The American Cancer Society [1] estimates that in 2022, 19,880 women will receive a new diagnosis of ovarian cancer, and 12,810 will die from the disease.
Ovarian cancer (OC) is the most lethal gynecologic cancer. It ranks number five in cancer deaths among women, causing more deaths than other female reproductive system cancer.
Part of the reason it is so deadly is that it is tough to detect in its early stages. It’s been estimated that there are more than 30 different types of ovarian cancer, and there is a very wide variation in incidence and outlook in terms of the different types.
- Key Statistics for Ovarian Cancer. (n.d.). American Cancer Society. Retrieved May 25, 2022, from https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html
What is ovarian cancer?
Ovaries are reproductive glands found only in females (women). The ovaries produce eggs for reproduction, which travel from the ovaries through the fallopian tubes and into the uterus, where a fertilized egg develops into a fetus. The ovaries are also the main source of the female hormones estrogen and progesterone.
There is one ovary on each side of the uterus. Cancer starts when cells in the body begin to grow out of control. Ovarian cancers [2] were previously believed to begin only in the ovaries, but recent evidence suggests that many ovarian cancers may start in the cells in the far (distal) end of the fallopian tubes.
2. What Is Ovarian Cancer? (n.d.). American Cancer Society. Retrieved May 25, 2022, from https://www.cancer.org/cancer/ovarian-cancer/about/what-is-ovarian-cancer.html
What role do genetics, ethnicity, and race play in ovarian cancer?
Black women have lower survival rates and higher recurrence rates than non-Hispanic White women.
Data from the US National Cancer Institute [3] in Bethesda, Maryland, shows that the frequency that Black women have specific subtypes of ovarian tumors is different than White women. Black women are more likely to get germ-cell [4] and stromal-cell tumors [5] and less likely to have epithelial ovarian cancers [6] .
Some recent studies [7] have focused on the genetic basis of disparity and socioeconomic origin. Different polymorphisms, mutations, and expressions of genes have been reported in ovarian cancer patients of diverse racial and ethnic backgrounds.
3. George, S. G. (2021, December 15). Why Black women with ovarian cancer require greater focus. Nature. Retrieved May 25, 2022, from https://www.nature.com/articles/d41586-021-03715-9
4. Ovarian Germ Cell Tumors Treatment (PDQ®)–Patient Version. (n.d.). NIH National Cancer Institute. Retrieved May 25, 2022, from https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq#:~:text=and%20treatment%20options.-,Ovarian%20germ%20cell%20tumor%20is%20a%20disease%20in%20which%20malignant,often%20affect%20just%20one%20ovary.
5. STROMAL CELL OVARIAN CANCER. (n.d.). MOCA Minnesota Ovarian Cancer Alliance. Retrieved May 25, 2022, from https://mnovarian.org/stromal-cell-ovarian-cancer/
6. Whitmore G, Ramzan A, Sheeder J, et al.African American women with advanced-stage ovarian cancer have worse outcomes regardless of treatment type. InternationalJournal of Gynecologic Cancer2020;30:1018-1025. Retrieved from https://ijgc.bmj.com/content/30/7/1018.abstract
7. Srivastava, S.K., Ahmad, A., Miree, O.et al.Racial health disparities in ovarian cancer: not just black and white. J Ovarian Res10, 58 (2017). https://doi.org/10.1186/s13048-017-0355-y
What Should I Know About Screening?
Screening is any test used to check for a disease before symptoms occur. Unfortunately, there is no screening test for ovarian cancer.
Cancer screening tests are the most valuable when they can detect disease early because this is when treatments work best. Diagnostic tests aim to find out or diagnose what is causing symptoms. Diagnostic tests may also be used to test a person who is considered at high risk for ovarian cancer.
The Pap test does not detect ovarian cancer. It only checks for cervical cancer. Since there is no simple and reliable way to screen for any gynecologic cancer (except for cervical cancer), it is essential to be alert for warning signs.
Risk factors for ovarian cancer
Several things may increase a woman’s risk for ovarian cancer:
- being middle-aged or older
- close family members who have had ovarian cancer
- Having a genetic mutation (abnormality) called BRCA1 or BRCA2 [8] or one associated with Lynch syndrome [9]
- you’ve had breast [10] ,uterine [11] or colorectal (colon) [12] cancer
- you have an Eastern European or Ashkenazi Jewish background [13]
- you have endometriosis [14] (a condition where tissue from the lining of the uterus grows outside of the uterus)
- you never gave birth, or you have had difficulty getting pregnant
Some studies suggest that women who take estrogen by itself (without progesterone) [15] for ten years or longer might have an increased risk of ovarian cancer. If one or more of these applies to you, it does not mean you will get ovarian cancer. But it would be best if you spoke with your provider about your risk. If your family has a history of ovarian cancer, you can ask your provider about genetic counseling.
