Ovarian cancerCancer - ovaries
Ovarian cancer is cancer that starts in the ovaries. The ovaries are the female reproductive organs that produce eggs.
Ovarian cancer is the fifth most common cancer among women. It causes more deaths than any other type of female reproductive organ cancer.
The cause of ovarian cancer is unknown.
Risks of developing ovarian cancer include any of the following:
- The fewer children a woman has and the later in life she gives birth, the higher her risk for ovarian cancer.
- Women who have had breast cancer or have a family history of breast or ovarian cancer have an increased risk for ovarian cancer (due to defects in the BRCA1 or BRCA2 genes).
- Women who take estrogen replacement only (not with progesterone) for 5 years or more may have a higher risk for ovarian cancer. Birth control pills, though, decrease the risk for ovarian cancer.
- Fertility medicine probably does not increase the risk for ovarian cancer.
- Older women are at highest risk of developing ovarian cancer. Most deaths from ovarian cancer occur in women age 55 and older.
Ovarian cancer symptoms are often vague. Women and their doctors often blame the symptoms on other, more common conditions. By the time the cancer is diagnosed, the tumor has often spread beyond the ovaries.
See your doctor if you have the following symptoms on a daily basis for more than a few weeks:
- Bloating or swollen belly area
- Difficulty eating or feeling full quickly (early satiety)
- Pelvic or lower abdominal pain (area may feel "heavy")
- Back pain
- Swollen lymph nodes in groin
Other symptoms that can occur:
Exams and Tests
A physical exam is often normal. With advanced ovarian cancer, the doctor may find a swollen abdomen often due to accumulation of fluid (ascites).
A pelvic examination may reveal an ovarian or abdominal mass.
A CA-125 blood test is not considered a good screening test for ovarian cancer. But, it may be done if a woman has:
- Symptoms of ovarian cancer
- Already been diagnosed with ovarian cancer to determine how well treatment is working
Other tests that may be done include:
Surgery, such as a pelvic laparoscopy or exploratory laparotomy, is often done to find the cause of symptoms. A biopsy will be done to help make the diagnosis.
No lab or imaging test has ever been shown to be able to successfully screen for or diagnose ovarian cancer in its early stages, so no standard screening tests are recommended at this time.
Surgery is used to treat all stages of ovarian cancer. For early stages, surgery may be the only treatment. Surgery may involve removing both ovaries and fallopian tubes, the uterus, or other structures in the belly or pelvis.
Chemotherapy is used after surgery to treat any cancer that remains. Chemotherapy can also be used if the cancer comes back (relapses). Chemotherapy can be given intravenously (through an IV). It can also be injected directly into the abdominal cavity (intraperitoneal, or IP).
Radiation therapy is rarely used to treat ovarian cancer in the United States.
After surgery and chemotherapy, follow instructions about how often you should see your doctor and the tests you should have.
You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.
Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made:
- Nearly one half of women live longer than 5 years after diagnosis
- If diagnosis is made early in the disease and treatment is received before the cancer spreads outside the ovary, the 5-year survival rate is high
When to Contact a Medical Professional
Contact your health care provider if you are a woman 40 years or older who has not recently had a pelvic exam. Routine pelvic exams are recommended for all women 20 years or older.
Call for an appointment with your provider if you have symptoms of ovarian cancer.
There are no standard recommendations for screening for ovarian cancer. Pelvic ultrasound or a blood test, such as CA-125, has not been found to be effective and is not recommended.
BRCA1 or BRCA2 genetic testing may be recommended for women at high risk for ovarian cancer. These are women who have a personal or family history of breast or ovarian cancer.
Removing the ovaries and fallopian tubes in women who have a proven mutation in the BRCA1 or BRCA2 gene may reduce the risk of developing ovarian cancer. But, ovarian cancer may still develop in other areas of the pelvis.
Coleman RL, Ramirez PT, Gershenson DM. Neoplastic diseases of the ovary: screening, benign and malignant epithelial and germ cell neoplasms, sex-cord stromal tumors. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 33.
Morgan M, Boyd J, Drapkin R, Seiden MV. Cancers arising in the ovary. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 89.
National Cancer Institute website. BRCA mutations: cancer risk and genetic testing. www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet. Updated January 30, 2018. Accessed November 12, 2018.