Ovarian Cancer

Ovarian cancer is a type of cancer that begins in the ovaries, the female reproductive organs that produce eggs and hormones. It ranks as the fifth most common cause of cancer deaths among women and is often called the "silent killer" because symptoms are typically subtle and appear only after the disease has spread. There are several types of ovarian cancer, with epithelial tumors (which begin in the cells covering the ovaries) being the most common, accounting for about 90% of cases. Other types include germ cell tumors (starting in egg cells) and stromal tumors (beginning in the cells that produce hormones). The prognosis for ovarian cancer largely depends on how early it's detected. When found in its earliest stages, the five-year survival rate can exceed 90%, but unfortunately, only about 20% of cases are diagnosed early. With advances in treatment options and ongoing research, outcomes continue to improve for women with ovarian cancer.

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What Causes It?

Age - Risk increases with age, particularly after menopause, with most cases occurring in women over 50.

Family history - Having close relatives (mother, sister, daughter) with ovarian, breast, or colorectal cancer increases risk.

Genetic mutations - Inherited changes in BRCA1, BRCA2, and genes associated with Lynch syndrome significantly increase risk.

Reproductive history - Never having been pregnant, starting menstruation early, or experiencing menopause late increases lifetime exposure to estrogen.

Hormone replacement therapy - Particularly estrogen-only formulations used for extended periods after menopause.

Endometriosis - This condition has been associated with certain types of ovarian cancer.

Obesity - Higher body mass index increases risk, especially in women who have never used hormone replacement therapy.

Fertility treatments - Some studies suggest possible links between certain fertility drugs and ovarian cancer, though research is ongoing.

Smoking - Associated specifically with an increased risk of mucinous ovarian cancer.

Talcum powder - Some studies suggest a possible link between talc use in the genital area and ovarian cancer, though evidence remains controversial.

Radiation therapy - Previous radiation treatment to the pelvic area may slightly increase risk.

Polycystic ovary syndrome - May be associated with a higher risk, particularly in younger women.

Signs & Symptoms

Abdominal bloating or swelling - Persistent and often one of the earliest signs.

Pelvic or abdominal pain - May be vague discomfort or more severe pain.

Difficulty eating or feeling full quickly - Even after small meals.

Urinary symptoms - Urgency or frequency beyond what's normal for you.

Fatigue - Persistent and unexplained tiredness.

Back pain - Particularly in the lower back.

Pain during intercourse - New onset of discomfort during sexual activity.

Changes in bowel habits - Constipation or diarrhea that persists.

Menstrual irregularities - Changes in period patterns in premenopausal women.

Unexplained weight loss - Losing weight without trying.

Abdominal distension - Due to fluid accumulation (ascites) in advanced stages.

Shortness of breath - In later stages, possibly due to fluid around the lungs or cancer spread.

Note: These symptoms are often attributed to more common conditions, leading to delayed diagnosis. Persistent symptoms, especially several occurring together, warrant medical evaluation.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Pelvic Examination

A physical exam where the doctor checks the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum for masses or abnormalities. While this can detect larger tumors, early-stage ovarian cancer is difficult to feel during a routine exam.

Transvaginal Ultrasound

An imaging procedure where a wand-like device is inserted into the vagina to create sound waves that generate images of the ovaries and uterus. This can help identify masses but cannot determine if they are cancerous.

CA-125 Blood Test

Measures levels of a protein called Cancer Antigen 125, which can be elevated in women with ovarian cancer. However, many other conditions can raise CA-125 levels, so this test is not specific enough for screening but is useful for monitoring treatment response and recurrence.

Other Blood Tests

Additional tumor markers like HE4, complete blood count, and liver and kidney function tests may be performed to assess overall health and gather more information.

Imaging Studies

CT scans, MRI, or PET scans may be used to determine if cancer has spread beyond the ovaries and to help plan treatment. These can show detailed images of the abdomen, pelvis, and other areas.

Laparoscopy

A minimally invasive surgical procedure where a thin, lighted tube with a camera is inserted through small incisions in the abdomen to view the ovaries and other pelvic organs. Tissue samples can be taken during this procedure.

Surgical Staging/Debulking

Often, definitive diagnosis and staging occur during surgery to remove the tumor and surrounding tissues. The extent of surgery depends on the suspected stage and patient factors. Tissue removed during surgery is examined by a pathologist to confirm cancer type and stage.

Genetic Testing

Tests for mutations in genes like BRCA1, BRCA2, and those associated with Lynch syndrome may be recommended, especially for women with a family history of ovarian, breast, or colorectal cancer. Results can influence treatment decisions and have implications for family members.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Surgery

The primary treatment for most ovarian cancers, typically including removal of both ovaries, fallopian tubes, uterus (hysterectomy), nearby lymph nodes, and the omentum (fatty tissue in the abdomen). In advanced cases, the goal is optimal debulking - removing as much visible cancer as possible. For young women with early-stage cancer who wish to preserve fertility, less extensive surgery may sometimes be an option.

Chemotherapy

Typically involves platinum-based drugs (like carboplatin) combined with taxanes (like paclitaxel), given intravenously every 3-4 weeks for 6 cycles. In some cases, intraperitoneal chemotherapy (directly into the abdominal cavity) may be used. Chemotherapy may be given after surgery (adjuvant) or before surgery (neoadjuvant) to shrink tumors.

Targeted Therapy

Medications that target specific vulnerabilities in cancer cells. PARP inhibitors (like olaparib, niraparib, and rucaparib) have shown significant benefits, especially for women with BRCA mutations or homologous recombination deficiency. Bevacizumab, which targets blood vessel growth, may also be used in certain situations.

