Table of Contents

Ovarian Cancer

What is ovarian cancer?

Ovarian cancer is known for its rapid progression, making early detection crucial. Women have approximately a 2% (1 in 50) lifetime risk of developing ovarian cancer. Having a first-degree relative with ovarian cancer doubles this risk to 4% (1 in 25). Additionally, the presence of BRCA 1&2 genes significantly increases the risk, up to 50%.

The female reproductive system includes two ovaries, each roughly the size of an almond, located on either side of the uterus. Ovaries are responsible for producing eggs (ova) and hormones like estrogen and progesterone.

Typical treatment for ovarian cancer often comprises surgery and chemotherapy.

Types of ovarian cancer

The type of ovarian cancer a patient has is determined by the origin cell type, which guides the best treatment approach. Types of ovarian cancer include:

Epithelial ovarian cancer, the most prevalent form, encompassing various subtypes like serous carcinoma and mucinous carcinoma.

Stromal tumors, less common and usually identified earlier than other ovarian cancers.

Germ cell tumors, also rare and typically occurring at a younger age.


Ovarian cancer is often difficult to detect in its early stages due to minimal symptoms, making awareness of symptoms essential. Commonly manifesting post-menopause (after age 50), the symptoms of ovarian cancer can be quite unclear, including:

– Swelling and bloating of the abdomen

– Onset of pelvic discomfort

– Feelings of nausea and early satiety

– Increased urge to urinate

– Appetite reduction and weight loss

– Presence of a lower abdominal mass

– Pain in the lower back

– Frequent urination

– Alterations in bowel habits, such as constipation or diarrhea

– Unusual vaginal discharge or bleeding, particularly notable outside of regular menstrual cycles or post-menopause.


The exact cause of ovarian cancer remains unknown, but certain risk factors have been identified by medical professionals.

Ovarian cancer is known to originate when cells in or around the ovaries undergo DNA mutations. These mutations alter the normal instructions of a cell’s DNA, leading the cells to proliferate rapidly and form a mass, or tumor, of abnormal cells. Unlike healthy cells that die naturally, these cancerous cells persist, potentially invading adjacent tissues and even detaching from the original tumor to metastasize, or spread, to other body parts.

Ovarian cancer stages

Ovarian cancer stages are categorized as follows:

Stage I: This initial stage is further divided into three phases. Stage IA involves cancer in just one ovary or fallopian tube. In Stage IB, both ovaries or fallopian tubes are affected. Stage IC indicates cancer presence in both ovaries or fallopian tubes and extends outside the ovary, either on its surface or into the peritoneal cavity surrounding the ovary.

Stage II: This stage also has several sub-stages. In Stage IIA, the cancer has spread from the ovary to the uterus. Stage IIB sees the cancer reaching other pelvic structures.

Stage III: Comprising three sub-stages, Stage IIIA involves the cancer spreading from the pelvis to the abdomen (microscopically) or to lymph nodes. In Stage IIIB, the tumor, measuring up to 2 centimeters, extends beyond the pelvis or to lymph nodes. Stage IIIC indicates the cancer has grown larger than 2 centimeters outside the pelvis or is present in lymph nodes, possibly affecting organs like the liver and spleen.

Stage IV: This is the most advanced stage. The cancer has migrated to internal organs, such as the liver or spleen. Stage IVA involves cancer near the lungs, while Stage IVB indicates it has spread to groin lymph nodes or into the chest.

How is ovarian cancer diagnosed?

Despite extensive research, an effective screening test for ovarian cancer has not yet been developed, making early detection challenging.

When ovarian cancer is suspected, healthcare providers typically start with a discussion of symptoms and a pelvic examination to identify any unusual growths or organ enlargement.

Further diagnostic measures may include:

Imaging Tests: These may encompass a variety of scans, such as:

   – A pelvic ultrasound.

   – MRI (Magnetic Resonance Imaging).

   – CT (Computed Tomography) scan.

   – PET (Positron Emission Tomography) scan.