8. Hereditary Breast and Ovarian Cancer – The BRCA1 and BRCA2 Genes. (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 25, 2022, from https://www.cdc.gov/genomics/disease/breast_ovarian_cancer/genes_hboc.htm
9. Lynch Syndrome. (n.d.). CDC Centers for Disease Control and Activity. Retrieved May 25, 2022, from https://www.cdc.gov/genomics/disease/colorectal_cancer/lynch.htm
10. Breast Cancer. (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 25, 2022, from https://www.cdc.gov/cancer/breast/
11. What You Need to Know About Uterine Cancer. (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 25, 2022, from https://www.cdc.gov/cancer/uterine/
12. Colorectal (Colon) Cancer. (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 25, 2022, from https://www.cdc.gov/cancer/colorectal/
13. Jewish Women and BRCA Gene Mutations. (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 25, 2022, from https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/hereditary_breast_cancer/jewish_women_brca.htm
14. Endometriosis. (n.d.). Medline Plus. Retrieved May 25, 2022, from https://medlineplus.gov/endometriosis.html
15. What Are the Risk Factors for Ovarian Cancer? (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 25, 2022, from
What can I do to reduce my risk of ovarian cancer?
Pay attention to your body, and know what is normal for you. If you notice any changes that are not normal for you that could be a sign of ovarian cancer, talk with your healthcare provider. There is not yet a known way to prevent it, but the following factors can lower the chance of getting ovarian cancer:
- using oral contraception (birth control pills) for five or more years
- having both tubes removed ( salpingectomy ) [16] , both ovaries removed ( oophorectomy ) [17] or the uterus ( hysterectomy ) [18] removed, or all three removed
- having given birth
- regular visits to the gynecologist for a pelvic exam
- possibly breastfeeding
Some studies show that women who breastfeed for a year or more may have a modestly reduced risk of ovarian cancer. These actions are not recommended for everyone, as risks and benefits are associated with each one. For example, birth control pills can increase your chances of getting breast cancer.
16. Sterilization by Laparoscopy. (n.d.). ACOG American College of Obstetricians and Gynecologists. Retrieved May 25, 2022, from https://www.acog.org/womens-health/faqs/sterilization-by-laparoscopy
17. Oophorectomy. (n.d.). NIH National Library of Medicine. Retrieved May 25, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK559235/
18. Hysterectomy. (n.d.). ACOG The American College of Obstetricians and Gynecologists. Retrieved May 25, 2022, from https://www.acog.org/womens-health/faqs/hysterectomy
What Are the Symptoms of Ovarian Cancer?
Pay close attention to your body, so that you know what is normal for you. If you have unusual vaginal bleeding, or if you have any of the other listed symptoms (and they are not normal for you), see a doctor or nurse practitioner. There are other causes for these symptoms, but the only way to know is to see a doctor or nurse practitioner.
Ovarian cancer may cause the following signs and symptoms:
- Vaginal bleeding or unusual discharge
- Pain or pressure in the abdomen or pelvic area
- Abdominal or back pain
- Bloating, or abdominal swelling
- Indigestion and feeling nauseous
- Feeling full too quickly, or difficulty eating
- A change in your bathroom habits, such as more frequent or urgent need to urinate and/or constipation
- Unexplained weight loss or weight gain
- Pain during sex
- Fatigue
Make an appointment with your healthcare provider if you are experiencing these symptoms.
How is Ovarian Cancer diagnosed?
After a physical exam, either a primary care physician or gynecologic oncologist can order these tests to detect ovarian cancer. The pathway to diagnosis includes:
- A pelvic exam [19]
- A transvaginal or pelvic ultrasound [20]
- CA-125 blood test [21]
- Imaging such as MRI scans or CT scans [22]
Pelvic examination is commonly performed to evaluate women with lower abdominal symptoms, and many clinicians feel that pelvic examination of the ovaries is useful for screening for ovarian cancer.
TVUS (transvaginal ultrasound) is a test that uses sound waves to produce images of the uterus, fallopian tubes, and ovaries by placing an ultrasound wand into the vagina. It can help find a mass (tumor) in the ovary, but it can’t tell if a mass is cancer or benign.
The CA-125 blood test measures the amount of a protein called CA-125 that is in the blood. Many women with ovarian cancer have high levels of CA-125. This test can be useful as a tumor marker to help guide treatment in women with ovarian cancer because a high level often goes down if treatment is working.
MRI is not commonly used for imaging ovaries and other tissues in the pelvis to diagnose ovarian cancer. PET/CT is a nuclear medicine imaging exam that uses a small amount of radioactive material and x-ray to help determine the extent of various diseases, including ovarian cancer.