Hormone Therapy

For certain types of ovarian cancer, particularly low-grade serous carcinomas or recurrent disease, hormone therapies like aromatase inhibitors (letrozole, anastrozole) or tamoxifen may be options.

Immunotherapy

While not yet standard treatment for most ovarian cancers, immune checkpoint inhibitors and other immunotherapies are being studied in clinical trials, particularly for specific subtypes or in combination with other treatments.

Clinical Trials

Participation in clinical trials may provide access to promising new treatments before they become widely available. These might include novel combinations of existing drugs, new targeted therapies, immunotherapies, or innovative approaches like virotherapy or adoptive cell therapy.

Palliative Care

Focuses on improving quality of life by managing symptoms and side effects, regardless of stage or other treatments being received. May include procedures to relieve fluid accumulation, pain management, nutritional support, and emotional and psychological care.

Home Remedies

Nutrition Support

Eat small, frequent meals if experiencing nausea or early satiety. Focus on nutrient-dense foods like fruits, vegetables, lean proteins, and whole grains when appetite allows. Stay hydrated and consider working with a dietitian who specializes in oncology nutrition for personalized guidance.

Managing Nausea

Beyond prescribed anti-nausea medications, some find relief with ginger (tea, chews, or candies), peppermint tea, or cold foods with minimal odor. Eat slowly and avoid lying flat after meals. Keep crackers or dry toast at bedside for morning nausea.

Physical Activity

Gentle exercise as tolerated and approved by your healthcare team can help manage fatigue, maintain strength, and improve mood. Options might include short walks, gentle yoga, or swimming. Listen to your body and rest when needed.

Fatigue Management

Plan activities during times of peak energy, prioritize important tasks, accept help from others, and schedule rest periods. Light exercise paradoxically can help combat fatigue, as can attention to good sleep hygiene.

Emotional Support

Connect with support groups specifically for ovarian cancer patients, either in-person or online. Practice stress-reduction techniques such as deep breathing, meditation, gentle yoga, or whatever brings you peace. Consider professional counseling or therapy if struggling emotionally.

Comfort Measures

For abdominal discomfort, some find relief with warm (not hot) packs, gentle abdominal massage with approved oils, or loose, comfortable clothing that doesn't constrict the waist. Positioning pillows for support while resting can also help.

Complementary Approaches

Some women find benefit from acupuncture, massage therapy, or relaxation techniques for symptom management, particularly pain, nausea, and anxiety. Always discuss these with your healthcare team, as some complementary approaches may interfere with treatment.

Prevention Tips

Attend all scheduled follow-up appointments for surveillance after treatment.

Complete recommended imaging studies and blood tests as scheduled.

Report any new or recurring symptoms to your healthcare team promptly.

Consider genetic counseling and testing if you have a personal or family history of ovarian, breast, or colorectal cancer.

For high-risk women who have completed childbearing, preventive surgery to remove ovaries and fallopian tubes significantly reduces risk.

Maintain a healthy weight through balanced nutrition and appropriate physical activity.

Limit alcohol consumption and avoid tobacco products.

For women at average risk, understand that routine pelvic exams, ultrasounds, or CA-125 testing have not been proven effective for general screening.

Discuss any persistent gastrointestinal or pelvic symptoms with your doctor, even if they seem minor.

For women of childbearing age, hormonal contraceptives (birth control pills) used for 5+ years may reduce ovarian cancer risk.

Pregnancy and breastfeeding are associated with lower ovarian cancer risk.

Consider participating in ovarian cancer research studies or registries to advance knowledge and treatment options.

Join support groups or advocacy organizations to stay informed about new developments in ovarian cancer research and treatment.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Cytoreductive (Debulking) Surgery

The standard surgical approach for ovarian cancer, aiming to remove all visible cancer. Typically includes total hysterectomy (removal of uterus), bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes), omentectomy (removal of fatty tissue covering abdominal organs), lymph node sampling or removal, and removal of any other visible tumors in the abdomen and pelvis. The goal is "optimal debulking," leaving no visible tumor or only small residual tumors (less than 1 cm), which improves the effectiveness of subsequent chemotherapy.

Fertility-Sparing Surgery

For young women with early-stage ovarian cancer who wish to preserve fertility, this may involve removing only the affected ovary and fallopian tube, leaving the uterus and unaffected ovary intact. This option is typically considered only for stage IA tumors (confined to one ovary) and certain cancer types like borderline tumors, germ cell tumors, or early-stage low-grade epithelial cancers. Careful staging and close follow-up are essential.

Minimally Invasive Surgery

Laparoscopic or robotic approaches may be used for early-stage disease, diagnostic procedures, or in clinical trials. These techniques use small incisions and specialized instruments, potentially offering faster recovery and less pain. However, traditional open surgery remains standard for advanced ovarian cancer to ensure complete tumor assessment and optimal debulking.

Secondary Cytoreduction

For women with recurrent ovarian cancer, a second debulking surgery may be considered if the recurrence is limited to a few sites, there has been a good interval since primary treatment, and the patient is otherwise in good health. This approach is individualized based on several factors and may improve outcomes in carefully selected patients.

Palliative Surgical Procedures

Surgical interventions aimed at relieving symptoms rather than curing the cancer. These might include procedures to relieve bowel obstruction, place drainage catheters for ascites (fluid accumulation), or address other complications affecting quality of life. The goals are symptom management and improved comfort when cure is not possible.

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