The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones estrogen and progesterone.
About 21,750 women in the United States will receive an ovarian cancer diagnosis in 2020, and about 14,000 women will die from it.
In this article you’ll find information on ovarian cancer including:
- survival rates
What is ovarian cancer?
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumor. If left untreated, the tumor can spread to other parts of the body. This is called metastatic ovarian cancer.
Ovarian cancer often has warning signs, but the earliest symptoms are vague and easy to dismiss. Twenty percent of ovarian cancers are detected at an early stage.
What are the early symptoms of ovarian cancer?
It’s easy to overlook the early symptoms of ovarian cancer because they’re similar to other common illnesses or they tend to come and go. The early symptoms include:
- abdominal bloating, pressure, and pain
- abnormal fullness after eating
- difficulty eating
- an increase in urination
- an increased urge to urinate
Ovarian cancer can also cause other symptoms, such as:
- back pain
- menstrual irregularities
- painful intercourse
- dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles)
These symptoms may occur for any number of reasons. They aren’t necessarily due to ovarian cancer. Many women have some of these problems at one time or another.
These types of symptoms are often temporary and respond to simple treatments in most cases.
The symptoms will persist if they’re due to ovarian cancer. Symptoms usually become more severe as the tumor grows. By this time, the cancer has usually spread outside of the ovaries, making it much harder to treat effectively.
Again, cancers are best treated when detected early. Please consult with your doctor if you experience new and unusual symptoms.
Types of ovarian cancer
The ovaries are made up of three types of cells. Each cell can develop into a different type of tumor:
- Epithelial tumors form in the layer of tissue on the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumors.
- Stromal tumors grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumors.
- Germ cell tumors develop in the egg-producing cells. Germ cell tumors are rare.
Most ovarian cysts aren’t cancerous. These are called benign cysts. However, a very small number can be cancerous.
An ovarian cyst is a collection of fluid or air that develops in or around the ovary. Most ovarian cysts form as a normal part of ovulation, which is when the ovary releases an egg. They usually only cause mild symptoms, like bloating, and go away without treatment.
Cysts are more of a concern if you aren’t ovulating. Women stop ovulating after menopause. If an ovarian cyst forms after menopause, your doctor may want to do more tests to find out the cause of the cyst, especially if it’s large or doesn’t go away within a few months.
If the cyst doesn’t go away, your doctor may recommend surgery to remove it just in case. Your doctor can’t determine if it’s cancerous until they remove it surgically.
Risk factors for ovarian cancer
The exact cause of ovarian cancer is unknown. However, these factors can increase your risk:
- a family history of ovarian cancer
- genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
- a personal history of breast, uterine, or colon cancer
- the use of certain fertility drugs or hormone therapies
- no history of pregnancy
Older age is another risk factor. Most cases of ovarian cancer develop after menopause.
It’s possible to have ovarian cancer without having any of these risk factors. Likewise, having any of these risk factors doesn’t necessarily mean you’ll develop ovarian cancer.
How is ovarian cancer diagnosed?
It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect.
Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumor. There’s no routine diagnostic screening available for ovarian cancer. That’s why it’s so important for you to report unusual or persistent symptoms to your doctor.
If your doctor is concerned that you have ovarian cancer, they’ll likely recommend a pelvic exam. Performing a pelvic exam can help your doctor discover irregularities, but small ovarian tumors are very difficult to feel.
As the tumor grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.
Your doctor may also do the following tests:
- Transvaginal ultrasound (TVUS). TVUS is a type of imaging test that uses sound waves to detect tumors in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine whether tumors are cancerous.
- Abdominal and pelvic CT scan. If you’re allergic to dye, they may order a pelvic MRI scan.
- Blood test to measure cancer antigen 125 (CA-125) levels. A CA-125 test is a biomarker that’s used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect CA-125 levels in the blood.
- Biopsy. A biopsy involves removing a small sample of tissue from the ovary and analyzing the sample under a microscope.
It’s important to note that, although all of these tests can help guide your doctor toward a diagnosis, a biopsy is the only way your doctor can confirm whether you have ovarian cancer.
What are the stages of ovarian cancer?
Your doctor determines the stage based on how far the cancer has spread. There are four stages, and each stage has substages:
Stage 1 ovarian cancer has three substages:
- Stage 1A.The cancer is limited, or localized, to one ovary.
- Stage 1B. The cancer is in both ovaries.
- Stage 1C. There are also cancer cells on the outside of the ovary.
In stage 2, the tumor has spread to other pelvic structures. It has two substages:
- Stage 2A. The cancer has spread to the uterus or fallopian tubes.
- Stage 2B. The cancer has spread to the bladder or rectum.
Stage 3 ovarian cancer has three sub-stages:
- Stage 3A. The cancer has spread microscopically beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
- Stage 3B. The cancer cells have spread beyond the pelvis to the lining of the abdomen and are visible to naked eye but measure less than 2 cm.
- Stage 3C. Deposits of cancer at least 3/4 of an inch are seen on the abdomen or outside the spleen or liver. However, the cancer isn’t inside the spleen or liver.
In stage 4, the tumor has metastasized, or spread, beyond the pelvis, abdomen, and lymph nodes to the liver or lungs. There are two substages in stage 4:
- In stage 4A, the cancerous cells are in the fluid around the lungs.
