Ovarian cancer describes cancer in women that begins in the different cells of the ovaries (they produce eggs), fallopian tubes or peritoneum, which determines the type of ovarian cancer.
Women have two ovaries, which are reproductive glands that produce eggs for reproduction. The eggs travel from the ovaries through the fallopian tubes into the uterus, where a fertilized egg develops into a fetus.
Recent research in women with ovarian cancer shows that cancer actually starts in the fallopian tubes and spreads to the surface of the ovaries and beyond. In comparison, the ovarian cancer lifetime risk for the women in the general population is less than 2%.
Symptoms of ovarian cancer
See your UCHealth gynecologist right away if you are experiencing any of these:
- Abdominal bloating
- Back pain
- Difficulty eating or feeling full quickly
- Menstrual irregularities
- Pain with intercourse
- Pelvic or abdominal pain
- Swelling in the pelvis or abdomen
- Upset stomach
- Urinary symptoms, such as urgency or frequency
- Vaginal discharge, which may be clear, white, or tinged with blood
Ovarian cancer: FAQs
Can I have a baby with ovarian cancer?
It depends on the surgery performed to treat you. Women with ovarian cancer who are able to keep one ovary can have a baby after treatment. Women who needed to have both ovaries removed, and possible their womb, cannot have babies afterwards.
Does a hysterectomy cure ovarian cancer?
No. A hysterectomy does not remove your ovaries, so you may still be at risk for ovarian cancer.
Can my doctor tell if I have ovarian cancer through a pelvic exam?
A pelvic exam is an important part of detecting ovarian cancer, but it alone is not definitive. If your doctor suspects that you might have cancer based on the pelvic exam, she would need to order further tests to make a proper diagnosis.
Diagnosis of ovarian cancer
Your UCHealth specialist may perform one or more of the following.
Medical history and physical exam. Your doctor will take your medical history, and will likely do a pelvic exam to check for an enlarged ovary or signs of fluid in the abdomen. If there is reason to suspect you have ovarian cancer based on your symptoms and/or physical exam, your doctor will order some tests to check further.
Consultation with a specialist. If the results of your pelvic exam or other tests suggest that you have ovarian cancer, you will meet with a gynecologic oncologist, who is specially trained in treating cancers of the female reproductive system. This helps ensure that you get the best kind of surgery for your cancer.
Biopsy. The only way to determine for certain if a growth is cancer is to remove a piece of it and examine it in the lab. For ovarian cancer, the biopsy is most commonly done by removing the tumor during surgery. In rare cases, a suspected ovarian cancer may be biopsied during a laparoscopy procedure or with a needle placed directly into the tumor through the skin of the abdomen. We would only do this if you cannot have surgery because of an advanced stage of cancer or some other serious medical condition, because there is concern that a biopsy could spread the cancer.
Laparoscopy. A thin, lighted tube through which your doctor can look at your ovaries and other pelvic organs and tissues in the area. Laparoscopy provides a view of organs that can help plan surgery or other treatments, and can help us confirm the stage of the cancer. We can also manipulate small instruments through the laparoscopic incision(s) to perform biopsies.
Blood tests. Your doctor will order blood count tests to make sure you have enough red blood cells, white blood cells and platelets, and tests to measure your kidney and liver function as well as your general health. Your doctor will also order a CA-125 test. If you have a high CA-125 level, we would refer you to a gynecologic oncologist.
Genetic counseling and testing. If you have been diagnosed with an epithelial ovarian cancer, we will recommend that you get genetic counseling to help you decide if you should be tested for a mutation in the BRCA1 or BRCA2 gene. Some ovarian cancers are linked to mutations in these or other genes.
Chest x-ray. Might be done to determine whether ovarian cancer has metastasized to the lungs.
Computed tomography (CT) scans. Helps us see if ovarian cancer has spread. We don’t use CT scans to biopsy an ovarian tumor, but we can use it to help biopsy a suspected metastasis in a procedure called a CT-guided needle biopsy.
Magnetic resonance imaging (MRI) scans. MRI scans are not used often to look for ovarian cancer, but they are particularly helpful to examine the brain and spinal cord where cancer could spread.
Barium enema x-ray. Tests to see if the cancer has invaded the colon or rectum.
PET/CT scan. Some machines can do both a PET and CT scan at the same time.
Positron emission tomography (PET) scan. A test to see if the cancer has spread to lymph nodes or other parts of the body.
Ultrasound. Often the first test done if a problem with the ovaries is suspected.
Ovarian cancer staging
UCHealth follows the two systems used for staging ovarian cancer—the International Federation of Gynecology and Obstetrics (FIGO) and the American Joint Committee on Cancer (AJCC) staging system.