Blood Tests: These tests primarily look for CA-125, a marker that can indicate cancer. Elevated CA-125 levels might suggest cancer, but they can also be seen in non-cancerous conditions and might be normal in some cancer cases. Thus, blood tests are usually used alongside other diagnostic methods.

Surgical Evaluation: Ovarian cancer can often be diagnosed during surgery. If abnormal growths are discovered, they are typically removed in the same procedure.

Laparoscopy: This minimally invasive surgery involves a small incision in the abdomen through which a laparoscope (a thin camera) is inserted. This allows the surgeon to examine and possibly remove ovarian tumors, as well as conduct staging biopsies.

Main tests for ovarian cancer

Initially, to diagnose ovarian cancer, a blood test and a scan are typically performed, but additional tests are often required for a definitive diagnosis.

An ultrasound scan can be conducted to check for any changes in the ovaries. This might involve a transvaginal scan, where a slender scanning device is inserted into the vagina, or an external abdominal scan over the stomach area.

If the scan results are normal but symptoms persist for over a month, it’s advisable to consult a GP again. Post-menopause, ovaries may be too small to be clearly visible on a scan.

Other diagnostic procedures might include:

A CT scan.

– Performing a needle biopsy to extract a small sample of cells or fluid from the ovaries.

– Conducting a laparoscopy, where a camera on a tube is inserted through a small incision in the abdomen to examine the ovaries.

– Undergoing a laparotomy, which may involve the removal of tissue or the ovaries themselves.

Pelvic ultrasound, utilizing soundwave echoes to create images of the ovaries and uterus.

PET scan, which detects abnormal tissues in the body.

Colonoscopy, a thorough examination of the bowel to rule out bowel-related symptoms.

While these tests can identify abnormalities, a biopsy, involving the removal of a tissue sample, is the only method to conclusively confirm a cancer diagnosis.

What about screening?

CA125 blood tests and ultrasound scans are often utilized for screening, particularly in women with a heightened risk of ovarian cancer. Nonetheless, these tests can sometimes produce inaccurate results, both false positives and negatives. Benign ovarian cysts, which are quite common, can elevate CA125 levels, as can other prevalent conditions like fibroids and endometriosis. Additionally, only about 50% of stage 1 ovarian cancers and 80% of all ovarian cancers present with elevated CA125 levels. Furthermore, even with annual screening, there remains the possibility of developing the disease in the meantime.

Screening options for ovarian health issues are available and can be discussed further.

Treatment options for ovarian cancer

Treating cancer effectively often involves eliminating as much of the cancer as possible from the body. Typical treatments for ovarian cancer encompass:

Surgery: The primary approach usually includes removing reproductive organs and any other organ affected by cancer. Surgical methods range from laparoscopy (less invasive) to laparotomy (open surgery with an abdominal incision).

Regarding surgery for ovarian cancer, options include:

– Removing one ovary: Suitable for early-stage cancer confined to one ovary, preserving fertility.

– Removing both ovaries: If both ovaries are affected but no further cancer is present, this surgery may still allow pregnancy with assisted reproductive technologies.

– Removing ovaries and uterus: Recommended for more extensive cancer or if childbearing is not a consideration.

– Advanced cancer surgery: Involves removing as much cancer as possible, sometimes combined with chemotherapy.

Chemotherapy aims to eliminate rapidly dividing cells, including cancer cells, through oral intake or intravenous injections. This may be advised before or after surgery and involves using drugs that specifically target and destroy cancer cells.  It’s often used post-surgery to target remaining cancer cells or pre-surgery in certain cases. Sometimes, during surgery, chemotherapy drugs are heated and infused directly into the abdomen (hyperthermic intraperitoneal chemotherapy).

Targeted therapy focuses on attacking specific vulnerabilities in cancer cells, often requiring testing of cancer cells to find the most effective treatment. This treatment involves drugs that specifically target cancer cells, altering their growth and division processes.

Hormone therapy is used to block estrogen’s effects on certain ovarian cancer cells. It’s an option for specific slow-growing cancers or recurrent cancers post-initial treatment.

