Ovarian Cancer: Symptoms, Causes & Complete Treatment Guide

What Is Ovarian Cancer?

Ovarian cancer is a malignant tumor that develops in the ovaries, fallopian tubes, or peritoneum (the lining of the abdominal cavity). It is the 8th most common cancer in women worldwide, with approximately 313,000 new cases diagnosed each year. Most ovarian cancers are epithelial tumors, originating from the cells that cover the outer surface of the ovary.

Ovarian cancer occurs when cells in or around the ovaries begin to grow uncontrollably, forming a tumor that can spread to other parts of the body. The term "ovarian cancer" is often used to describe cancers that originate in the ovaries, fallopian tubes, or primary peritoneal cancer, as these are treated similarly and share common features.

Understanding the biology of ovarian cancer has evolved significantly in recent years. Scientists now recognize that many "ovarian" cancers actually begin in the fallopian tubes before spreading to the ovaries. This discovery has important implications for prevention strategies, particularly for women with BRCA gene mutations who may benefit from having their fallopian tubes removed.

The disease is relatively uncommon compared to breast cancer, but it causes more deaths because it's typically not detected until it has spread. Approximately 70% of women are diagnosed at an advanced stage (Stage III or IV), when the cancer has already spread beyond the pelvis. This is why ovarian cancer is sometimes called "the silent killer" – its symptoms are often subtle and easily attributed to other conditions.

Types of Ovarian Cancer

There are three main types of ovarian tumors, classified by the type of cell where they originate. Each type behaves differently and requires specific treatment approaches:

• Epithelial tumors (90-95%): The most common type, arising from cells on the surface of the ovary. Subtypes include high-grade serous (the most common), endometrioid, clear cell, mucinous, and low-grade serous carcinomas.
• Germ cell tumors (2-3%): Develop from the egg-producing cells. These typically occur in younger women and have an excellent prognosis with treatment.
• Stromal tumors (1-2%): Form in the hormone-producing tissue of the ovary. These are often detected earlier because they can produce hormones that cause symptoms.

What Are the Symptoms of Ovarian Cancer?

The most common symptoms of ovarian cancer include persistent bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary urgency or frequency. These symptoms are often vague and can mimic other conditions, which is why ovarian cancer is frequently diagnosed at later stages. If symptoms persist for more than 2-3 weeks, consult a healthcare provider.

Ovarian cancer symptoms are often subtle and can be easily mistaken for common digestive or bladder problems. Many women dismiss these symptoms as normal fluctuations in their bodies or attribute them to aging, stress, or dietary changes. However, when caused by ovarian cancer, these symptoms tend to be persistent and represent a change from what's normal for you.

The key difference between ovarian cancer symptoms and normal bodily changes is their persistence and progression. While occasional bloating after a large meal is normal, persistent daily bloating that doesn't improve is cause for concern. Similarly, minor digestive changes are common, but a sustained inability to eat normally warrants medical attention.

Research has identified a symptom index that may help distinguish ovarian cancer symptoms from other conditions. The symptoms below, when present for less than one year and occurring more than 12 times per month, may indicate the need for further evaluation:

• Bloating: Persistent abdominal bloating that doesn't come and go but remains constant
• Pelvic or abdominal pain: Discomfort in the lower belly or pelvis that is new or unusual
• Difficulty eating or feeling full quickly: Also called early satiety, feeling unable to finish normal-sized meals
• Urinary symptoms: Increased urgency or frequency of urination

Additional Symptoms to Watch For

Beyond the core symptoms, ovarian cancer can cause a range of other symptoms as the tumor grows or spreads. These additional symptoms may appear as the disease progresses:

• Fatigue that doesn't improve with rest
• Unexplained weight loss or gain
• Changes in bowel habits (constipation or diarrhea)
• Back pain, especially lower back pain
• Pain during sex (dyspareunia)
• Menstrual changes or post-menopausal bleeding
• Abdominal swelling with visible enlargement

What Causes Ovarian Cancer?

The exact cause of ovarian cancer is not fully understood, but several risk factors increase the likelihood of developing the disease. These include genetic mutations (BRCA1/BRCA2), family history of ovarian or breast cancer, age over 50, never having been pregnant, endometriosis, and certain hormone therapies. About 10-15% of ovarian cancers are hereditary.

While the precise mechanisms that trigger ovarian cancer remain under investigation, scientists have identified several factors that contribute to its development. Cancer occurs when cells acquire genetic changes (mutations) that cause them to grow uncontrollably. In ovarian cancer, these mutations can be inherited or acquired during a person's lifetime.

