Ovarian Cancer

What is ovarian cancer?

Cancer starts when cells change and grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

Ovarian cancer is cancer that starts in the cells of your ovaries or in cells at the end of the fallopian tubes next to an ovary. The fallopian tubes are a pair of tubes connecting your ovaries to your uterus. Your ovaries make hormones and release eggs that travel through the fallopian tubes to the uterus. 

Who is at risk for ovarian cancer?

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The risk factors for ovarian cancer include:

• Older age
• Obesity
• Never carried a pregnancy to term or having first full-term pregnancy after age 35
• Infertility
• Use of estrogen hormone therapy after menopause
• Family history of ovarian and breast cancer
• Family history of certain genetic cancer syndromes, like hereditary breast and ovarian cancer syndrome or Lynch syndrome
• Personal history of breast, uterine, rectal, or colon cancer
• Endometriosis

Talk with your healthcare provider about your risk factors for ovarian cancer and what you can do about them.

Can ovarian cancer be prevented?

There's no sure way to prevent ovarian cancer. But there are some things that may help lower your risk for it, such as: 

• Staying at a healthy weight
• Taking birth control pills (oral contraceptives) for at least 5 years
• Not taking hormone replacement therapy after menopause
• Having surgery to remove your ovaries, your fallopian tubes, or both if you have a high risk for ovarian cancer

Are there screening tests for ovarian cancer?

There are no screening tests for people at average risk for ovarian cancer. Screening tests are done to check for disease in people who don’t have symptoms.

Still, regular pelvic exams are important. You also should see a healthcare provider if you have symptoms that last for more than a few weeks. (See below.)

If you’re at high risk, you can talk with your healthcare provider about using ultrasound to check your ovaries for tumors. Regular blood tests for CA-125 may also be a choice. CA-125 is a protein found in the cells of some kinds of ovarian cancer. But this isn’t a perfect screening test. It’s not higher in all people with ovarian cancer. And if it is higher, it doesn’t mean you have ovarian cancer.

What are the symptoms of ovarian cancer?

Ovarian cancer often doesn’t cause any symptoms until it has spread outside the ovary. Symptoms may include:

• Indigestion or upset stomach
• Belly swelling or discomfort
• Pelvic pain or cramping
• Bloating or a sense of fullness, especially after eating
• Backache
• Painful, frequent, or burning urination with no infection
• Constipation
• Feeling tired all the time
• No desire to eat or feeling full quickly
• Vaginal discharge, bleeding, or irregular periods
• Pain during sex

Many of these may be caused by other health problems. But it’s important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

How is ovarian cancer diagnosed?

Ovarian cancer is most often diagnosed when you see your healthcare provider because of symptoms. The healthcare provider will talk with you about your health history, symptoms, risk factors, and family history of disease. A pelvic exam will be done. Blood tests and imaging tests may be needed.

Unlike many other types of cancer, a biopsy is rarely needed to diagnose ovarian cancer before surgery. This is because if there is cancer and it's only inside the ovary, doing a biopsy breaks the covering of the ovary. This may allow the cancer to spread. A diagnosis of ovarian cancer is most often confirmed at the time of surgery. At that time, the surgeon removes the tumor or tumors and takes out tiny pieces (called samples) of nearby tissues to find out if the cancer has spread. The removed tissues are sent to a lab and checked for cancer cells.

After a diagnosis of ovarian cancer, more tests might be needed. These help your healthcare providers learn more about the cancer. They can help find the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It's one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

How is ovarian cancer treated? 

Your treatment choices depend on the type of ovarian cancer you have, test results, and the stage of the cancer. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and targeted therapy are systemic treatments. You may have just one treatment or a combination of treatments.

Ovarian cancer may be treated with:

• Surgery
• Chemotherapy
• Targeted therapy
• Radiation therapy

Talk with your healthcare providers about your treatment choices. Make a list of questions. Think about the benefits and possible side effects of each choice. Talk about your concerns with your healthcare provider before making a decision.

What are treatment side effects?

Cancer treatments, like chemotherapy and radiation, can damage normal cells. This can cause side effects, such as hair loss, mouths sores, and vomiting. 

Talk with your healthcare provider about side effects you might have and ways to manage them. There are often things you can do and medicines you can take to help prevent or control side effects.

Coping with ovarian cancer

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and cancer treatment on your daily life.

Here are tips:

• Talk with your family or friends.
• Ask your healthcare team or social worker for help.
• Speak with a counselor.
• Talk with a spiritual advisor, such as a minister, rabbi, or imam.
• Ask your healthcare team about medicines for depression or anxiety.
• Keep socially active.
• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.
• Drink plenty of water, fruit juices, and other liquids.
• Keep physically active.
• Rest as much as needed.
• Talk with your healthcare team about ways to manage treatment side effects.
• Take your medicines as directed by your team.

When should I call my healthcare provider?

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the following:

• New symptoms or symptoms that get worse
• Signs of an infection, such as a fever
• Side effects of treatment that affect your daily function or don’t get better with treatment

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays. 

Next steps

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.