The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
In this article you’ll find information on ovarian cancer including:
- survival rates
Ovarian cancer occurs when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer.
Ovarian cancer often has warning signs, but the earliest symptoms are vague and easy to dismiss.
The early signs and symptoms of ovarian cancer can sometimes be easy to miss or dismiss. And there’s no routine diagnostic screening available for ovarian cancer. Most often, women with later-stage forms of the cancer will experience symptoms — but even early-stage ovarian cancer can produce them.
Early signs and symptoms
- abdominal bloating, pressure, and pain
- abnormal fullness after eating
- difficulty eating
- an increase in urination
- an increased urge to urinate
While many of these early signs of ovarian cancer can be signs of other, more benign conditions, it’s important to note that with ovarian cancer, these symptoms will be persistent, and will be a noticeable change from your typical, day-to-day sensations.
If you find yourself experiencing these symptoms more than
Later signs and symptoms
Ovarian cancer can also cause other symptoms, especially if it’s not caught early. Some of these possible symptoms include
- back pain
- menstrual irregularities (bleeding outside of your normal cycle)
- painful intercourse
- dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles)
- loss of appetite
- weight loss
- changes in bowel habits (constipation)
The symptoms will persist if they’re due to ovarian cancer. Symptoms usually become more severe as the tumor grows. By this time, the cancer has usually spread outside of the ovaries, making it much harder to treat effectively.
If the cancer has reached a later stage without intervention, some individuals may develop:
- fluid buildup around the lungs (pleural effusion)
- fluid buildup in the abdomen (ascites)
- obstruction or blockage of the digestive tract (bowel obstruction)
If you are dealing with pleural effusion, you may experience shortness of breath, a cough, and/or chest pain.
While many of the symptoms of ovarian cancer are the same pre- and post-menopause, one big difference is bleeding.
Once you’ve gone through menopause, you’ll no longer have your monthly period. And while menopause can be a process, if you’ve stopped having your periods for some time, and then notice bleeding, it could be a sign of ovarian cancer.
It’s also important to note that ovarian cancer is more common in women over 60.
The ovaries are made up of three types of cells. Each cell can develop into a different type of tumor:
- Epithelial ovarian carcinomas form in the layer of tissue on the outside of the ovaries. About
85 to 90 percentof malignant ovarian cancers are epithelial ovarian tumors.
- Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumors.
- Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare.
Most ovarian cysts aren’t cancerous. These are called benign cysts. However, a very small number can be cancerous.
An ovarian cyst is a collection of fluid or air that develops in or around the ovary. Most ovarian cysts form as a normal part of ovulation, which is when the ovary releases an egg. They usually only cause mild symptoms, like bloating, and go away without treatment.
Cysts are more of a concern if you aren’t ovulating. Women stop ovulating after menopause. If an ovarian cyst forms after menopause, your doctor may want to do more tests to find out the cause of the cyst, especially if it’s large or doesn’t go away within a few months.
If the cyst doesn’t go away, your doctor may recommend surgery to remove it just in case. Your doctor can’t determine if it’s cancerous until they remove it surgically.
Ovarian cyst vs. cancer
While ovarian cysts are typically not cancerous, it can be nerve-wracking when one is first discovered, especially if your doctor is not certain which they might be dealing with. However, there are a few subtle differences:
- ovarian cysts are usually filled with fluid, while ovarian tumors are solid masses of cells
- ovarian cysts may grow or appear bigger or smaller with your menstrual cycle. Cancerous tumors do not go away on their own.
Your doctor will help you figure out which you may be dealing with.
The exact cause of ovarian cancer is unknown. However, these factors can increase your risk:
- a family history of ovarian cancer
- genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
- a personal history of breast, uterine, or colon cancer
- the use of certain fertility drugs or hormone therapies
- no history of pregnancy
Older age is another risk factor. Most cases of ovarian cancer develop after menopause.
It’s possible to have ovarian cancer without having any of these risk factors. Likewise, having any of these risk factors doesn’t necessarily mean you’ll develop ovarian cancer.
It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect.
Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumor. And unlike other cancers like breast and colon cancer, there are no routine screenings for ovarian cancer. That’s why it’s so important to report unusual or persistent symptoms to your doctor.
If your doctor is concerned that you have ovarian cancer, they’ll likely recommend a pelvic exam. Performing a pelvic exam can help your doctor discover irregularities, but small ovarian tumors are very difficult to feel.
As the tumor grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.
Your doctor may also do the following tests:
- Transvaginal ultrasound (TVUS). TVUS is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine whether tumors are cancerous.
- Abdominal and pelvic CT scan. If you’re allergic to dye, they may order a pelvic MRI scan.
- Blood test to measure cancer antigen 125 (CA-125) levels. A CA-125 test is a biomarker that’s used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect CA-125 levels in the blood.
- Biopsy. A biopsy involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope.
- Chest CT scan. To test for metastasis in the lungs
- Positron Emission Tomography (PET) scan. This test involves a special dye containing radioactive tracers that can either be swallowed or injected. Organs and tissues then absorb the tracer, which allow a doctor to see how well those organs are working.
While these tests can help guide your doctor toward a diagnosis, a biopsy is the only way your doctor can confirm whether you have ovarian cancer.
Your doctor determines the stage based on how far the cancer has spread. There are four stages, and each stage has substages:
Stage 1 ovarian cancer has three substages:
- Stage 1A.The cancer is limited, or localized, to one ovary.
- Stage 1B. The cancer is in both ovaries.
