Ovarian Cancer
Topic Overview
What is ovarian cancer?
Ovarian cancer happens when cells that are not normal grow in or near your ovaries. The ovaries are two small glands, located on either side of your uterus. They produce female sex hormones and store and release eggs (ova).
Treatments for ovarian cancer are more successful when the cancer is found early. But most of the time, cancer has already spread by the time it is found.
This topic is about epithelial ovarian cancer. This is cancer that grows in the tissue covering the ovaries. It is the most common type of ovarian cancer and usually occurs in women who are past menopause.
What causes ovarian cancer?
Experts don’t know exactly what causes ovarian cancer. But they do know that DNA changes play a role in many cancers.
What are the symptoms?
Symptoms of ovarian cancer may include:
- Recent, frequent bloating.
- Pain in the belly or pelvis.
- Trouble eating, or feeling full quickly.
- Urinary problems, such as an urgent need to urinate or urinating more often than usual.
These symptoms may be common in women who don’t have ovarian cancer. But if these symptoms are new for you, and they happen almost daily for 2 to 3 weeks, you should see a doctor.
How is ovarian cancer diagnosed?
Sometimes the doctor may feel a lump in or on an ovary during a pelvic exam. Often a lump may be seen during an ultrasound. Most lumps aren’t cancer.
If your doctor thinks you may have ovarian cancer, you may have a blood test called CA-125 (cancer antigen 125). Too much CA-125 in your blood can be a sign of ovarian cancer. But too much CA-125 in the blood can be caused by many things, such as the menstrual cycle, endometriosis, and uterine fibroids.
The only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery. Tissue samples will be sent to a lab to see if they contain cancer.
How is it treated?
Surgery is the main treatment. The doctor will remove any tumors that he or she can see. This usually means taking out one or both ovaries. It may also mean taking out the fallopian tubes and uterus. Chemotherapy is often part of treatment. It may be given before and after surgery. Targeted therapy or hormone therapy may also be used.
When you find out that you have cancer, you may feel many emotions and may need some help coping. Talking with other women who are going through the same thing may help. Your doctor or your local branch of the American Cancer Society can help you find a support group.
What are your chances of getting ovarian cancer?
For most women, the chances of getting this cancer are small. It most often affects women who are past menopause. You may be more likely to get it if other women in your family have had it. Also, some women inherit gene changes that increase their chances of getting it.
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Cause
Experts don’t know exactly what causes ovarian cancer. Genetics, such as DNA changes, are a risk factor for some women.
About 10 out of 100 ovarian cancers are thought to be caused by gene mutations in the BRCA1 or BRCA2 genes.footnote 1 The risk for women who have these gene changes is much higher than for women without them.
Symptoms
In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian cancer include:
- Frequent bloating.
- Pain in your belly or pelvis.
- Trouble eating, or feeling full quickly.
- Urinary problems, such as an urgent need to urinate or urinating more often than usual.
If you have one or more of these symptoms, and it occurs almost daily for more than 2 or 3 weeks, talk with your doctor.
These symptoms are common for some women. They may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a pattern:
- They start suddenly.
- They feel different than your normal digestive or menstrual problems.
- They happen almost every day and don’t go away.
Other symptoms that affect some women with ovarian cancer include:
- Fatigue.
- Indigestion.
- Back pain.
- Pain with intercourse.
- Constipation.
- Menstrual cycle changes.
But these symptoms are also common in some women who don’t have ovarian cancer.
What Happens
Ovarian cancer often spreads early. Because it grows in the tissues covering the ovaries, it can spread easily within the abdominal cavity to the bowels and bladder or the abdominal lining. From there it may travel to other organs in the body, such as the liver or lungs.
What Increases Your Risk
A risk factor is anything that increases your chance of getting a disease such as cancer. The main risk factors for ovarian cancer include:
- Having a family history of ovarian cancer. Having a mother, sister, or daughter who has had ovarian cancer will raise your risk. And if you have two close relatives with cancer, you will have a higher risk.
- Inheriting gene changes. A small number of women with a family history of cancer have inherited gene changes, such as the BRCA gene changes. Having certain gene changes can put a woman at the highest risk for ovarian cancer.
But most women who get ovarian cancer do not have these risk factors.