- In stage 4B, the most advanced stage, the cells have reached the inside of the spleen or liver or even other distant organs like the skin or brain.
How ovarian cancer is treated
The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:
- surgery to stage the cancer and remove the tumor
- targeted therapy
- hormone therapy
Surgery is the main treatment for ovarian cancer.
The goal of surgery is to remove the tumor, but a hysterectomy, or complete removal of the uterus, is often necessary.
Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue.
Identifying all tumor locations is difficult.
In one study, researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.
Targeted therapies, such as chemotherapy, attack the cancer cells while doing little damage to normal cells in the body.
Newer targeted therapies to treat advanced epithelial ovarian cancer include PARP inhibitors, which are drugs that block an enzyme used by cells to repair damage to their DNA.
The first PARP inhibitor was approved in 2014 for use in advanced ovarian cancer that had been treated previously with three lines of chemotherapy (meaning at least two recurrences).
The three PARP inhibitors currently available include:
- olaparib (Lynparza)
- niraparib (Zejula)
- rucaparib (Rubraca)
The addition of another drug, bevacizumab (Avastin), has also been used with chemotherapy following surgery.
Cancer treatments, including chemotherapy, radiation, and surgery, can damage your reproductive organs, making it difficult to become pregnant.
If you want to become pregnant in the future, talk to your doctor before starting treatment. They can discuss your options for possibly preserving your fertility.
Possible fertility preservation options include:
- Embryo freezing. This involves freezing a fertilized egg.
- Oocyte freezing. This procedure involves freezing an unfertilized egg.
- Surgery to preserve fertility. In some cases, surgery that only removes one ovary and keeps the healthy ovary can be done. This is usually only possible in early stage ovarian cancer.
- Ovarian tissue preservation. This involves removing and freezing ovarian tissue for future use.
- Ovarian suppression. This involves taking hormones to suppress ovarian function temporarily.
Ovarian cancer research and studies
New treatments for ovarian cancer are studied each year.
Researchers are also exploring new ways to treat platinum-resistant ovarian cancer. When platinum resistance occurs, standard first-line chemotherapy drugs like carboplatin and cisplatin are ineffective.
The future of PARP inhibitors will be in identifying what other drugs can be used in combination with them to treat tumors that show unique characteristics.
Recently, some promising therapies have started clinical trials such as a potential vaccine against recurrent ovarian cancers that express the survivin protein.
In May 2020,
New targeted therapies are being studied, including the antibody navicixizumab, the ATR inhibitor AZD6738, and the Wee1 inhibitor adavosertib. All have shown signs of anti-tumor activity.
In 2018, the FDA fast-tracked a protein therapy called AVB-S6-500 for platinum-resistant ovarian cancer. This aims to prevent tumor growth and cancer spread by blocking a key molecular pathway.
An ongoing clinical trial combining immunotherapy (which helps a person’s immune system fight cancer) with existing approved therapies has shown promise.
Ovarian cancer treatment primarily focuses on surgery to remove the ovaries and uterus and chemotherapy. As a result, some women will experience menopause symptoms.
A 2015 article looked at intraperitoneal (IP) chemotherapy. This study found that those who received IP therapy had a median survival rate of 61.8 months. This was an improvement as compared to 51.4 months for those who received standard chemotherapy.
Can ovarian cancer be prevented?
There are no proven ways to totally eliminate your risk of developing ovarian cancer. However, there are steps you can take to lower your risk.
Factors that have been shown to lower your risk of developing ovarian cancer include:
- taking oral birth control pills
- surgical procedures on your reproductive organs (like a tubal ligation or hysterectomy)
What is the outlook?
Your outlook depends on a variety of factors, including:
- the stage of the cancer at diagnosis
- your overall health
- how well you respond to treatment
Every cancer is unique, but the stage of the cancer is the most important indicator of outlook.
The survival rate is the percentage of women who survive a certain number of years at a given stage of diagnosis.
For example, the 5-year survival rate is the percentage of patients who received a diagnosis at a particular stage and live at least 5 years after their doctor diagnosed them.
The relative survival rate also takes into account the expected rate of death for people without cancer.
Epithelial ovarian cancer is the most common type of ovarian cancer. Survival rates may differ based on the type of ovarian cancer, the progression of the cancer, and continuing advancements in treatments.
The American Cancer Society uses information from the SEER database that the National Cancer Institute (NCI) maintains to estimate the relative survival rate for this type of ovarian cancer.
Here’s how SEER currently categorizes the various stages:
- Localized. No sign that the cancer has spread outside of the ovaries.
- Regional. Cancer has spread outside the ovaries to nearby structures or lymph nodes.
- Distant. Cancer has spread to distant parts of the body, such as the liver or lungs.
5-year relative survival rates for ovarian cancer
Invasive epithelial ovarian cancer
|SEER stage||5-year relative survival rate|
Ovarian stromal tumors
|SEER stage||5-year relative survival rate|
Germ cell tumors of the ovary
|SEER stage||5-year relative survival rate|
Note that this data comes from studies that could be at least 5 years or older.
Scientists are currently researching more improved and reliable ways to detect ovarian cancer early. Advancements in treatments improve, and with it, the outlook for ovarian cancer.