Ovarian Cancer
What is ovarian cancer?
Ovarian cancer is a group of gynecologic cancers that may arise from the ovaries, the fallopian tubes, or the peritoneum, which is the thin lining inside the abdomen. Today, many high-grade serous ovarian cancers are thought to begin in the fallopian tubes. For this reason, ovarian, fallopian tube, and primary peritoneal cancers are often discussed together and treated with similar principles.
Ovarian cancer is not a single disease. The most common group is epithelial ovarian cancer. Less common types include germ cell tumors, sex cord-stromal tumors, and borderline tumors. Treatment depends on the tumor type, stage, patient’s age, general health, fertility wishes, and genetic or molecular features of the tumor.
Why is ovarian cancer often called a “silent” disease?
Ovarian cancer may not cause obvious symptoms in its early stages. When symptoms occur, they can resemble common digestive, urinary, menstrual, or menopausal problems. This is one reason why many patients are diagnosed at an advanced stage.
However, “silent” does not mean “undetectable.” New, persistent, frequent, or worsening abdominal and pelvic symptoms should always be evaluated.
What symptoms should raise concern?
The following symptoms should be taken seriously, especially if they are new, persistent, frequent, or do not improve within a few weeks:
Abdominal bloating or swelling
Pelvic or abdominal pain
Feeling full quickly or difficulty eating
Loss of appetite
Frequent urination or urgent need to urinate
Constipation or changes in bowel habits
Increase in abdominal size or tighter clothing
Unexplained weight loss or weight gain
Vaginal bleeding after menopause
Fatigue, back pain, or a general feeling of discomfort
“Is bloating normal, or should it be checked?”
Bloating is very common and is usually not caused by cancer. What matters is the pattern. Bloating that is new, almost daily, persistent, progressive, and not explained by diet or routine digestive problems should be assessed by a physician.
Who is at higher risk?
Ovarian cancer can occur in any woman, but certain factors may increase risk:
Increasing age, especially after menopause
Family history of ovarian, breast, pancreatic, or prostate cancer
Inherited mutations such as BRCA1 or BRCA2
Hereditary cancer syndromes such as Lynch syndrome
Personal history of breast cancer
Never having given birth or a history of infertility
Endometriosis
Obesity
Long-term estrogen-only hormone therapy
Having a risk factor does not mean a person will develop ovarian cancer. Likewise, ovarian cancer can occur without obvious risk factors. Individual risk should be discussed with a healthcare professional.
Is there a screening test for ovarian cancer?
For women at average risk who have no symptoms, there is currently no reliable routine screening test proven to detect ovarian cancer early and reduce deaths. CA-125 blood testing and transvaginal ultrasound may be useful in evaluation or follow-up, but they are not sufficient as general population screening tools.
CA-125 can be elevated in some ovarian cancers, but it may also rise in benign conditions such as endometriosis, fibroids, inflammation, menstruation, and other non-cancerous conditions. Also, not every ovarian cancer causes an elevated CA-125 level. Test results must therefore be interpreted together with symptoms, examination findings, and imaging.
“Can an ultrasound definitely detect ovarian cancer?”
No. Ultrasound can show ovarian masses, cysts, fluid, or suspicious features, but not every mass is cancer, and not every cancer is clearly visible at an early stage. Ultrasound is an important diagnostic tool, but it does not provide a definitive diagnosis on its own.
How is ovarian cancer diagnosed?
When ovarian cancer is suspected, evaluation usually includes several steps.
1. Medical history and examination
The physician asks about symptoms, duration, family history, menstrual or menopausal status, and previous medical conditions. A pelvic examination may be performed.
2. Imaging
Transvaginal or abdominal ultrasound is often used first. If findings are suspicious, CT, MRI, or sometimes PET/CT may be requested. Imaging helps assess disease extent and plan treatment.
3. Blood tests
CA-125 is the most commonly used tumor marker in epithelial ovarian cancer. In selected cases, HE4, ROMA score, or other tumor markers may be considered. In younger patients or when rare tumors are suspected, markers such as AFP, beta-hCG, and LDH may be requested.
4. Pathological confirmation
The definitive diagnosis is made by examining tumor tissue under a microscope. Tissue is usually obtained during surgery. In some advanced cases, or when immediate surgery is not appropriate, a biopsy may be performed.
Why is staging important?
Staging describes how far the cancer has spread. In ovarian cancer, stage is determined by whether the disease is limited to the ovaries or fallopian tubes, has spread within the pelvis or abdomen, involves lymph nodes, or has reached distant organs.