The "incessant ovulation" hypothesis suggests that the repeated process of ovulation causes damage to the ovarian surface, which may increase the risk of abnormal cell growth. This theory helps explain why factors that reduce the number of ovulations (such as pregnancy, breastfeeding, and oral contraceptive use) appear to lower ovarian cancer risk.

Another theory focuses on the role of inflammation. Conditions that cause chronic inflammation in the pelvic area, such as endometriosis and pelvic inflammatory disease, have been associated with increased ovarian cancer risk. This chronic inflammation may promote genetic changes that lead to cancer development.

Genetic Risk Factors

Hereditary factors play a significant role in ovarian cancer, with approximately 10-15% of cases linked to inherited gene mutations. Understanding your genetic risk can be life-saving, as it opens up options for increased surveillance and preventive measures:

• BRCA1 mutation: Carries a 39-46% lifetime risk of ovarian cancer
• BRCA2 mutation: Carries a 10-27% lifetime risk of ovarian cancer
• Lynch syndrome (HNPCC): Associated with 10-12% lifetime risk
• Other genes: RAD51C, RAD51D, BRIP1, and PALB2 also increase risk

If you have a strong family history of ovarian or breast cancer, genetic counseling can help determine whether testing is appropriate for you. A genetic counselor can assess your personal and family history, explain the benefits and limitations of testing, and help you understand the implications of the results.

Other Risk Factors

Beyond genetics, several lifestyle and reproductive factors influence ovarian cancer risk. Some of these factors can be modified, offering opportunities for risk reduction:

• Age: Risk increases with age, with most cases occurring after age 50
• Nulliparity: Never having been pregnant increases risk
• Endometriosis: Increases risk of certain types (clear cell and endometrioid)
• Hormone replacement therapy: Long-term use, especially estrogen-only therapy, may increase risk
• Obesity: Associated with increased risk, particularly for certain types
• Fertility treatments: Some studies suggest a possible association, though evidence is mixed
• Talcum powder: Historical use in the genital area may be associated with slight increased risk, though research is ongoing

How Is Ovarian Cancer Diagnosed?

Ovarian cancer diagnosis involves a combination of pelvic examination, imaging tests (transvaginal ultrasound, CT scan), blood tests (CA-125 and other tumor markers), and ultimately a biopsy to confirm the diagnosis. There is no reliable screening test for average-risk women, making awareness of symptoms crucial for early detection.

The diagnostic process for ovarian cancer typically begins when a woman reports persistent symptoms to her healthcare provider or when an abnormality is discovered during a routine examination. Because there is no effective screening test for ovarian cancer in the general population, most cases are diagnosed after symptoms develop.

Your healthcare provider will begin with a thorough medical history, asking about your symptoms, their duration and severity, family history of cancer, and reproductive history. A physical examination, including a pelvic exam, may reveal an enlarged ovary or mass. However, early-stage ovarian cancer is often not detectable on physical examination.

Diagnostic Tests

Several tests may be used to evaluate a suspected ovarian cancer:

• Transvaginal ultrasound: Uses sound waves to create images of the ovaries. Can distinguish between solid and fluid-filled masses and identify suspicious features.
• CA-125 blood test: Measures a protein often elevated in ovarian cancer. However, CA-125 can be elevated in other conditions and may be normal in early-stage cancer.
• HE4 blood test: Another tumor marker that may be used alongside CA-125 to improve diagnostic accuracy.
• CT scan: Provides detailed images of the abdomen and pelvis to assess the extent of disease and look for spread.
• MRI: May be used to better characterize ovarian masses or assess specific areas.
• PET scan: Can help detect cancer spread and is sometimes used in staging or to monitor treatment response.

Confirming the Diagnosis

A definitive diagnosis of ovarian cancer requires tissue examination (biopsy). In most cases, this occurs during surgery. A gynecologic oncologist performs surgery to remove the suspicious mass, and a pathologist examines the tissue to determine if cancer is present and what type it is.

Sometimes, if surgery is not immediately possible or if the cancer appears advanced, a biopsy may be obtained through a less invasive procedure. This can be done using image-guided needle biopsy or laparoscopy (minimally invasive surgery).

Genetic Testing

All women diagnosed with epithelial ovarian cancer should be offered genetic testing for BRCA1/BRCA2 and other genes associated with hereditary cancer syndromes. This information is important for:

• Treatment planning (PARP inhibitors are particularly effective for BRCA-mutated cancers)
• Informing family members who may also carry the mutation
• Guiding surveillance and prevention strategies for at-risk relatives

What Are the Stages of Ovarian Cancer?