Ovarian cancer most often affects postmenopausal women. You may also be more likely to get this cancer if:
- You never had a baby.
- You started your menstrual cycles before age 12 and went through menopause after age 50.
- You are unable to become pregnant.
- You have used hormone therapy for menopause symptoms.
Some things that lower a woman’s risk for ovarian cancer include:
- Taking birth control pills (oral contraceptives). But birth control pills may have other health risks, so talk with your doctor.
- Having babies and breastfeeding.
- Having both tubes tied (tubal ligation) or having a hysterectomy. But you will not be able to become pregnant after having either of these surgeries.
If you have a strong family history of ovarian or breast cancer, you may want to talk with your doctor or a genetic counselor about having genetic testing to look for gene changes.
When should you call your doctor?
Ovarian cancer may cause early symptoms. Talk to your doctor if you have one or more of the following symptoms almost daily for more than 2 or 3 weeks:
- Bloating.
- Pain in your belly or pelvis.
- Trouble eating, or feeling full quickly.
- Urinary problems, such as feeling an urgent need to urinate or urinating more often than usual.
These symptoms may be common for some women. They may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a pattern:
- They start suddenly.
- They feel different than your normal digestive or menstrual problems.
- They happen almost every day and don’t go away.
If you’ve been diagnosed
If you have been diagnosed with ovarian cancer, be sure to follow your doctor’s instructions about calling when you have problems, new symptoms, or symptoms that get worse.
Who to see
Health professionals who can evaluate your symptoms and your risk for ovarian cancer include:
- Nurse practitioner.
- Physician assistant.
- Internist.
- Gynecologist.
- Obstetrician.
- Family medicine physician.
Doctors who can manage your cancer treatment include:
- Gynecologic oncologist.
- Medical oncologist (often called an “oncologist”).
Exams and Tests
Some exams and tests that are done to look for or diagnose ovarian cancer include:
- A biopsy, which is the only way to know for sure if a woman has ovarian cancer. This usually is done with a laparotomy, through a cut (incision) in the belly.
- A physical exam, including a pelvic exam and Pap test. An ovarian lump may be felt during a pelvic exam. A rectovaginal exam may also be done to feel the pelvic organs.
- A cancer antigen 125 (CA-125) level, to measure a protein found on the surface of many ovarian cancer cells.
- A pelvic and transvaginal ultrasound, to look for an ovarian lump.
- A pelvic or abdominal CT scan or MRI, to check for the spread of cancer.
Early detection
The United States Preventive Services Task Force (USPSTF) doesn’t recommend routine screening for ovarian cancer.footnote 2 They haven’t found proof that having regular tests to find ovarian cancer early helps women live longer. But this recommendation isn’t for women with known gene changes (such as BRCA) who have a higher risk for ovarian cancer.
For women who have an average risk for ovarian cancer, experts do not recommend using the CA-125 test as a screening test for ovarian cancer. This is because this test often has false-positive results that can lead to unneeded surgery. But some doctors may recommend the CA-125 test and a transvaginal ultrasound for women who have a very high risk of ovarian cancer, such as those with BRCA gene changes. For these women, the benefits of screening may outweigh the harms.
Treatment Overview
Types of treatment
The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children must also be considered.
Here are the main treatment choices.
- Surgery. This is used to find out if you have cancer and to treat it. This may include taking biopsies to check for the spread of cancer.
- Chemotherapy. This uses medicines to kill cancer cells. It is recommended after surgery for most stages of ovarian cancer. Women with more advanced ovarian cancer may have part of their chemotherapy before surgery and the rest of it after surgery. This can make the surgery safer for these women.
- Targeted therapy. This uses medicines that target just the cancer cells to destroy them or keep them from growing.
- Hormone therapy. This stops your body from making a certain hormone or keeps that hormone from helping the cancer cells to grow.
Additional information about ovarian cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/ovarian.
Side effects of treatment
Most treatments for ovarian cancer cause side effects. They may differ, depending on the type of treatment and your age and overall health.
Here are the possible side effects of each treatment.
- Surgery. The side effects of surgery vary depending on the extent of your surgery. If the doctor removes your ovaries, you will no longer be able to bear children. And if you were still menstruating before your surgery, you will start menopause.
