About ovarian cancer

Ovarian cancer develops in the ovaries, which are part of the female reproductive system and produce eggs during a woman's reproductive years. The ovaries also produce the female hormones estrogen and progesterone.

The American Cancer Society estimates that 21,410 new cases of ovarian cancer will be diagnosed in the United States in 2021. Although relatively rare—accounting for about 3 percent of all cancers in women—ovarian cancer is the fifth leading cause of cancer-related deaths among women in the United States.

At Cancer Treatment Centers of America^® (CTCA), our gynecologic oncologists are trained and experienced in treating all stages of gynecologic cancer, from diagnosis to survivorship. They will lead your multidisciplinary care team and work with you to design a comprehensive, personalized cancer care plan. The plan will be tailored to meet your needs and treatment goals, and may include fertility-preserving options if necessary and appropriate. Your cancer care plan will also be designed to help you manage ovarian cancer-related side effects, such as fatigue, nausea and neuropathy, so that you are better able to maintain your quality of life throughout treatment.

While the exact cause is not known, several factors may increase the risk of ovarian cancer. Women with a strong family history of breast or ovarian cancer may be at an increased risk.

Some other common risk factors for ovarian cancer include:

• Inherited genetic BRCA mutations on breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2)
• Inherited genetic disorders of Lynch syndrome or Peutz-Jeghers syndrome
• Previous breast cancer, colorectal cancer or endometrial cancer

There are also factors that lower the risk for ovarian cancer, which include:

• Childbearing status, with the risk declining as a woman has more children (breastfeeding further reduces the risk)
• Birth control, with women who use oral contraceptives for at least three months at lower risk and the risk further declining the longer contraceptives are taken and continuing for years after the contraceptives are stopped
• Gynecologic surgery, with women who have had a tubal ligation or hysterectomy at reduced risk

Two-thirds of women who develop ovarian cancer are diagnosed after menopause, at age 55 or older.

Those with a mother, sister, grandmother or aunt who has had ovarian cancer are also high risk for ovarian cancer.

There are more than 30 different types of ovarian cancer, with most identified based on the name of the cell in which the cancer originates.

Cancerous ovarian tumors develop most commonly in the epithelial cells, which make up the outer layer of the ovary (epithelial ovarian cancer); in the germ cells, which form eggs (germ cell tumors); or in the stromal cells, which produce and release hormones (ovarian stromal tumors).

The types of cancer of the ovaries include:

• Epithelial ovarian carcinomas, including mucinous, endometrioid, clear cell, undifferentiated and, in rare instances, some that form in ovarian low malignant potential tumors
• Primary peritoneal carcinoma (also called primary peritoneal cancer)
• Fallopian tube cancer
• Immature teratomas
• Dysgerminoma ovarian germ cell cancer
• Endodermal sinus tumor (yolk sac tumor)
• Choriocarcinomas
• Sex cord-stromal tumors (also called sex cord tumors, sex cord-gonadal stromal tumors or ovarian stromal tumors), including granulosa cell tumors, granulosa-theca
• tumors and Sertoli-Leydig tumors
• Ovarian sarcomas, including carcinosarcomas, adenosarcomas, leiomyosarcomas and fibrosarcomas
• Ovarian cysts
• Recurrent ovarian cancer

Women are more likely to experience symptoms once the cancer cells have spread beyond the ovaries, typically to the lymph nodes outside the abdomen, the skin, the liver, the spleen, the fluid around the lungs, the intestines or the brain. The lack of early symptoms can make early detection difficult.

Symptoms caused by ovarian tumors may be confused with less serious, non-cancerous conditions.

Common symptoms of ovarian cancer may include:

• Abdominal bloating, indigestion or nausea
• Trouble eating, such as a loss of appetite or feeling full sooner
• Pressure in the pelvis or lower back
• More frequent urination or an urgent need to urinate
• Changes in bowel habits and/or constipation
• Increased abdominal girth
• Tiredness or low energy
• Changes in menstruation
• Elevated levels of the protein CA-125

Ovarian cysts, masses and tumors may be either benign (non-cancerous) or malignant (cancerous). Symptoms of these pelvic masses may include:

Many people mistakenly believe that a Pap smear test can provide an ovarian cancer diagnosis. In fact, there is no reliable routine screening test for ovarian cancer. Most ovarian cancers aren’t diagnosed until they have progressed to a more advanced stage. Symptoms during the early stages of the disease mimic common stomach and digestive issues that are often mistaken for minor ailments.

At CTCA^®, our oncology team uses a variety of techniques to diagnose ovarian cancer, including:

• Biopsy
• Computed tomography scan (CT scan)
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET)/CT scan
• Ultrasound, including transvaginal ultrasound
• Advanced genetic testing, examining abnormal cells for DNA alterations
• CA-125 test, a blood test to determine levels of the CA-125 protein
• Pelvic exam

According to the American Cancer Society, the five-year survival rate for ovarian cancer ranges from 30 percent for advanced ovarian cancer that has spread to distant parts of the body to 92 percent for cancer that has not spread outside the ovaries.

Treatment options for ovarian cancer patients may include:

• Surgery, which may involve debulking (locating and removing visible signs of cancer) or the removal of the ovaries and fallopian tubes, also known as salpingo-oophorectomy. Surgery may also involve the removal of the uterus (hysterectomy), lymph nodes in the area or the surrounding organs and tissue
• Chemotherapy, given orally or intravenously, or injected directly into the abdomen through intraperitoneal chemotherapy
• Hormone therapy
• Ovarian cortex cryopreservation, involving freezing ovarian tissue before treatment so a woman may be able to bear children later
• Targeted therapy, including the use of PARP (the enzyme poly ADP-ribose polymerase) inhibitors