holding the ovary together). 
  • Clinical trials: Some ovarian cancer patients may choose to participate in clinical trials in order to access new treatments or combination therapies before they become widely available.

How to Prevent Ovarian Cancer

There is no guaranteed way to prevent ovarian cancer, but there are things you can do to lower your risk of developing the disease: 

  • Consider using hormonal oral contraceptives (birth control pills
  • Consider breastfeeding for a year or more 
  • Maintain a healthy weight 
  • Avoid taking hormone replacement therapy after menopause 
  • Having a tubal ligation (surgical removal of the fallopian tubes, often called “getting your tubes tied”) 
  • Having a hysterectomy (removal of the uterus and sometimes the cervix), oophorectomy (removal of the ovaries), or bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) 

Comorbid Conditions

Having ovarian cancer can increase the risk of developing other conditions: 

  • Other cancers: People with a history of ovarian cancer are at an increased risk of developing other types of cancer, especially breast cancer and colorectal cancer. This is particularly true for people who have BRCA gene mutations. Chemotherapy drugs used to treat ovarian cancer are linked to an increased risk of leukemia, or blood cancer. 
  • Cardiovascular disease: Research shows that ovarian cancer surviors are at an increased risk of developing cardiovascular disease, including stroke, heart failure, pericarditis, coronary artery disease, and arrhythmia (irregular heartbeat). 

Living With Ovarian Cancer

Living with ovarian cancer can take a toll on your physical and emotional health. Along with your physical symptoms and treatment side effects, you may feel a wide range of emotions and wonder what lies ahead as you navigate your cancer journey. 

The overall 5-year survival rate for ovarian cancer is 49%. Though this number is disheartening, it’s important to remember that survival statistics cannot predict what will happen to you. There are many factors that can influence how you will respond to treatment, and researchers continue to find new, better ways to diagnose and treat ovarian cancer. 

No matter what you are feeling, you don’t have to go through it alone. Talk to your healthcare provider about what to expect, and ask for help to manage your symptoms and side effects. Reach out to family and friends for support as you need it. If you want to connect with others who understand what you’re going through, consider joining an ovarian cancer support group online or in person. 

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