- Chemotherapy. The side effects of chemotherapy may include loss of appetite, nausea, vomiting, fatigue, and hair loss. There is also an increased chance of getting a serious infection.
- Targeted therapy. The side effects of targeted therapy may include high blood pressure, headache, nosebleeds, runny nose, skin problems, and back pain.
- Hormone therapy. The side effects of hormone therapy may include hot flashes, nausea, skin changes, constipation or diarrhea, or absent, missed, or irregular periods.
Home treatment may help you manage the side effects.
Advanced-stage ovarian cancer
Your doctor may recommend chemotherapy before surgery to treat advanced-stage ovarian cancer. This depends on how far your cancer has spread and what other illnesses you may have. Surgery for advanced-stage ovarian cancer involves removing as much of the cancer as possible. The uterus, the tissue lining the abdominal wall (omentum), and any areas of visible cancer are removed. This may include surgery on the intestines, urinary system, or spleen, or scraping of the diaphragm to remove all the cancer. The long-term outcome is better if no cancer cells remain.
Clinical trials
Your doctor may talk to you about being in a clinical trial of a treatment such as immunotherapy or targeted therapy.
Coping with emotions
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It’s normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it’s important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.
Body image and sexual problems
Your feelings about your body may change after treatment for cancer. Managing body image issues may involve talking about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.
Sexual problems can be caused by the physical or emotional effects of cancer or its treatment. Some women may feel less sexual pleasure or lose their desire to be intimate. For more information, see the topic Sexual Problems in Women.
Follow-up care
After treatment for ovarian cancer, it’s important to receive follow-up care, because ovarian cancer may come back (recur). Your doctor will set up a schedule of checkups and tests.
If the cancer recurs or spreads (metastasizes), it’s usually treated with chemotherapy. Surgery may also be done. Or your doctor may recommend that you join a clinical trial for treatment with surgery or immunotherapy.
Palliative care
Palliative care is a kind of care for people who have a serious illness. It’s different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don’t want. And they can help your loved ones understand how to support you.
If you’re interested in palliative care, talk to your doctor.
For more information, see the topic Palliative Care.
End-of-life care
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see the topics:
Prevention
You cannot control some things that put you at risk for ovarian cancer, such as your family history or inheriting gene changes. But you can make some personal choices that lower your risk of cancer and other diseases.
- Eat a healthy diet with plenty of fruits, vegetables, and whole grains.
- Be active. Talk with your doctor about what kinds of activity and how much activity would be good for you.
If you are at high risk for ovarian cancer
If you are concerned about your risk for ovarian cancer, talk with your doctor. You may be a good candidate for taking birth control pills. Taking birth control pills for 5 years has been shown to reduce ovarian cancer risk by 50%.footnote 3 The protection lasts for many years after the pills are taken. But birth control pills may have other health risks, so talk with your doctor about the risks and benefits before taking birth control pills.
If you are at a very high risk because of your family history, you may want to have gene testing. Women at very high risk because of inherited genes may want to have surgery to remove their ovaries and fallopian tubes. This is usually done between the ages of 35 and 40, or when women are finished having children. Having this surgery greatly reduces a woman’s risk for ovarian cancer, but it will cause a woman to start menopause early, which may have other risks.
Home Treatment
The side effects of ovarian cancer treatment can be serious. Your doctor may give you medicines to help you with certain side effects. Healthy habits—such as eating a balanced diet and getting enough sleep and exercise—may help control your symptoms. You can try home treatments:
- For nausea or vomiting, such as ginger or peppermint tea, gum, or candy.
- For diarrhea, such as small, frequent sips of water and bites of salty crackers.
- For constipation, such as plenty of water and fiber in your diet. Do not use a laxative without first talking to your doctor.
Other issues that can be treated at home include:
- Sleep problems. If you have trouble sleeping, try having a regular bedtime and getting exercise daily.
- Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.
- Hair loss. Hair loss may be unavoidable. But using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.
- Pain. Home treatment can help you manage pain. Be sure to talk with your doctor about any home treatment you use.
Handling the stress of having cancer
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
- Get the support you need. Spend time with people who care about you, and let them help you.
- Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about your feelings. Find a support group where you can share your experience.
- Try new ways to relax. And do things each day that help you stay calm and relaxed. Stress reduction techniques may help.
Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.