- Stage 1C. There are also cancer cells on the outside of the ovary.
In stage 2, the tumor has spread to other pelvic structures. It has two substages:
- Stage 2A. The cancer has spread to the uterus or fallopian tubes.
- Stage 2B. The cancer has spread to the bladder or rectum.
Stage 3 ovarian cancer has three substages:
- Stage 3A. The cancer has spread microscopically beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
- Stage 3B. The cancer cells have spread beyond the pelvis to the lining of the abdomen and are visible to naked eye but measure less than 2 centimeters.
- Stage 3C. Deposits of cancer at least 3/4 of an inch are seen on the abdomen or outside the spleen or liver. However, the cancer isn’t inside the spleen or liver.
In stage 4, the tumor has metastasized, or spread, beyond the pelvis, abdomen, and lymph nodes to the liver or lungs. There are two substages in stage 4:
- In stage 4A, the cancerous cells are in the fluid around the lungs.
- In stage 4B, the most advanced stage, the cells have reached the inside of the spleen or liver or even other distant organs like the skin or brain.
The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:
- surgery to stage the cancer and remove the tumor
- targeted therapy
- hormone therapy
Surgery is the main treatment for ovarian cancer.
The goal of surgery is to remove the tumor, but a hysterectomy, or complete removal of the uterus, is often necessary.
Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue.
Identifying all tumor locations is difficult.
In one study, researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.
Targeted therapies, such as chemotherapy, attack the cancer cells while doing little damage to normal cells in the body.
Newer targeted therapies to treat advanced epithelial ovarian cancer include PARP inhibitors. These drugs block an enzyme used by cells to repair damage to their DNA.
The first PARP inhibitor was approved in 2014 for use in advanced ovarian cancer that had been treated previously with three lines of chemotherapy (meaning at least two recurrences). However, for those with advanced ovarian cancers, PARP inhibitors may be offered alongside chemotherapy.
The three PARP inhibitors currently available include:
- olaparib (Lynparza)
- niraparib (Zejula)
- rucaparib (Rubraca)
The addition of another drug, bevacizumab (Avastin), has also been used with chemotherapy following surgery.
Individuals who have the BRCA1 or BRCA2 genes may have slightly different targeted therapy options,
Cancer treatments — including chemotherapy, radiation, and surgery — can damage your reproductive organs, making it difficult to become pregnant.
If you want to become pregnant in the future, talk to your doctor before starting treatment. They can discuss your options for possibly preserving your fertility.
- Embryo freezing. This involves freezing a fertilized egg.
- Oocyte freezing. This procedure involves freezing an unfertilized egg.
- Surgery to preserve fertility. In some cases, surgery that only removes one ovary and keeps the healthy ovary can be done. This is usually only possible in early stage ovarian cancer.
- Ovarian tissue preservation. This involves removing and freezing ovarian tissue for future use.
- Ovarian suppression. This involves taking hormones to suppress ovarian function temporarily.
Ovarian cancer treatment primarily focuses on surgery to remove the ovaries and uterus, plus chemotherapy. As a result, some women will experience menopause symptoms.
New treatments for ovarian cancer are studied each year.
Researchers are also exploring new ways to treat platinum-resistant ovarian cancer. When platinum resistance occurs, platinum-based chemotherapy drugs such as carboplatin or cisplatin are ineffective.
The future of PARP inhibitors will be in identifying what other drugs can be used in combination with them to treat tumors that show unique characteristics.
Recently, some promising therapies have started clinical trials such as a potential vaccine against recurrent ovarian cancers that express the survivin protein.
In May 2020,
New targeted therapies are being studied, including the antibody navicixizumab, the ATR inhibitor AZD6738, and the Wee1 inhibitor adavosertib. All have shown signs of anti-tumor activity.
In 2018, the FDA fast-tracked a protein therapy called AVB-S6-500 for platinum-resistant ovarian cancer. This aims to prevent tumor growth and cancer spread by blocking a key molecular pathway.
There are no proven ways to totally eliminate your risk of developing ovarian cancer. However, factors that have been shown to lower your risk of developing ovarian cancer include:
- taking oral birth control pills
- surgical procedures on your reproductive organs (like a tubal ligation or hysterectomy)
Your outlook depends on a variety of factors, including:
- the stage of the cancer at diagnosis
- your overall health
- how well you respond to treatment
Every cancer is unique, but the stage of the cancer is the most important indicator of outlook.
The survival rate is the percentage of women who survive a certain number of years at a given stage of diagnosis.
For example, the 5-year survival rate is the percentage of patients who received a diagnosis at a particular stage and live at least 5 years after their doctor diagnosed them.
The relative survival rate also takes into account the expected rate of death for people without cancer.
Here’s how SEER currently categorizes the various stages:
- Localized. No sign that the cancer has spread outside of the ovaries.
- Regional. Cancer has spread outside the ovaries to nearby structures or lymph nodes.
- Distant. Cancer has spread to distant parts of the body, such as the liver or lungs.
5-year relative survival rates for ovarian cancer
Invasive epithelial ovarian cancer
|SEER stage||5-year relative survival rate|
Ovarian stromal tumors
|SEER stage||5-year relative survival rate|
Germ cell tumors of the ovary
|SEER stage||5-year relative survival rate|
Note that this data comes from studies that could be at least 5 years or older.
Scientists are currently researching more improved and reliable ways to detect ovarian cancer early. Advancements in treatments improve, and with it, the outlook for ovarian cancer.