Douglas A. Nelson, MD, is double board-certified in medical oncology and hematology. He was a physician in the US Air Force and now practices at MD Anderson Cancer Center, where he is an associate professor.
Ovarian cancer affects a woman’s ovaries and surrounding structures. It rarely causes symptoms at early stages, but may cause infertility or produce vague abdominal and pelvic discomfort at late stages. Ovarian cancer comprises 1.2% of cancer diagnoses and 2.3% of cancer deaths in the United States. The average five-year survival rate for all types of ovarian cancer is 49%. However, if ovarian cancer is found and treated before it spreads outside the ovaries, the five-year survival rate is 93%.
Ovarian cancer is linked with hereditary and environmental factors. It is diagnosed with a combination of clinical exam, imaging tests, and biopsy. Blood tumor markers, like CA-125, can be elevated.
Staging is based on tumor invasiveness and extent of metastases. Subtypes correspond to the tissue type of origin—epithelial, stromal, germ cell, and small cell carcinoma. Treatment, which includes surgical and medical intervention, can improve survival and quality of life.
Ovarian cancer is caused by a harmful overgrowth of cells in and around the ovaries. The cancer can start in the lining of the ovary or fallopian tube, the supportive tissue, or in the egg cell. There are several associated risk factors, including hereditary and acquired genetic mutations (alterations in the DNA), and the influence of hormones.
Ovarian cancer may be detected with a pelvic exam, but it might be too small to identify with this method. Imaging, including transvaginal ultrasound or non-invasive abdominal imaging may reveal the tumor. A biopsy is the method of definitive diagnosis. Cancer markers like CA-125, HE4, and CA-19-9 might be elevated in the blood, but are not specific for ovarian cancer.
There are several lifestyle risk factors associated with increased chances of developing ovarian cancer, but it isn’t clear whether they cause it. Obesity, smoking, estrogen therapy, a high-fat diet, a diet high in processed food, heavy alcohol use, a sedentary lifestyle, and the use of talc-containing feminine products have all been correlated with an increased risk of ovarian cancer.
Genetic changes associated with ovarian cancer can be hereditary or acquired. BRCA 1 and BRCA 2, the most frequently seen mutations in this cancer, are inherited and are primarily associated with breast cancer. Overall, non-BRCA genetic changes, including ATM, STK11, RAD51B, are more common in this cancer, but there isn’t a single gene mutation that is more common than BRCA in ovarian cancer.
The likelihood of a cure of ovarian cancer depends on the stage at diagnosis. Surgery, radiation, hormone therapy, chemotherapy, and targeted therapies can shrink or eliminate the tumor. Ovarian cancer diagnosed at stage 1 has a 5-year survival rate of over 90%, but more advanced ovarian cancer generally has a lower survival rate and can be fatal.
Ovarian cancer can spread within months after diagnosis, especially if it is already at a late stage. The cancer usually spreads faster in premenopausal than post menopausal women. Certain types, including high grade epithelial serous carcinoma and stromal tumors, tend to grow especially rapidly.
Ovarian cancer doesn’t usually cause pain or any symptoms, but it can hurt, especially at late stages. Issues such as abdominal discomfort, bloating, back pain, frequent urination, and pain during sex can develop due to physical pressure or blockage caused by the tumor. Weight loss can occur due to metastasis or appetite changes.
Having a first child before age 26, breastfeeding, using oral contraceptives, and tubal ligation surgery are associated with a decreased risk of ovarian cancer. If a woman has a family history of ovarian, breast, or colon cancer, regularly scheduled screening for ovarian cancer (as well as these other types of cancer) can identify it at an early stage to help prevent serious consequences.
Epithelial tumors arise from the tissue that lines and protects organs. Epithelial ovarian tumors are the most common type of ovarian tumor. They arise from the tissue that lines the ovaries or fallopian tubes and they include low grade and high grade tumor types. These cancers can be treated with surgery, radiation, and chemotherapy.
Germ cell tumors form from egg cells and grow in the ovary. They can be benign or malignant, and usually affect women between ages 10 to 30. Germ cell tumors are often diagnosed in the early stages but can grow rapidly, and may cause severe pelvic pain. Subtypes include dysgerminomas, endodermal sinus tumors, and immature teratomas. Treatment is usually oophorectomy (surgical ovary removal).
