Ovarian cancer: Full guide

What is ovarian cancer?

Ovarian cancer starts when cells grow out of control in the ovaries or nearby tissue. The ovaries are two small organs that make eggs and hormones.

Doctors now know many of these cancers start in the fallopian tubes. These are the thin tubes that carry eggs to the uterus. Some start in the peritoneum, the thin lining inside the belly. These three cancers act alike and are treated the same way.

Early ovarian cancer often causes few or vague symptoms. These can include bloating, belly or pelvic pain, feeling full fast, or needing to pee often. Because of this, many people are diagnosed after the cancer has spread inside the belly.

Age is the biggest risk factor. Family history matters too. Inherited gene changes like BRCA1, BRCA2, and Lynch syndrome raise the risk. Everyone with ovarian cancer should be offered genetic counseling and testing.

Treatment has improved. Surgery, chemotherapy, and maintenance medicines help many people control the cancer for a long time. Your care team will explain what this means for you.

Types

High-grade serous carcinoma

The most common type. It often starts in the fallopian tube and is usually found at a later stage. It often responds well to platinum chemotherapy at first.

Low-grade serous carcinoma

A less common type that tends to grow slowly. It responds less to chemotherapy. Hormone medicines and targeted pills can help some people.

Endometrioid carcinoma

Often found at an earlier stage and in younger people. It can be linked to endometriosis and Lynch syndrome.

Clear cell carcinoma

A less common type that is often found early. It may respond less to chemotherapy. It can be linked to endometriosis and Lynch syndrome.

Mucinous carcinoma

A rare type. Doctors check the stomach and bowel to make sure the cancer did not start there.

Fallopian tube and primary peritoneal cancer

Cancers that start in the fallopian tube or the lining of the belly. They are treated just like ovarian cancer.

Borderline tumors

Also called low malignant potential tumors. They are not fully cancer and rarely spread. Surgery alone is usually enough.

Germ cell and stromal tumors

Rare tumors that start in egg cells or hormone-making cells. Germ cell tumors often affect teens and young adults and usually respond very well to treatment. Surgery that keeps fertility is often possible.

Tests you may have

Pelvic exam

Your doctor feels the ovaries and uterus to check for a lump or swelling.

Transvaginal ultrasound

A small wand placed in the vagina uses sound waves to make pictures of the ovaries. It shows the size and look of a mass.

CT scan

A detailed X-ray of the chest, belly, and pelvis. It shows where the cancer is and helps plan surgery.

CA-125 blood test

CA-125 is a protein that is often high in ovarian cancer. It helps track treatment. It is not used alone to diagnose or to screen people without symptoms.

Biopsy or surgery

A tissue sample is the only way to know for sure. It may be taken with a needle, or during surgery to remove the tumor.

Laparoscopy

A thin camera goes into the belly through small cuts. It helps the surgeon see how far the cancer has spread and if it can all be removed.

Paracentesis

Draining fluid from the belly with a needle. It can ease bloating and check the fluid for cancer cells.

Genetic testing

A blood or saliva test for inherited gene changes like BRCA1 and BRCA2. Results can guide treatment and help your family.

Tumor testing

Tests on the tumor itself for BRCA changes, HRD, and other markers. These help choose maintenance and later treatments.

What the stage means

The stage tells how far the cancer has spread. It is usually set during surgery, when the surgeon looks inside the belly and takes samples.

Ovarian cancer uses stages 1 to 4. Many people are diagnosed at stage 3.

Stage 1

The cancer is only in one or both ovaries or fallopian tubes. Surgery may be all that is needed for some. Others also get chemotherapy.

Stage 2

The cancer has spread to other organs in the pelvis, like the uterus or bladder surface. Surgery and chemotherapy are usually used.

Stage 3

The cancer has spread to the belly lining outside the pelvis, or to lymph nodes deep in the belly. This is the most common stage at diagnosis. Treatment uses surgery, chemotherapy, and often maintenance medicine.

Stage 4

The cancer has spread to distant places. This may be fluid around the lungs, or the inside of the liver or other organs. Treatment uses medicine through the whole body, and sometimes surgery.

Tumor markers and gene tests

Gene tests on your blood and your tumor can change your treatment. They also help decide which maintenance medicine may work best after chemotherapy.

Results can also matter for your relatives. If you carry an inherited gene change, family members can get tested and take steps to lower their risk.

BRCA1 and BRCA2

Genes that help repair damaged DNA. A change in these genes can be inherited or found only in the tumor. These cancers often respond well to platinum chemotherapy and PARP inhibitors.

HRD (homologous recombination deficiency)

A test that shows if the tumor has trouble fixing its DNA, even without a BRCA change. HRD-positive tumors are more likely to respond to PARP inhibitors.