Ovarian cancer is staged using the FIGO system, ranging from Stage I (confined to the ovaries) to Stage IV (spread to distant organs). Stage at diagnosis is the most important factor affecting prognosis. Unfortunately, about 70% of women are diagnosed at Stage III or IV because early symptoms are often vague or absent.

Staging determines how far the cancer has spread and guides treatment decisions. Ovarian cancer staging is determined surgically by examining the abdomen and pelvis, taking tissue samples, and analyzing them under a microscope. The staging system used is from the International Federation of Gynecology and Obstetrics (FIGO):

Each stage is further subdivided (A, B, C) based on more specific criteria about tumor size, location, and extent of spread. This detailed staging helps oncologists tailor treatment and estimate prognosis more precisely.

How Is Ovarian Cancer Treated?

Ovarian cancer treatment typically involves a combination of surgery and chemotherapy. Surgery aims to remove as much tumor as possible (cytoreductive surgery), often including the ovaries, fallopian tubes, uterus, and affected tissue. Chemotherapy usually includes platinum-based drugs and taxanes. Newer treatments include PARP inhibitors for BRCA-mutated cancers and targeted therapies like bevacizumab.

Treatment for ovarian cancer is highly individualized based on the stage, type, and grade of the cancer, as well as the patient's overall health and preferences. A gynecologic oncologist—a surgeon with specialized training in cancers of the female reproductive system—typically leads the treatment team.

The cornerstone of ovarian cancer treatment is optimal cytoreductive surgery (debulking), which aims to remove all visible tumor. Studies consistently show that women whose surgery achieves no visible residual disease (complete cytoreduction) have significantly better outcomes than those with remaining tumor.

Surgery

The extent of surgery depends on the stage of the cancer and the patient's overall condition. Standard surgical procedures may include:

• Bilateral salpingo-oophorectomy: Removal of both ovaries and fallopian tubes
• Total hysterectomy: Removal of the uterus and cervix
• Omentectomy: Removal of the fatty tissue covering the intestines
• Lymph node dissection: Removal and examination of pelvic and para-aortic lymph nodes
• Peritoneal biopsies: Tissue samples from the abdominal lining
• Debulking of visible tumors: Removal of cancer that has spread to other areas

For young women with early-stage disease who wish to preserve fertility, fertility-sparing surgery may be an option. This involves removing only the affected ovary and fallopian tube while preserving the uterus and the other ovary. This decision requires careful discussion with your oncology team.

Chemotherapy

Most women with ovarian cancer require chemotherapy, either after surgery (adjuvant chemotherapy) or before surgery (neoadjuvant chemotherapy). The standard regimen combines:

• Platinum-based drugs: Carboplatin is most commonly used; cisplatin may be used in certain situations
• Taxanes: Paclitaxel is standard; docetaxel is an alternative

Chemotherapy is typically given in cycles, with treatment followed by a rest period to allow the body to recover. Most women receive 6 cycles of treatment. Chemotherapy may be given intravenously (through a vein) or, in some cases, directly into the abdominal cavity (intraperitoneal chemotherapy).

Targeted Therapies

Advances in understanding ovarian cancer biology have led to the development of targeted therapies that attack specific vulnerabilities in cancer cells:

• PARP inhibitors (olaparib, niraparib, rucaparib): Particularly effective for cancers with BRCA mutations or homologous recombination deficiency (HRD). They work by preventing cancer cells from repairing their DNA, leading to cell death.
• Bevacizumab (Avastin): An anti-angiogenic drug that blocks the growth of new blood vessels that tumors need to grow. Often used in combination with chemotherapy.

PARP inhibitors have transformed the treatment landscape for ovarian cancer. In clinical trials, maintenance therapy with PARP inhibitors has significantly extended the time before cancer returns, particularly for women with BRCA-mutated cancers.

What If Ovarian Cancer Comes Back?

Unfortunately, ovarian cancer recurs in about 70-80% of women with advanced disease. Recurrent ovarian cancer is generally considered chronic but treatable. Treatment depends on when the cancer returns (platinum-sensitive vs. platinum-resistant) and may include additional chemotherapy, targeted therapies, surgery, or clinical trials.

Recurrence is one of the most challenging aspects of ovarian cancer. Even when initial treatment is successful and the cancer appears to be completely gone, microscopic cancer cells may remain and eventually grow. The goal of treatment for recurrent ovarian cancer shifts from cure to controlling the disease and maintaining quality of life.

