Which Way Does Ovarian Cancer Tend to Spread or Metastasize?

Ovarian cancer usually originates in the fallopian tubes. It can spread within the pelvis or beyond the pelvis walls.

“Most commonly, the cancer originates from a mutation in the epithelial cells,” explains Michelle Forcier, MD, a gender affirming clinician with virtual healthcare service FOLX. This is known as epithelial ovarian cancer.

Epithelial cells cover the surface of the ovaries, line the fallopian tubes, and cover the peritoneal membrane, which encases organs in the abdomen and pelvis, they say.

When the cancer spreads within the pelvis — such as to the peritoneal cavity and lower abdomen — it’s known as locally advanced ovarian cancer.

Without a diagnosis and treatment, the cancer can spread to more distant parts of the body, explains Forcier. Cancer that spreads beyond the boundaries of the pelvis is known as metastatic ovarian cancer.

Metastatic ovarian cancer commonly affects lymph nodes, then the liver, and then the lungs before spreading further into the body.

There are three main spreading patterns typically observed in undiagnosed, untreated, or ineffectively treated ovarian cancer.

The main dissemination pattern is through intracavity spread, while lymphatic and hematogenous spread represent secondary routes.

Intracavity spread

Sometimes, ovarian cancer starts by spreading beyond the ovaries to other surfaces within the pelvis. This is known as intracavity spread.

Here, cancer may spread to the:

• peritoneal cavity, the space between the pelvis and the abdomen
• area under the diaphragm’s surface
• omentum, the tissue that overlays the abdominal organs
• walls of the bowel, appendix, or liver

Lymphatic spread

A network of lymph vessels connects all lymph nodes in the body. So, when cancerous cells affect one lymph node, the other nodes and broadly interconnected lymphatic channels can become cancerous, too.

Hematogenous

Also known as bloodstream spread, this type happens when ovarian cancer cells enter the blood vessels and circulation.

How quickly the cancer spreads depends on the particular case’s spreading pattern. Cancer spreads more quickly through the blood than through the lymph system. Intracavity spread is typically the slowest.

Ovarian cancer that begins in the fallopian tubes takes about 6 1/2 years to spread to the ovaries. If cancer reaches the ovaries, it may spread much more quickly to other body parts.

Some data suggests ovarian cancer can take approximately 2 years to spread to places like the peritoneal cavity and abdomen. However, this is an average — not a guarantee.

“In some patients, ovarian cancer will spread from early stage to advanced stage within a year,” explains Tchabo.

Further, one of the most common types of ovarian cancer, called cancerous epithelial carcinoma, can spread within a matter of weeks to months, she says.

Healthcare professionals use a staging system to describe the size of a cancerous tumor and show how far the cancer spread extends from its origin in the body.

There are four widely recognized stages of ovarian cancer:

• Stage 1: First, the cancer spread involves one or both ovaries or the fallopian tubes.
• Stage 2: Second, the cancer spread reaches other pelvis organs, like the uterus, bladder, and rectum.
• Stage 3: Third, the cancer spreads to the lymph nodes, abdominal lining, or omentum.
• Stage 4: Lastly, the fourth stage involves cancer spreading to distant organs, such as the lungs or liver.

Experts may break down these classifications into substages.

One of the challenges with ovarian cancer is that the signs and symptoms associated with this disease are nonspecific, says Sanaz Memarzadeh, MD, a gynecologic oncologist with UCLA Health in Los Angeles.

Some people can easily attribute certain symptoms to other conditions, including menstruation and menopause, she says.

A 2020 study found that many people who receive ovarian cancer diagnoses recall experiencing symptoms that, although they didn’t make sense initially, make sense following diagnosis.

This suggests that people might often be unaware of what symptoms to watch for or report to a healthcare professional.

The following symptoms commonly link to ovarian cancer, says Memarzadeh:

• abdominal pain or pelvic pain
• distention (abdominal swelling) or bloating
• changes in bowel or bladder function
• early satiety (feeling full faster than usual)
• loss of appetite
• unintentional weight loss

Unexpected vaginal bleeding and unusual changes in vaginal discharge can also indicate ovarian cancer — in particular, among postmenopausal people.

“If you are experiencing any of these symptoms, it’s best to see a physician so that you can undergo a gynecologic evaluation in addition to other indicated tests,” says Memarzadeh.

Ovarian cancer is the second most common gynecologic cancer in the United States. However, the American Cancer Society notes that diagnoses have declined over the past few decades.

Currently, there’s no reliable way to screen for ovarian cancer, so it’s important to be aware of the symptoms. Prompt diagnosis and treatment can help improve the overall outlook and reduce the risk of long-term complications.

Make an appointment with a healthcare professional if you have questions about your risk, symptoms you have, or other concerns.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.