Ovarian Cancer

What it is

Most ovarian cancer is epithelial, meaning it starts in the surface cells. We now know that many of these cancers begin in the far end of the fallopian tube and spread to the ovary from there. That is why ovarian cancer, fallopian tube cancer, and primary peritoneal cancer, which starts in the lining of the abdomen, are grouped together and treated the same way. [1]

Signs and symptoms

In its earliest stages ovarian cancer may not cause any symptoms you would notice. [2] When symptoms do come, the Society of Gynecologic Oncology lists them as abdominal pain and bloating, weight loss, feeling full without having eaten much, changes in bowel habits and especially constipation, needing to urinate frequently, a feeling of fullness in the pelvis, clothes fitting more tightly around the belly, nausea and vomiting, fatigue, and lower back pain. [2]

Why there is no screening test

Women often assume a Pap test would catch this. It would not. A Pap test samples cells from the cervix and screens for cervical cancer. It tells us nothing about the ovaries.

The CA-125 blood test and pelvic ultrasound are both useful once we are already investigating a symptom or following a known cancer. [1] As a screening test for healthy women at average risk, they have not been shown to save lives, and they lead to operations that turn out not to have been needed. That is where the evidence stands today, and it is why paying attention to symptoms matters as much as it does.

Women with an inherited risk, such as a BRCA gene change or a strong family history, are a different conversation. For them there are real risk-reducing options worth discussing well before any symptom appears.

What raises the risk

The National Cancer Institute lists family history, inherited risks if you carry a genetic mutation such as BRCA1 and BRCA2, endometriosis, hormone therapy after menopause, obesity, and greater height among the risk factors. Age is the largest one. [1]

How it is diagnosed

The workup usually starts with a physical and pelvic exam, a CA-125 blood test, and an ultrasound. Depending on what those show, we may add a CT scan, a PET scan, an MRI, or a chest x-ray, and at some point tissue has to be looked at under a microscope. [1]

An ovarian mass on a scan is not the same as a cancer. Many are benign. What we are weighing is size, appearance, your age, your blood work, and your symptoms together.

How it is treated

For early-stage disease, treatment usually means removing the uterus, the tubes and ovaries, and the omentum, which is the apron of fatty tissue that hangs in front of the bowel, along with lymph nodes. Chemotherapy may follow. [1]

For advanced disease, treatment combines surgery with chemotherapy, and may include targeted drugs such as bevacizumab or a PARP inhibitor. [1] Sometimes chemotherapy comes first and surgery follows, which gives the operation a better chance of removing everything visible.

For what chemotherapy involves, visit by visit, see chemotherapy and radiation.

Some ovarian cancers are caused by inherited gene changes. [1] Genetic testing is part of standard care for this diagnosis, because the result can open up treatment options such as PARP inhibitors and because it tells your sisters and daughters something they need to know.

Should I call, or should I go in?

If you are not sure how urgent your symptoms are, work through this. It does not diagnose anything. It only helps you decide who to call.