The timing of recurrence relative to the last platinum-based chemotherapy is crucial for determining treatment options:

• Platinum-sensitive recurrence: Cancer returns more than 6 months after completing platinum-based chemotherapy. These cancers often respond well to additional platinum-based treatment.
• Platinum-resistant recurrence: Cancer returns within 6 months of completing platinum-based chemotherapy. Different chemotherapy drugs or targeted therapies are typically used.

For selected patients with platinum-sensitive recurrent disease, secondary cytoreductive surgery may be beneficial, especially if complete resection of visible disease is achievable. This decision is individualized based on factors including disease distribution, patient fitness, and surgeon expertise.

Treatments for Recurrent Disease

Multiple treatment options exist for recurrent ovarian cancer:

• Platinum-based combination chemotherapy (for platinum-sensitive disease)
• Non-platinum chemotherapy agents (pegylated liposomal doxorubicin, topotecan, gemcitabine)
• PARP inhibitors (especially for BRCA-mutated cancers)
• Bevacizumab in combination with chemotherapy
• Hormone therapy for certain tumor types
• Clinical trials investigating new treatments

How Does Ovarian Cancer Affect Daily Life?

Living with ovarian cancer involves managing physical symptoms, emotional challenges, and practical concerns. Common issues include fatigue, digestive changes, menopausal symptoms, and emotional distress. Support from healthcare teams, support groups, and loved ones is essential. Many women with ovarian cancer continue to live full, meaningful lives during and after treatment.

An ovarian cancer diagnosis affects virtually every aspect of life. Beyond the physical challenges of the disease and its treatment, women face emotional, social, and practical challenges that require ongoing support and management.

Understanding what to expect and connecting with resources can help you navigate this journey. Your healthcare team should include not just medical oncologists and surgeons, but also nurses, social workers, nutritionists, and mental health professionals who can address your comprehensive needs.

Managing Physical Symptoms

Treatment for ovarian cancer can cause various side effects that affect daily life:

• Fatigue: Often the most common and persistent symptom. Rest when needed, but also try to maintain some physical activity, which can actually help reduce fatigue.
• Digestive issues: Nausea, changes in appetite, and bowel changes are common. A dietitian can help manage these symptoms.
• Menopausal symptoms: Surgical removal of the ovaries causes immediate menopause, with symptoms including hot flashes, mood changes, and vaginal dryness.
• Peripheral neuropathy: Some chemotherapy drugs can cause numbness or tingling in the hands and feet.

Emotional and Psychological Support

A cancer diagnosis brings emotional challenges including fear, anxiety, depression, and uncertainty about the future. These feelings are normal and valid. Resources that may help include:

• Individual counseling with a psychologist or licensed therapist
• Support groups (in-person or online) connecting you with other ovarian cancer patients
• Mindfulness and stress-reduction techniques
• Open communication with family and friends

Sexuality and Intimacy

Ovarian cancer and its treatment can affect sexuality and intimate relationships. Physical changes from surgery, hormonal shifts from menopause, and emotional factors can all impact desire and physical comfort. Open communication with your partner and healthcare providers is important. Solutions are available for many concerns, including vaginal lubricants, hormone treatments (when appropriate), and counseling.

Can Ovarian Cancer Be Prevented?

While ovarian cancer cannot be completely prevented, several strategies can reduce risk. Oral contraceptive use for 5+ years reduces risk by about 50%. For high-risk women with BRCA mutations, preventive removal of ovaries and fallopian tubes after childbearing reduces risk by 80-90%. There is no effective screening test for average-risk women.

Prevention strategies vary based on individual risk level. For women at average risk, lifestyle modifications and awareness of symptoms are the primary approaches. For women at high risk due to genetic mutations or strong family history, more aggressive preventive measures may be appropriate.

Risk-Reducing Strategies for All Women

• Oral contraceptives: Using birth control pills for 5 or more years can reduce ovarian cancer risk by approximately 50%, with protection lasting 20-30 years after stopping
• Pregnancy and breastfeeding: Both reduce the number of ovulations and lower risk
• Tubal ligation: Having fallopian tubes tied or removed may reduce risk
• Healthy lifestyle: Maintaining a healthy weight and avoiding smoking may help reduce risk

For High-Risk Women

Women with BRCA1/BRCA2 mutations or strong family histories should discuss enhanced options with their healthcare providers:

• Risk-reducing salpingo-oophorectomy (RRSO): Surgical removal of ovaries and fallopian tubes, typically recommended after childbearing is complete (by age 35-40 for BRCA1, by age 40-45 for BRCA2)
• Enhanced surveillance: Regular transvaginal ultrasound and CA-125 testing, though these are not proven to reduce mortality
• Oral contraceptives: Particularly beneficial for high-risk women