Illness & Conditions - Health Conditions
What is ovarian cancer?
Ovarian cancer happens when cells that are not normal grow in one or both of 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:
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?
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.
Almost all women whose ovarian cancer is found early will live at least 5 more years. 1 But how long a woman lives usually depends on how far the cancer has spread by the time it is found and treated.
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.
Frequently Asked Questions
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Experts don't know exactly what causes ovarian cancer. Genetics, such as DNA changes, are a risk factor for some women.
In general, about 1 out of 100 women will get ovarian cancer. That risk goes up to 5 out of 100 if one family member has had ovarian cancer, and 7 out of 100 if two or three relatives have had it. 2
About 10 out of 100 ovarian cancers are thought to be caused by gene mutations in the BRCA1 or BRCA2 genes. 3 The risk for women who have these gene changes is much higher than for women without them.
In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian cancer include: 4
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:
Other symptoms that affect some women with ovarian cancer include:
But these symptoms are also common in some women who don't have ovarian cancer.
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 peritoneal 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:
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:
Some things that lower a woman's risk for ovarian cancer include:
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 a blood test to look for BRCA1 and BRCA2 gene changes.
When To Call a 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:
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:
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:
Doctors who can manage your cancer treatment include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Some exams and tests that are done to look for or diagnose ovarian cancer include:
The United States Preventive Services Task Force (USPSTF) doesn't recommend routine screening for ovarian cancer. 6 There is no proof that having regular tests helps women live longer by finding ovarian cancer early.
Still, some experts recommend that women who have inherited a BRCA gene change and have not had their ovaries removed have a transvaginal ultrasound and a CA-125 blood test at least once a year, starting at age 35. Women who have inherited a BRCA1 gene change (not a BRCA2 gene change) may want to start having these tests as early as age 25. 7
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.
The main treatment choices are:
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.
Radiation therapy may be used to destroy cancer cells using high-dose X-rays or other high-energy rays. For more information, see Other Treatment.
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.
Radiation treatment also can cause side effects. For more information, see Other Treatment.
Home treatment may help you manage the side effects.
Advanced-stage ovarian cancer
Surgery in 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.
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.
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 .
The long-term outcome for recurrent ovarian cancer depends on whether the cancer has spread. Even with no sign of cancer after treatment, 3 to 5 out of 10 women who are treated for ovarian cancer have cancer return within 5 years. This also means that cancer doesn't recur within 5 years in 5 to 7 out of 10 women. 8
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It also can help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure 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 this isn't the end of treatment. It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. You and your doctor can decide when you may be ready for hospice care .
For more information, see:
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.
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%. 9 The protection lasts for many years after the pills are taken. But birth control pills have been linked to a slight increase in breast cancer and 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.
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:
Other issues that can be treated at home include:
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:
Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.
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.
Some of the chemotherapy medicines used for ovarian cancer include:
Other medicines that may be used include:
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 is the main treatment for ovarian cancer.
If you have very early-stage ovarian cancer and wish to have children, discuss your choices with your doctor.
What to think about
Side effects from your surgery can include 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.
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 bladder inflammation and scarring. You may also have an increased risk of infection.
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:
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.
Other Places To Get Help
Last Revised: October 22, 2012
American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010.
National Cancer Institute (2010). Ovarian Cancer Prevention PDQ–Health Professional Version. Available online: http://nci.nih.gov/cancertopics/pdq/prevention/ovarian/healthprofessional.
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.
Rossing MA, et al. (2010). Predictive value of symptoms for early detection of ovarian cancer. Journal of the National Cancer Institute, 102(4): 222–229.
National Comprehensive Cancer Network (2011). Ovarian cancer, including fallopian tube cancer and primary peritoneal cancer. NCCN Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.
U.S. Preventive Services Task Force (2004). Screening for ovarian cancer. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsovar.htm.
National Cancer Institute (2011). Genetics of Breast and Ovarian Cancer (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.
Brennan K, et al. (2007). Premalignant and malignant disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971–884. New York: McGraw-Hill.
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.
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