Ovarian Cancer: Causes, Symptoms, and Treatments

Known as the “silent killer” because most cases are found after the disease has spread, ovarian cancer is a type of gynecologic cancer that starts growing in the ovaries. Ovarian cancer is not the most common type of gynecologic cancer, but it has the distinction of causing more deaths than any other cancer of the female reproductive system. Educating yourself about your risk of ovarian cancer and its warning signs may improve your survival.

About 20,000 people will be diagnosed with ovarian cancer in the U.S. in 2022, and about 13,000 people are expected to die from the disease.

It has the lowest survival rate of all gynecologic cancers. Only about 50% of people diagnosed with ovarian cancer live longer than 5 years after diagnosis. However, if the disease is caught and treated early – before it has spread – the survival rate jumps to about 93%.

What is ovarian cancer?

A person with a female reproductive system normally has two ovaries. The ovaries are small, shaped like an almond, and can be found on either side of the uterus. Your eggs are stored in your ovaries, and hormones are also released from the ovaries.

Ovarian cancer occurs when cells grow uncontrollably in the ovaries. This disease mainly develops in people who have undergone menopause, about age 63 or older, but any person with a female reproductive system can be at risk.

Many types of ovarian cancer exist, and they’re named based on the cells they originate from. Epithelial ovarian cancer is the most common type and starts in the epithelium – the surface of the ovaries. Other less common types of ovarian cancer are germ cell tumors, stromal tumors, and primary peritoneal carcinoma.

Causes and risk factors of ovarian cancer

The cause of ovarian cancer is not known. There is a theory about a possible link between the number of times a person ovulates and their risk of ovarian cancer, but it is still being researched.

Scientists know that a change in the DNA (the carrier of genetic information) causes ovarian cancer, but why this change happens is still unknown. Some of these genetic changes can develop as you get older, while some are inherited – meaning it runs in your family and is passed down to you.

They’ve looked at two types of genes: BRCA1 and BRCA2. When they work normally, these genes prevent some cells from growing uncontrollably. A defect in the DNA of these genes – called BRCA1 or BRCA2 mutation – may increase your risk of developing breast cancer, ovarian cancer, or both.

Certain factors that might increase your risk of developing epithelial ovarian cancer include:

• Being older, usually having gone through menopause.
• Having obesity or being overweight.
• Having children later in life or never having given birth.
• Taking hormone replacement therapy.
• Having a family history of ovarian cancer, breast cancer, or colon cancer.
• Having had breast cancer or colon cancer.
• Having a BRCA1 or BRCA2 genetic mutation.
• Having an inherited condition like Hereditary Breast and Ovarian Cancer Syndrome (HBOC) or Peutz-Jeghers syndrome.
• Smoking.

The risk factors for the less common types of ovarian cancer are not well known and are being studied.

Moreover, certain factors, like having carried a pregnancy to full term or taking birth control pills, have been associated with a decreased risk of ovarian cancer.

Ovarian cancer symptoms to watch for

Very few symptoms are present in the early stage of ovarian cancer, and they tend to be vague and attributed to other less serious conditions or non-cancerous diseases.

While they vary from person to person, common symptoms of ovarian cancer include:

• Pelvic or belly pain, sometimes you’ll feel pressure.
• Bloating or swelling in your belly.
• Feeling full quickly or having trouble eating.
• Constantly feeling like you need to urinate.
• Unusual vaginal bleeding (change in your menstrual periods or bleeding after menopause).
• Abnormal vaginal discharge.
• Back pain.
• Pain with sex.
• Change in your bowel habits (constipation, diarrhea).
• Feeling tired all the time.

Talk to your healthcare provider if you notice these symptoms, especially if they are persistent or occur frequently.

How is ovarian cancer diagnosed?

There are no reliable screening tests available for ovarian cancer. The Pap test or HPV test are not effective at diagnosing ovarian cancer.

However, a vital step in diagnosing ovarian cancer is getting regular gynecology checkups. During your checkup, your gynecologist typically performs a pelvic exam to check for any mass, enlargement, or unusual findings that are potential signs of cancer. Some small cancers may not be detected during a pelvic exam.

If your doctor feels anything abnormal or if there are any concerns based on your risk factors or symptoms, they may recommend that you undergo a transvaginal ultrasound. You may also be asked to do a CA-125 test – a blood test that measures the protein CA-125, which is usually high in people with ovarian cancer.

If your test results are positive, your doctor may order additional imaging tests, like a CT scan, to help evaluate further.

Another key in diagnosing ovarian cancer is knowing your body and reporting unusual changes to your healthcare provider as soon as possible.

Stages of ovarian cancer

If you’ve been diagnosed with ovarian cancer, staging is essential to help determine if the tumor has progressed and the best treatment plan.

Ovarian cancer is often described in 4 stages:

Stage I: The tumor is in one or both ovaries or fallopian tube(s).

Stage II: The tumor has spread to nearby organs within the pelvis like the uterus, bladder, or colon.

Stage III: The tumor has spread to the lymph nodes in your pelvis or abdomen.

Stage IV: Tumor cells are found in other body parts such as the liver, spleen, and lungs.

Your doctor might further describe each stage of ovarian cancer by a substage. For example, stage IIIB means the tumor is less than 2 cm (smaller than a peanut), whereas stage IIIC means the tumor is larger than 2 cm (bigger than a peanut) and cancer cells are found on the surface of the liver or spleen but not inside these organs.

How is ovarian cancer treated?

Several specialists may be part of your treatment team: a gynecologic oncologist, a medical oncologist, and a radiation oncologist in some cases. They will consider factors like the stage of your cancer, tumor size, overall health, age, and personal preferences as they determine the best treatment options.

Surgery is usually the primary treatment for ovarian cancer. Depending on many factors, they may recommend that you undergo a debulking procedure to remove as much cancer as possible. A hysterectomy with salpingo-oophorectomy (removal of your ovaries) may be recommended for some types of ovarian cancer.

Chemotherapy may then be recommended to kill any remaining cancer cells not removed by the surgery. Sometimes, intraperitoneal chemotherapy – a treatment where chemotherapy is administered directly into the abdomen – can be given, and this would be done at the time of surgery.

Radiation therapy – although rarely used to treat ovarian cancer – can be given to destroy any residual cancer cells.

Targeted therapy may also be added to your treatment plan. These drugs attack cancer cells without damaging normal cells.

For some types of ovarian cancer, like ovarian stromal tumors, hormone therapy may be an option.

Your doctor may also talk to you about participating in a clinical trial to help scientists evaluate if certain treatments are safe and effective.

Be sure to discuss the risks and benefits of each treatment, your preferences, and your desire to have children in the future – if that’s your wish – with your team of healthcare providers before starting treatment. If time permits, you may talk to a different doctor to get a second opinion regarding your treatment plan.

Ovarian cancer may sound scary because it’s difficult to detect in its early stages and has a low overall survival rate. It’s important to remember that treatment can be successful if the disease is diagnosed early. When caught and treated early, about 93 out of every 100 people with ovarian cancer are alive five years after the diagnosis, and many continue to live for years longer. Paying attention to changes in your body, getting regular gynecology checkups, and knowing your family history of cancer are steps you can take to improve the odds of an early diagnosis.