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Ovarian cancer

Ovarian cancer types

Every ovarian cancer patient is different, and each deserves a treatment plan tailored to her needs and specific diagnosis. That starts with knowing what type of ovarian cancer you have. Although ovarian cancer is categorized into more than 30 different types, most are identified based on the name of the cell in which the cancer originated. Cancerous ovarian tumors develop most commonly in the epithelial cells, which make up the outer layer of the ovary; the germ cells, which form eggs; or in the stromal cells, which produce and release hormones.

Ovarian epithelial cancer

Although most epithelial ovarian tumors are benign, cancerous epithelial tumors, or epithelial ovarian carcinomas, account for 85 percent to 90 percent of ovarian cancers. They are often referred to by their subtype: mucinous, endometrioid, clear cell and undifferentiated. They commonly spread to the lining and organs of the pelvis and abdomen first before spreading elsewhere, such as to the lungs and liver. They also may spread to the brain, bones and skin.

Ovarian low malignant potential tumors are an ovarian epithelial subtype that occurs when abnormal cells form in the tissue covering the ovary. They are so named because the tumors have a low likelihood of turning into cancer. But in rare instances, the abnormal cells become malignant, and when they do, these tumors tend to grow slowly and affect younger women. They also do not typically spread beyond the ovary, and they usually respond well to treatment.

Two other types of cancer are similar to epithelial ovarian cancer: primary peritoneal carcinoma and fallopian tube cancer, both of which closely resemble epithelial ovarian cancer and are often treated with the same approaches and techniques. Primary peritoneal carcinoma develops in the lining of the pelvis and abdomen. Fallopian tube cancer starts in the fallopian tubes. Both are rare.

Germ cell tumors

Tumors may appear in the germ cells, or egg-producing cells, of the ovaries. Most of these tumors are benign. Cancerous germ cell tumors make up less than 2 percent of ovarian cancers. Teens and women in their 20s are more likely to have this type of ovarian cancer.

Ovarian germ cell tumors are divided into the following subtypes:

  • Teratomas are germ cell tumors that are either benign (mature) or cancerous (immature). Immature teratomas are rare. Their cells commonly contain different types of tissue, such as hair, muscle and bone.
  • Dysgerminoma ovarian germ cell cancer is rare, but it’s the most common germ cell ovarian cancer. Dysgerminomas don’t typically grow or spread quickly. They may also occur in other parts of the body, such as the central nervous system.
  • Endodermal sinus tumor (yolk sac tumor) and choriocarcinoma tumors are extremely rare. Choriocarcinomas may start in either the placenta during pregnancy, which are more common, or in the ovaries.

Sex cord-stromal tumors

Also called sex cord tumors, sex cord-gonadal stromal tumors and ovarian stromal tumors, sex cord-stromal tumors are rare, making up about 1 percent of ovarian cancers. They develop from the stroma tissue cells that produce the female hormones estrogen and progesterone. Because sex-cord stromal tumors make an overabundant supply of estrogen, they often cause abnormal vaginal bleeding.

Subtypes of sex cord-stromal tumors include granulosa cell tumors, granulosa-theca tumors and Sertoli-Leydig tumors.

Less common types

Ovarian cancer is rare, accounting for about 3 percent of cancers among women. While the most common types of ovarian cancer are epithelial, germ cell and stromal tumors, some of the rarer types of ovarian cancer occur more than others. These include:

  • Ovarian sarcoma: Unlike their carcinoma counterparts, ovarian sarcoma tumors develop in the connective tissues of ovarian cells. Their most common subtypes are carcinosarcomas, adenosarcomas, leiomyosarcomas and fibrosarcomas.
  • Krukenberg tumors: A Krukenberg tumor is cancer that spreads to the ovaries from other organs, typically from the gastrointestinal tract. Gynecologic oncologists usually treat Krukenberg tumors in collaboration with the medical oncologist and other members of the care team treating the patient’s original cancer.
  • Ovarian cysts: Ovarian cysts are fluid-filled sacs that develop inside the ovary. They’re common during ovulation and often go away on their own without treatment. Although most ovarian cysts are benign, some may develop into cancer.

Recurrent ovarian cancer

Recurrent or relapsed ovarian cancer occurs when malignant cells reappear after cancer treatments such as surgery or chemotherapy have been completed for a period of time. When ovarian cancer recurs, it is not re-staged. Recurrent ovarian cancer may return at its original location, or it may be found somewhere else in the body.

Ovarian cancer typically recurs when a small number of cancer cells survive the treatment process but are not detected on tests. After treatment, these cancer cells may grow into tumors.

The signs of recurrent ovarian cancer may vary from patient to patient. Because ovarian cancer often recurs in the abdomen and pelvis, near the bladder and the intestines, gastrointestinal and urinary symptoms typically develop.

Signs and symptoms of ovarian cancer recurrence may include:

  • Persistent abdominal bloating, indigestion or nausea
  • Changes in appetite, typically a loss of appetite or feeling full sooner
  • Pressure in the pelvis or lower back
  • Urge to urinate more frequently
  • Changes in bowel movements
  • Increased abdominal girth
  • Lethargy, fatigue or lack of energy
  • Abdominal pain or swelling
  • Elevated levels of the protein CA-125

According to the Ovarian Cancer National Alliance, most patients diagnosed with ovarian cancer develop a recurrence. The cancer recurrence rate varies by patient, but the risk increases with the cancer’s stage at the time it was originally diagnosed (the more advanced the stage, the higher the risk). Follow-up appointments with your oncologist may help detect cancer relapse early. Routine gynecologic care and annual pelvic exams are recommended to screen for symptoms of relapsed ovarian cancer.

Next topic: What are the stages of ovarian cancer?