Immunotherapy employs the body’s immune system to combat cancer by disrupting the cancer cells’ ability to hide from immune cells. It’s considered in certain ovarian cancer cases.

Supportive or palliative care is critical for relieving pain and other symptoms associated with serious illnesses like cancer. This care is provided by a specialized team and is often used alongside other treatments to enhance quality of life and potentially extend survival.

Radiation Therapy: Rarely used in ovarian cancer treatment, this method employs high-energy beams to kill cancer cells.

Getting Ready for Your Medical Consultation

Begin by setting up an appointment with your general practitioner or gynecologist if you notice symptoms that cause concern.

Should your primary healthcare provider suspect ovarian cancer, a referral to a gynecological oncologist might be made. These specialists are OB-GYNs with extra training in diagnosing and treating ovarian and other gynecologic cancers.


Pre-appointment Tips:

– Check if there are any restrictions before your appointment, like fasting.

– Note down all your symptoms, even those that might not seem related to your current health concerns.

– Record your medical history, including other health conditions you have.

– Jot down significant personal life changes or stress factors.

– List all medications, vitamins, or supplements you’re taking.

– Consider bringing a family member or friend for support and to help remember the doctor’s advice.

– Prepare a list of questions for your doctor.


Key Questions for Your Doctor:

– What could be causing my symptoms?

– What tests will I need to undergo?

– What treatment options are available and their possible side effects?

– What’s my prognosis?

– If I’m considering future pregnancies, what are my options?

– How can I effectively manage my other health conditions alongside this?


Be Prepared for Questions from Your Doctor:

-Expect your doctor to ask various questions. Being ready with answers can help you utilize the appointment time more effectively. These might include inquiries about the onset, severity, and frequency of your symptoms, any factors that alleviate or worsen them, family history of ovarian or breast cancer, and other cancers in your family.

What are the chances of beating ovarian cancer?

The specifics of your situation, including factors like age, overall health, the type and stage of ovarian cancer, and your response to treatment, can greatly influence the outcome. Your doctor is best equipped to offer more information. It’s crucial to actively ask questions during consultations (consider bringing someone along for support), and if clear-cut answers aren’t available, inquire about the best and worst-case scenarios.

Risk factors

Risk factors for ovarian cancer include:

Advancing age. As you get older, the likelihood of developing ovarian cancer rises, with a higher incidence in older adults.

Genetic predispositions. A minority of ovarian cancer cases are due to inherited genetic mutations. The BRCA1 and BRCA2 genes, known for their association with breast cancer risk, also elevate ovarian cancer risk. Other genetic mutations linked to an increased risk include those related to Lynch syndrome and the BRIP1, RAD51C, and RAD51D genes.

Family medical history. Having family members diagnosed with ovarian cancer can heighten your own risk.

Excess body weight. Being overweight or obese is associated with a higher risk of ovarian cancer.

Hormone replacement therapy after menopause. Using hormone replacement therapy for menopause symptoms can increase ovarian cancer risk.

– The presence of endometriosis, a condition where uterine-like tissue grows outside the uterus, can be a risk factor.

Menstrual history. An early onset of menstruation or late menopause, or both, might raise the risk of ovarian cancer.

Nulliparity. Women who have never been pregnant may face a greater risk of developing ovarian cancer.


While there’s no guaranteed method to avert ovarian cancer, certain strategies might help in lowering your risk:

– Consider using birth control pills. Discuss with your doctor if oral contraceptives are a suitable option for you. Using birth control pills has been linked to a decreased risk of ovarian cancer. However, these pills come with their own set of risks, so it’s important to weigh the pros and cons in your specific case.

– Talk to your doctor about your risk factors. If there’s a history of breast and ovarian cancers in your family, mention this to your doctor. They can assess how this family history might affect your cancer risk. You might also be advised to see a genetic counselor who can assist in deciding if genetic testing is appropriate for you. Should genetic testing reveal a gene mutation that heightens your ovarian cancer risk, you might consider preventative ovarian removal surgery.