Staging
After confirming a diagnosis, your doctor may recommend another series of tests to determine the extent of your cancer; this is called staging [23] . Staging tests include imaging scans of the abdomen, pelvis, and lungs. The cancer stage might not be fully determined until you have surgery to remove cancer and the tumor can be examined.
Ovarian cancer stages range from 0 (very early) to IV (advanced stage). The lower the number, the less cancer has spread. Higher numbers, like stage IV, signify that cancer has spread to other sites in the body. The staging system most commonly used for ovarian cancer is the American Joint Committee on Cancer (AJCC) TNM System [23] , which is based on:
- the tumor size (T)
- spread to the surrounding lymph nodes (N)
- The spread (metastasis) to distant sites (M)
AJCC uses the pathologic stage (also called the surgical stage), which is determined by examining tumor tissue removed during surgery. This is also called surgical staging and is likely to be more accurate than clinical staging, which is based on a physical exam, biopsies, and imaging tests, done before surgery.
Understanding your pathology report
A pathologist is a doctor who evaluates tissue, including ovarian tissue removed during a biopsy or surgery. The findings are written up as a Pathology Report [24] . It contains essential information about your tumor and is used to decide the best treatment option for you. You might want to request a copy of this report and take it with you when visiting your treating doctor so they can help you better understand your cancer diagnosis.
19. Screening for Ovarian Cancer: Recommendation Statement. (n.d.). American Family Physician. Retrieved May 25, 2022, from https://www.aafp.org/afp/2018/0615/od1.html
20. Transvaginal ultrasound. (n.d.). MedlinePlus. Retrieved May 26, 2022, from https://medlineplus.gov/ency/article/003779.htm
21. Can Ovarian Cancer Be Found Early? (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/detection.html
22. Ovarian Cancer – How is ovarian cancer diagnosed and evaluated? (n.d.). Radiologyinfo.Org. Retrieved May 26, 2022, from https://www.radiologyinfo.org/en/info/ovarian-cancer
23. Ovarian Cancer Stages. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/staging.html
24. Understanding My Report. (n.d.). Johns Hopkins Medicine. Retrieved May 26, 2022, from https://pathology.jhu.edu/ovarian-cancer/understanding-report
How Is ovarian cancer treated?
If your provider says that you have an ovarian, fallopian tube, or primary peritoneal cancer, they will refer you to a gynecologic oncologist; a physician specializing in treating women’s reproductive system cancers. Gynecologic oncologists [25] can perform surgery and give chemotherapy (medication) to women with ovarian cancer. Your provider will create a treatment plan with you.
Types of treatment
The treatment for ovarian cancer usually involves a combination of surgery and chemotherapy.
The types of treatment for ovarian cancer are:
During surgery, the surgeon removes the cancerous tissue. Chemotherapy uses medications to shrink or kill cancer. These drugs can be pills you take, medications in your veins, or sometimes both.
Radiation therapy is also sometimes used, where a type of x-ray is focused on cancer to kill the cancer cells. Hormone therapy uses hormones or hormone-blocking drugs to fight cancer. This type of systemic therapy is rarely used to treat epithelial ovarian cancer but is more often used to treat ovarian stromal tumors.
Different physicians on your medical team will provide various treatments. Gynecologic oncologists are physicians (and surgeons) trained to treat cancers of a woman’s reproductive system. Medical oncologists are physicians who treat cancer with medicine (chemotherapy), and radiation oncologists provide radiation therapy.
Your healthcare provider will explain the treatment options available for your type and stage of cancer. They will also explain the risks and benefits of each treatment and its side effects. Sometimes people get a second opinion from another cancer doctor, to make sure they are getting the right treatment for their cancer.
25. WHAT IS A GYNECOLOGIC ONCOLOGIST? (n.d.). SGO. Retrieved May 26, 2022, from https://www.sgo.org/what-is-a-gynecologic-oncologist/
26. Surgery for Ovarian Cancer. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/treating/surgery.html
27. Chemotherapy for Ovarian Cancer. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/treating/chemotherapy.html
28. Radiation Therapy. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation.html
29. Hormone Therapy for Ovarian Cancer. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/treating/hormone-therapy.html
Prognosis
Patient outcome is strongly dependent on the cancer stage at the time of diagnosis. Cancer caught in the early stages is associated with the highest likelihood of successful treatment.
Follow-up care after treatment [30] for ovarian cancer is essential. Even when cancer appears to have been completely removed or destroyed, the disease may recur. Undetected cancer cells can remain in the body after treatment. Your surgeon will monitor your recovery and check for cancer recurrence. Blood tests, clinical examinations, and imaging tests may also be performed.
Survival rates
Survival rates show what percentage of people with the same type and stage of cancer are alive a certain amount of time after diagnosis. They don’t determine how long you will live, but they may give you an understanding of how likely successful treatment is. Survival rates are only estimates based on the previous outcomes of large numbers of people. They don’t predict what will happen in any one person’s situation. These statistics may leave you with questions. Your treating physician can help you understand your situation; ask them how these statistics apply to you.