Lynch syndrome and MMR

Lynch syndrome is an inherited condition that raises the risk of colon, uterine, and ovarian cancer. Tumor tests for mismatch repair (MMR) can point to it and may open the door to immunotherapy.

Other inherited genes

Genes like BRIP1, RAD51C, RAD51D, and PALB2 can also raise ovarian cancer risk. A broad gene panel checks for these.

CA-125

A blood marker used to follow how the cancer responds. A rise alone does not always mean you need new treatment. Your team will also use scans and how you feel.

Folate receptor alpha (FRα)

A protein on the surface of many ovarian cancer cells. If the level is high, a targeted medicine called mirvetuximab may be an option when the cancer comes back.

PD-L1

A protein that can help predict who may benefit from immunotherapy. It may be checked if the cancer comes back.

BRAF and KRAS

Gene changes often seen in low-grade serous cancer. Targeted pills can block some of them.

Main treatments

Surgery (debulking)

The surgeon removes the ovaries, tubes, uterus, and as much visible cancer as possible. The goal is to leave no cancer that can be seen. A gynecologic oncologist (a surgeon who treats these cancers) should do this surgery.

Fertility-sparing surgery

For some early cancers and rare tumor types, the surgeon may remove only one ovary and tube. This can keep the chance of pregnancy. Ask early if fertility matters to you.

Platinum chemotherapy

Chemotherapy with carboplatin plus paclitaxel is the main medicine treatment. It is given by IV, often every three weeks. It may be given before surgery, after surgery, or both.

Chemotherapy before surgery

If the cancer is too widespread to remove at first, chemotherapy may be given first to shrink it. Surgery follows, then more chemotherapy.

HIPEC and IP chemotherapy

Chemotherapy placed directly into the belly. HIPEC uses heated chemotherapy during surgery. These are used only for some people. Ask if they fit your situation.

Bevacizumab

A medicine that blocks blood vessel growth to the tumor. It is given by IV with chemotherapy and then on its own. It can help control the cancer longer and reduce belly fluid.

PARP inhibitors (maintenance)

Pills like olaparib and niraparib taken after chemotherapy works. They block a way cancer cells repair DNA. They help most in BRCA-changed or HRD-positive cancers.

Treatment if the cancer comes back

Options depend on how long it has been since platinum chemotherapy. They may include more platinum chemotherapy, other chemotherapy, bevacizumab, immunotherapy, or a second surgery for some people.

Antibody-drug conjugates

An antibody carries chemotherapy straight to cancer cells. Mirvetuximab is used for some cancers that come back with high FRα levels.

Clinical trials and supportive care

Research studies test new treatments and can be a good option at any stage. Palliative care helps with symptoms like pain and bloating, at any stage, along with cancer treatment.

Common side effects and what helps

Fatigue

Feeling very tired is common. Short walks and light activity can help. Rest when you need to, and accept help from others.

Nausea

Anti-nausea medicines work well. Take them as directed, even before you feel sick. Eat small meals and sip fluids.

Low blood counts and infection

Chemotherapy and PARP inhibitors can lower blood counts. You will have regular blood tests. Call right away if you have a fever.

Numbness and tingling

Paclitaxel can cause numbness in the hands and feet. Tell your team early. Changing the treatment can keep it from getting worse.

Hair loss

Common with paclitaxel. Hair usually grows back after treatment ends. A soft hat, scarf, or wig can help.

Recovery after surgery

Healing from belly surgery takes weeks. Walk a little each day and avoid heavy lifting. Call about redness, fever, or belly pain that gets worse.

Sudden menopause

Removing the ovaries causes menopause if you have not gone through it. Hot flashes, sleep problems, and vaginal dryness can happen. Ask your team what is safe to help.

High blood pressure and protein in urine

Can happen with bevacizumab. Your team will check your blood pressure and urine often.

Eye changes

Mirvetuximab can cause blurry vision or dry eyes. You will see an eye doctor and use eye drops. Report any eye changes quickly.

Bowel changes and bloating

Constipation, diarrhea, and bloating are common. Drink fluids and ask about medicines. Call if you cannot pass gas or stool and your belly swells.

Living with and after ovarian cancer

After treatment, you will have regular visits with exams. Scans and CA-125 tests may be done if you have symptoms or as your team suggests.

Ovarian cancer often comes back, even after a great response. If it does, there are many treatments. Some people live for years with periods of treatment and breaks, like a long-term illness.

Maintenance medicines may go on for months or years. Tell your team about side effects so they can help, not just push through them.

Early menopause can affect your bones, heart, mood, and sex life. Ask about bone health, exercise, and treatments for vaginal dryness. Talking openly with your partner and team helps.

If you have a BRCA or other inherited gene change, your sisters, daughters, brothers, and sons may also carry it. Testing lets them make choices, like risk-reducing surgery, that can greatly lower their risk.

It is normal to feel worried about scans or test results. Support groups, counselors, and social workers can help you and your family.