Medications
Chemotherapy is used to shrink ovarian cancer and slow cancer growth. Chemotherapy is recommended for most women after the initial surgery for ovarian cancer. But sometimes chemotherapy is given to shrink the cancer before surgery. The number of cycles of treatment will depend on the stage of your disease.
Chemotherapy medicines for ovarian cancer may be taken by mouth, injected into a vein (IV), or given through a thin tube into the body (intraperitoneal, or IP). Sometimes treatments may be combined to give women both IV and IP chemotherapy.
Targeted therapy and hormone therapy are other treatments that include medicines to treat ovarian cancer. Targeted therapy medicines may be given by IV or as pills or capsules. Hormone therapy medicines are given as injections, tablets, or pills.
Medicine choices
Here are some medicines that may be used.
- Chemotherapy may include medicines such as carboplatin, paclitaxel, and docetaxel.
- Targeted therapy may include medicines such as bevacizumab, olaparib, or rucaparib.
- Hormone therapy may include medicines such as anastrozole, leuprolide, or tamoxifen.
Treatment of ovarian cancer with chemotherapy can cause nausea and vomiting. To help relieve nausea, your doctor will prescribe medicines you can take with your treatments and when you get home.
What to think about
Having both IV and IP chemotherapy often causes more serious side effects than having only IV or IP treatment. Side effects include belly pain, nerve pain (neuropathy), and kidney or liver problems. Your medical team will watch you closely. If your doctor has given you instructions or medicines to treat your symptoms, be sure to follow them.
Surgery
Surgery is the main treatment for ovarian cancer.
Surgery choices
- A total hysterectomy. This surgery removes the uterus and the cervix.
- A unilateral salpingo-oophorectomy. This surgery removes one ovary and one fallopian tube.
- A bilateral salpingo-oophorectomy. This surgery removes both ovaries and both fallopian tubes.
- An omentectomy. This surgery removes the fatty tissue (omentum) attached to some of the organs in the belly. It’s done to see if the cancer has spread.
- A lymph node biopsy. Nearby lymph nodes are removed and checked for cancer cells.
If you have very early-stage ovarian cancer and wish to have children, discuss your choices with your doctor.
What to think about
Having an experienced gynecologic oncologist will help you get the best possible treatment.
Side effects from your surgery can include pain, trouble urinating or problems with your bowels, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.
If your ovaries are removed, you may have symptoms of menopause. Talk with your doctor about treatment to manage these symptoms.
Other Treatment
Radiation treatment
Radiation treatment for ovarian cancer uses high-energy X-rays to kill cancer cells and shrink tumors. It’s not used very often to treat ovarian cancer.
Side effects of radiation may include nausea, vomiting, diarrhea, pain or discomfort when urinating, and bloody stools. The skin in the area where you get radiation may become red and tender. These side effects will slowly go away after this treatment ends.
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
- Acupuncture to relieve pain.
- Breathing exercises for relaxation.
- Massage and biofeedback to reduce pain and ease tension.
- Meditation or yoga to relieve stress.
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any of these therapies. They are not meant to take the place of standard medical treatment.
References
Citations
- Fleming GF, et al. (2009). Epithelial ovarian cancer. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., pp. 763–835. Philadelphia: Lippincott Williams and Wilkins.
- U.S. Preventive Services Task Force (2018). Screening for ovarian cancer: U.S. Preventive Services Task Force recommendation statement. JAMA, 319(6): 595–606. DOI:10.1001/jama.2017.21421. Accessed online February 14, 2018.
- Cass II, Karlan BY (2008). Ovarian and tubal cancers. In RS Gibbs et al., eds., Danforth’s Obstetrics and Gynecology, 10th ed., pp. 1022–1060. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
- Fritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.
- National Cancer Institute (2012). Ovarian Epithelial Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/Patient.
- National Cancer Institute (2013). Ovarian Epithelial Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/HealthProfessional.
- Vergote I, et al. (2010). Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. New England Journal of Medicine, 363(10): 943–953.
Current as of: December 19, 2018
Author: Healthwise Staff
Medical Review:Sarah Marshall MD – Family Medicine & Kathleen Romito MD – Family Medicine & E. Gregory Thompson MD – Internal Medicine & Ross Berkowitz MD – Obstetrics and Gynecology
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