Metastasis is the spread of cancer outside its initial location. Cancer cells can enter and travel through the blood vessels or lymphatic tissue, and then they can invade and grow in new locations. A tumor can metastasize within its organ of origin or in other organs, potentially causing pressure, obstruction, and dysfunction. Metastases are associated with a lower cancer survival rate.
Stromal tumors arise from supportive connective tissue, and they are a rare type of ovarian tumor. They may be hormone-producing and can result in vaginal bleeding or excessive hair growth (hirsutism). These tumors can be treated with surgery and chemotherapy, and symptoms may also be treated with hormone therapy.
Explore interactive models that show how ovarian cancer can metastasize (spread) in the pelvis, and how the disease changes as it progresses.
National Cancer Institute. Cancer stat facts: Ovarian cancer.
Debuquoy C, Romeo C, Vanacker H, Ray-Coquard I. Rare ovarian tumors: an update on diagnosis and treatment. Int J Gynecol Cancer. 2020 Jun;30(6):879-887. doi: 10.1136/ijgc-2020-001235. Epub 2020 May 26. PMID: 32461259.
Arthur R, Brasky TM, Crane TE, Felix AS, Kaunitz AM, Shadyab AH, Qi L, Wassertheil-Smoller S, Rohan TE. Associations of a Healthy Lifestyle Index With the Risks of Endometrial and Ovarian Cancer Among Women in the Women's Health Initiative Study. Am J Epidemiol. 2019 Feb 1;188(2):261-273. doi: 10.1093/aje/kwy249. PMID: 30407487; PMCID: PMC6357793.
Centers for Disease Control and Prevention. Does breast or ovarian cancer run in your family? October 14, 2020.
Forstner R. Early detection of ovarian cancer. Eur Radiol. 2020 Oct;30(10):5370-5373. doi: 10.1007/s00330-020-06937-z. Epub 2020 May 28. PMID: 32468105; PMCID: PMC7476911.
Sans M, Gharpure K, Tibshirani R, Zhang J, Liang L, Liu J, Young JH, Dood RL, Sood AK, Eberlin LS. Metabolic Markers and Statistical Prediction of Serous Ovarian Cancer Aggressiveness by Ambient Ionization Mass Spectrometry Imaging. Cancer Res. 2017 Jun 1;77(11):2903-2913. doi: 10.1158/0008-5472.CAN-16-3044. Epub 2017 Apr 17. PMID: 28416487; PMCID: PMC5750373.
American Cancer Society. Signs and symptoms of ovarian cancer. April 11, 2018.
American Cancer Society. What causes ovarian cancer? April 11, 2018.
Maoz A, Matsuo K, Ciccone MA, Matsuzaki S, Klar M, Roman LD, Sood AK, Gershenson DM. Molecular Pathways and Targeted Therapies for Malignant Ovarian Germ Cell Tumors and Sex Cord-Stromal Tumors: A Contemporary Review. Cancers (Basel). 2020 May 29;12(6):1398. doi: 10.3390/cancers12061398. PMID: 32485873; PMCID: PMC7353025
Psomiadou V, Prodromidou A, Fotiou A, Lekka S, Iavazzo C. Robotic interval debulking surgery for advanced epithelial ovarian cancer: current challenge or future direction? A systematic review. J Robot Surg. 2020 Oct 9. doi: 10.1007/s11701-020-01155-7. Epub ahead of print. PMID: 33037532
Trinidad CV, Tetlow AL, Bantis LE, Godwin AK. Reducing Ovarian Cancer Mortality Through Early Detection: Approaches Using Circulating Biomarkers. Cancer Prev Res (Phila). 2020 Mar;13(3):241-252. doi: 10.1158/1940-6207.CAPR-19-0184. PMID: 32132118; PMCID: PMC7080297.
Veneris JT, Mahajan P, Frazier AL. Contemporary management of ovarian germ cell tumors and remaining controversies. Gynecol Oncol. 2020 Aug;158(2):467-475. doi: 10.1016/j.ygyno.2020.05.007. Epub 2020 Jun 5. PMID: 32507650