The system described below is the most recent AJCC system effective January 2018. It is the staging system for ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.
|AJCC Stage||Stage grouping||FIGO Stage||Stage description|
|I||The cancer is only in the ovary (or ovaries) or fallopian tube(s) (T1).It has not spread to nearby lymph nodes (N0) or to distant sites (M0).|
|IA||The cancer is in one ovary, and the tumor is confined to the inside of the ovary; or the cancer is in one fallopian tube, and is only inside the fallopian tube. There is no cancer on the outer surfaces of the ovary or fallopian tube. No cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis (T1a).It has not spread to nearby lymph nodes (N0) or to distant sites (M0).|
|IB||The cancer is in both ovaries or fallopian tubes but not on their outer surfaces. No cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis (T1b). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).|
|IC||The cancer is in one or both ovaries or fallopian tubes and any of the following are present:The tissue (capsule) surrounding the tumor broke during surgery, which could allow cancer cells to leak into the abdomen and pelvis (called surgical spill). This is stage IC1.|
Cancer is on the outer surface of at least one of the ovaries or fallopian tubes or the capsule (tissue surrounding the tumor) has ruptured (burst) before surgery (which could allow cancer cells to spill into the abdomen and pelvis). This is stage IC2.
Cancer cells are found in the fluid (ascites) or washings from the abdomen and pelvis. This is stage IC3.
It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
|II||The cancer is in one or both ovaries or fallopian tubes and has spread to other organs (such as the uterus, bladder, the sigmoid colon, or the rectum) within the pelvis or there is primary peritoneal cancer (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).|
|IIA||The cancer has spread to or has invaded (grown into) the uterus or the fallopian tubes, or the ovaries. (T2a). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).|
|IIB||The cancer is on the outer surface of or has grown into other nearby pelvic organs such as the bladder, the sigmoid colon, or the rectum (T2b). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).|
|IIIA1||T1 or T2|
|IIIA1||The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer (T1) and it may have spread or grown into nearby organs in the pelvis (T2). It has spread to the retroperitoneal (pelvic and/or para-aortic) lymph nodes only. It has not spread to distant sites (M0).|
N0 or N1
|IIIA2||The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. During surgery, no cancer is visible in the abdomen (outside of the pelvis) to the naked eye, but tiny deposits of cancer are found in the lining of the abdomen when it is examined in the lab (T3a).The cancer might or might not have spread to retroperitoneal lymph nodes (N0 or N1), but it has not spread to distant sites (M0).|
N0 or N1
|IIIB||There is cancer in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. The deposits of cancer are large enough for the surgeon to see, but are no bigger than 2 cm (about 3/4 inch) across. (T3b).It may or may not have spread to the retroperitoneal lymph nodes (N0 or N1), but it has not spread to the inside of the liver or spleen or to distant sites (M0).|
N0 or N1
|IIIC||The cancer is in one or both ovaries or fallopian tubes, or there is primary peritoneal cancer and it has spread or grown into organs outside the pelvis. The deposits of cancer are larger than 2 cm (about 3/4 inch) across and may be on the outside (the capsule) of the liver or spleen (T3c).It may or may not have spread to the retroperitoneal lymph nodes (N0 or N1), but it has not spread to the inside of the liver or spleen or to distant sites (M0).|
|IVA||Cancer cells are found in the fluid around the lungs (called a malignant pleural effusion) with no other areas of cancer spread such as the liver, spleen, intestine, or lymph nodes outside the abdomen (M1a).|
|IVB||The cancer has spread to the inside of the spleen or liver, to lymph nodes other than the retroperitoneal lymph nodes, and/or to other organs or tissues outside the peritoneal cavity such as the lungs and bones (M1b).|
Source: American Cancer Society
Treatment and recovery
At UCHealth, treatment and recovery includes both treatment to control the disease as well as supportive therapy to improve your quality of life.
A typical plan includes drug therapy, such as targeted therapy and/or chemotherapy, with or without steroids. You may also need other types of treatments, such as radiation therapy and surgery.
Possible treatments include:
- Chemotherapy. Drugs that destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. We often use more than one drug at a time for maximum results.
- Targeted therapy or novel therapy. Drugs that target the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. In recent years, targeted therapy has proven to be increasingly successful at controlling myeloma and improving a prognosis.
- Immunotherapy or biologic therapy. Uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
- Other drug therapy. We may give steroids alone or at the same time as targeted therapy or chemotherapy.
- Radiation therapy. High-energy X-rays or other particles that destroy cancer cells.
Surgery is the main treatment for most ovarian cancers. How much surgery you have depends on the type, how far it has spread and on your general health. For women of childbearing age who have certain kinds of tumors and whose cancer is in the earliest stage, it may be possible to treat the disease without removing both ovaries and the uterus.
