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Ovarian cancer happens when cells that are not normal grow in or near 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.
Experts don't know exactly what causes ovarian cancer. But they do know that DNA changes play a role in many cancers.
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.
Sometimes the doctor may feel a lump in or on an ovary during a pelvic examination. Often a lump may be seen during an ultrasound. Most lumps aren't cancer.
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.
Surgery is the main treatment. The doctor will remove any tumours 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. Targeted therapy or hormone therapy may also be used.
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 Canadian Cancer Society can help you find a support group.
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.
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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.
About 10 out of 100 ovarian cancers are thought to be caused by gene mutations in the BRCA1 or BRCA2 genes.footnote 1 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:
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 abdominal lining. From there it may travel to other organs in the body, such as the liver or lungs.
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 post-menopausal 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 counsellor about having genetic testing to look for gene changes.
Talk to your doctor if you have any symptoms, such as:
If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.
Some examinations and tests that are done to look for or diagnose ovarian cancer include:
Experts do not recommend routine screening for ovarian cancer.footnote 2 They haven't found proof that having regular tests to find ovarian cancer early helps women live longer. But this recommendation isn't for women with known gene changes (such as BRCA) who have a higher risk for ovarian cancer.
For women who have an average risk for ovarian cancer, experts do not recommend using the CA-125 test as a screening test for ovarian cancer. This is because this test often has false-positive results that can lead to unneeded surgery. But some doctors may recommend the CA-125 test and a transvaginal ultrasound for women who have a very high risk of ovarian cancer, such as those with BRCA gene changes. For these women, the benefits of screening may outweigh the harms.
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.
Here are the main treatment options.
More information about treating ovarian cancer can be found online at the following websites:
Most treatments for ovarian cancer cause side effects. They may differ, depending on the type of treatment and your age and overall health.
Here are the possible side effects of each treatment.
Home treatment may help you manage the side effects.
Your doctor may recommend chemotherapy before surgery to treat advanced-stage ovarian cancer. This depends on how far your cancer has spread and what other illnesses you may have. Surgery for 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.
Your doctor may talk to you about being in a clinical trial of a treatment such as immunotherapy or targeted therapy.
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 centre may offer psychological or financial services. And a local chapter of the Canadian Cancer Society can help you find a support group.
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.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Hospice 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 doesn't mean that treatment ends. Hospice palliative care providers will work to help manage pain and other symptoms or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
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 palliative 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 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%.footnote 3 The protection lasts for many years after the pills are taken. But birth control pills 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:
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.
Targeted therapy and hormone therapy are other treatments that include medicines to treat ovarian cancer. Targeted therapy medicines may be given by IV or as pills or capsules. Hormone therapy medicines are given as injections, tablets, or pills.
Here are some medicines that may be used.
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.
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.
Having an experienced gynecologic oncologist will help you get the best possible treatment.
Side effects from your surgery can include pain, 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 tumours. 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 bloody stools. The skin in the area where you get radiation may become red and tender. These side effects will slowly go away after this treatment ends.
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.
CitationsFleming 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. U.S. Preventive Services Task Force (2018). Screening for ovarian cancer: U.S. Preventive Services Task Force recommendation statement. JAMA, 319(6): 595–606. DOI:10.1001/jama.2017.21421. Accessed online February 14, 2018.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.Other Works ConsultedFritz MA, Speroff L (2011). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 749–857. Philadelphia: Lippincott Williams and Wilkins.National Cancer Institute (2012). Ovarian Epithelial Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/Patient.National Cancer Institute (2013). Ovarian Epithelial Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/HealthProfessional.Vergote I, et al. (2010). Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. New England Journal of Medicine, 363(10): 943–953.
Current as of: December 17, 2020
Author: Healthwise StaffMedical Review: Sarah Marshall MD - Family MedicineDonald Sproule MDCM, CCFP - Family MedicineKathleen Romito MD - Family MedicineAdam Husney MD - Family MedicineE. Gregory Thompson MD - Internal MedicineRoss Berkowitz MD - Obstetrics and Gynecology
Current as of: December 17, 2020
Author: Healthwise Staff
Medical Review:Sarah Marshall MD - Family Medicine & Donald Sproule MDCM, CCFP - Family Medicine & Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Ross Berkowitz MD - Obstetrics and Gynecology
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