What is a 5-year relative survival rate?
A relative survival rate compares people with the same type and stage of cancer to people in the overall population.
As an example, if the 5-year relative survival rate [31] for a specific ovarian cancer stage is 80%, it means that people with that cancer are about 80% as likely (as people who don’t have that cancer) to be alive at least five years after being diagnosed. Survival rates for ovarian cancer differ based on the type of ovarian cancer (invasive epithelial, stromal, fallopian tube or germ cell tumor).
The SEER database [32] tracks 5-year relative survival rates for ovarian cancer in the United States, based on how far cancer has spread. However, the SEER database does not group cancers by the AJCC TNM stages. Instead, it groups cancers into the categories of localized, regional, and distant stages:
Localized: There is no sign that cancer has spread outside the ovaries.
Regional: Cancer has spread outside the ovaries to nearby structures or lymph nodes.
Distant: Cancer has spread to remote parts of the body such as the liver, lungs, or distant lymph nodes.
Invasive epithelial ovarian cancer
| SEER stage | 5-year relative survival rate |
| Localized | 93% |
| Regional | 75% |
| Distant | 31% |
| All stages combined | 49% |
Ovarian stromal tumors
| SEER stage | 5-year relative survival rate |
| Localized | 97% |
| Regional | 90% |
| Distant | 70% |
| All stages combined | 90% |
Germ cell tumors of the ovaries
| SEER stage | 5-year relative survival rate |
| Localized | 98% |
| Regional | 94% |
| Distant | 74% |
| All stages combined | 93% |
Fallopian tube tumors
| SEER stage | 5-year relative survival rate |
| Localized | 95% |
| Regional | 54% |
| Distant | 44% |
| All stages combined | 56% |
These numbers apply only to the cancer stage when it is first diagnosed. They do not apply later on if cancer grows, spreads, or comes back after treatment. These numbers don’t take everything into account. Your age, overall health, and how well cancer responds to treatment also can affect your outlook.
Those who are just now being diagnosed with ovarian cancer might have a better outlook (prognosis) than these numbers show. Research and treatments increase knowledge over time, and these numbers are based on those diagnosed and treated at least five years or more before now.
30. Living as an Ovarian Cancer Survivor. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/after-treatment/follow-up.html
31. Survival Rates for Ovarian Cancer. (n.d.). American Cancer Society. Retrieved May 26, 2022, from https://www.cancer.org/cancer/ovarian-cancer/detection-diagnosis-staging/survival-rates.html
32. Surveillance, Epidemiology, and End Results (SEER) Program. (n.d.). CDC Centers for Disease Control and Prevention. Retrieved May 22, 2022, from https://www.cdc.gov/cancer/uscs/technical_notes/contributors/seer.htm
Complementary therapy
Complementary and alternative medicine (CAM) [33] therapies appear to be beneficial in reducing side effects and improving cancer patients’ quality of life. Complementary therapies have generally been studied for all cancers, with acupuncture being the most researched, regardless of cancer type.
Many cancer centers in the US offer evidence-based complementary therapies coupled with conventional medicine in a process known as integrative medicine [34] .
33. Complementary and Alternative Medicine. (n.d.). NIH National Cancer Institute. Retrieved May 26, 2022, from https://www.cancer.gov/about-cancer/treatment/cam
34. Hyeongjun Yun, Lingyun Sun, Jun J. Mao, Growth of Integrative Medicine at Leading Cancer Centers Between 2009 and 2016: A Systematic Analysis of NCI-Designated Comprehensive Cancer Center Websites,JNCI Monographs, Volume 2017, Issue 52, November 2017, lgx004, https://doi.org/10.1093/jncimonographs/lgx004
Clinical trials
Clinical trials are research studies that involve people. Visit the National Cancer Institute’s (NCI) web page [35] to view cancer trials. All trials on the list are NCI-supported clinical trials sponsored or otherwise financially supported by NCI.
NCI’s basic information about clinical trials [36] explains the types and phases of trials and how they are carried out. Clinical trials test new ways to detect, prevent, and treat diseases. You may want to consider taking part in a clinical trial. Talk to your doctor for help deciding if there is one that is right for you.
35. NCI Search Results Results for: Treatment Clinical Trials for ovarian cancer. (n.d.). NIH National Cancer Institute. Retrieved May 26, 2022, from https://www.cancer.gov/search/results?swKeyword=Treatment+Clinical+Trials+for+ovarian+Cancer
36. What Are Clinical Trials? (n.d.). NIH National Cancer Institute. Retrieved May 26, 2022, from https://www.cancer.gov/about-cancer/treatment/clinical-trials/what-are-trials