Surgery for epithelial ovarian cancer. For epithelial ovarian cancer, surgery has two main goals: staging and debulking, which is removing as much of the tumor as possible. Debulking is very important when ovarian cancer has already spread throughout the abdomen at the time of surgery. The aim of debulking surgery is to leave behind no visible cancer or no tumors larger than one cm (less than 1/2 an inch). Sometimes the surgeon will also need to remove a piece of colon, small intestine, bladder, spleen and/or gall bladder, stomach, liver or pancreas.
Surgery for ovarian germ cell tumors and ovarian stromal tumors. We treat most ovarian germ cell tumors with a hysterectomy and bilateral salpingo-oophorectomy. If the cancer is in only one ovary and you still want to be able to have children, we remove only the ovary containing the cancer and the fallopian tube on the same side, leaving behind the other ovary and fallopian tube and the uterus. Ovarian stromal tumors are often confined to just one ovary, so surgery may just remove that ovary. If the cancer has spread, more tissue may need to be removed. This could mean a hysterectomy and bilateral salpingo-oophorectomy and even debulking surgery.
Types of ovarian cancer
Epithelial carcinoma. Makes up 85% to 90% of ovarian/fallopian tube cancers. The main types of epithelial tumors include serous, endometrioid, clear cell, mucinous, mixed tumors and several rare malignancies, including Brenner tumors.
Germ cell malignancies. Develops in the egg-producing cells of the ovaries, typically occurring in women 10 years to 29 years old. Types of germ cell tumors include dysgerminomas, immature teratoma, endodermal sinus tumors (called EST and yolk sac tumors) and embryonal carcinomas.
Sex cord stromal tumors. A rare form of ovarian tumor that develops in the connective tissue cells, called granulosa and theca cells, that hold the ovaries together. Over 90% of these stromal tumors are called granulosa cell tumors; the other types are Sertoli-Leydig cell tumors and steroid cell tumors.
Fallopian tube cancer. We now know that most cancers previously considered ovarian cancer actually began in a fallopian tube.
Causes of ovarian cancer
Research is ongoing, but we still don’t fully understand the exact cause of most ovarian cancers. The recent discovery that ovarian cancer typically starts in cells at the tail ends of the fallopian tubes—not the ovaries—has led to more research into prevention and screening. We have made significant progress in understanding how certain gene mutations can cause normal cells to become cancerous.
Inherited genetic mutations. We know that a small portion of ovarian cancers occur in women with inherited mutations linked to an increased risk of ovarian cancer, including mutations in the BRCA1 and BRCA2 genes.
Acquired genetic changes. Most mutations related to ovarian cancer are not inherited, but occur during a woman’s life. Studies have not linked any single chemical in the environment or in our diets to mutations that cause ovarian cancer—the cause of most acquired mutations remains unknown.
Risk factors in developing ovarian cancer
Even though we don’t know the exact cause of ovarian cancer, we do know that there are several risk factors:
- Aging. Ovarian cancer is rare in women younger than 40. Most ovarian cancers develop after menopause. Half of all ovarian cancers are found in women 63 years of age or older.
- Being overweight or obese. Obesity has been linked to a higher risk of developing many cancers.
- Fertility treatment. In vitro fertilization (IVF) seems to increase the risk. If you are taking fertility drugs, you should discuss the potential risks with your doctor.
- Having a family cancer syndrome. About 5 to 10% of ovarian cancers are a part of family cancer syndromes resulting from inherited changes in certain genes.
- Having a family history of ovarian cancer, breast cancer, or colorectal cancer. A family history of some other types of cancer such as colorectal and breast cancer is linked to an increased risk of ovarian cancer.
- Having had breast cancer. The risk of ovarian cancer after breast cancer is highest in those women with a family history of breast cancer.
- Having your first child after age 35 or never having a full-term pregnancy.
- Hereditary breast and ovarian cancer syndrome. Caused by inherited mutations in the genes BRCA1 and BRCA2, as well as possibly some other genes that have not yet been found.
- Hereditary nonpolyposis colon cancer (HNPCC). Also known as Lynch syndrome.
- Hormone therapy after menopause. Women using estrogens after menopause have an increased risk. The risk seems to be higher in women taking estrogen alone (without progesterone) for many years.
- MUTYH-associated polyposis. This syndrome is caused by mutations in the gene MUTYH.
- Peutz-Jeghers syndrome.
- PTEN tumor hamartoma syndrome. Also known as Cowden disease.
National Cancer Institute (NCI). Ovarian, Fallopian Tube, and Primary Peritoneal Cancer (https://www.cancer.gov/types/ovarian)
MedlinePlus: National Library of Medicine. Ovarian Cancer (https://medlineplus.gov/ovariancancer.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Ovarian Cancer (https://www.ncbi.nlm.nih.gov/books/NBK567760/)