In general:
Stage I: Cancer is limited to the ovary or fallopian tube.
Stage II: Cancer has spread to pelvic structures.
Stage III: Cancer has spread within the abdomen and/or to lymph nodes.
Stage IV: Cancer has spread to distant sites, such as inside the liver, around the lungs, or other organs.
Stage directly affects treatment planning and follow-up.
What are the treatment options?
Treatment is usually planned by a multidisciplinary team. This may include a gynecologic oncologist, medical oncologist, radiologist, pathologist, genetic counselor, and supportive care specialists.
1. Surgery
Surgery is one of the main components of ovarian cancer treatment. The goals are to confirm the diagnosis, determine the stage, and remove as much visible tumor as possible. This is called cytoreductive or debulking surgery.
The extent of surgery depends on the stage and the patient’s condition. Surgery may include removal of the uterus, ovaries, fallopian tubes, omentum, lymph nodes, and other tissues affected by tumor. In carefully selected young patients with early-stage disease, fertility-sparing surgery may be possible.
2. Chemotherapy
For epithelial ovarian cancer, platinum-based chemotherapy is commonly used. A frequently used standard combination is carboplatin and paclitaxel. Chemotherapy may be given after surgery, or before surgery if the disease is extensive or if immediate surgery carries high risk. Chemotherapy given before surgery is called neoadjuvant chemotherapy.
“Surgery first, or chemotherapy first?”
This decision depends on disease extent, the patient’s general condition, surgical risks, and whether complete or near-complete tumor removal appears feasible. In some patients, surgery first is preferred. In others, chemotherapy first may provide better safety and outcomes.
3. Targeted therapies
Some patients may receive targeted therapies in addition to chemotherapy. Bevacizumab is a drug that affects tumor blood vessel formation and may be used in selected cases.
PARP inhibitors are important maintenance treatment options, especially for patients with BRCA mutations or homologous recombination deficiency. Drugs in this group include olaparib, niraparib, and rucaparib. The choice depends on genetic and molecular test results, response to previous treatment, side-effect profile, and local availability or reimbursement rules.
4. Genetic and molecular testing
Genetic evaluation is very important in epithelial ovarian cancer. Testing may include BRCA1 and BRCA2 and other hereditary cancer susceptibility genes. Tumor testing for somatic mutations and homologous recombination deficiency may also guide treatment decisions.
These tests are important not only for choosing treatment but also for assessing cancer risk in family members. Genetic counseling may be recommended.
5. Radiotherapy and supportive care
Radiotherapy is not a main treatment for most ovarian cancers, but it may be used in selected situations, such as controlling pain or bleeding in a limited area. Supportive care is important throughout the entire cancer journey. Nutrition, pain control, psychological support, menopause management, physical activity, and side-effect management all help protect quality of life.
What happens after treatment?
After treatment is completed, regular follow-up is needed. The goal is not only to detect recurrence, but also to manage treatment-related side effects, support quality of life, address emotional and social needs, and monitor general health.
Follow-up is individualized, but commonly includes:
More frequent visits during the first 2 years
Gradually longer intervals in later years
Review of symptoms at each visit
Physical and pelvic examination when appropriate
CA-125 or other tumor marker monitoring if elevated at diagnosis
Imaging when symptoms, examination findings, or tumor markers suggest recurrence
Assessment of neuropathy, fatigue, menopausal symptoms, bone health, emotional wellbeing, and long-term treatment effects
Routine imaging and CA-125 monitoring are not identical for every patient. In some patients, close marker monitoring is useful. In others, it may increase anxiety or lead to unnecessary tests. The follow-up plan should be discussed openly between the patient and physician.
“If CA-125 rises, does that definitely mean recurrence?”
No. A rising CA-125 may be a warning sign, but it is not a diagnosis by itself. Infection, inflammation, and other non-cancerous conditions may also affect CA-125. Decisions should be based on symptoms, examination, imaging, previous values, and the overall clinical picture.
When should a doctor be consulted?
Medical evaluation is recommended without delay in the following situations:
New and persistent abdominal bloating
Ongoing pelvic or abdominal pain
Feeling full quickly, loss of appetite, or unexplained weight change
Frequent urination or urinary urgency
Vaginal bleeding after menopause
New persistent symptoms in a person previously treated for ovarian cancer
Family history of ovarian cancer or breast cancer at a young age
Conclusion
Ovarian cancer may progress quietly in its early stages, but persistent and new symptoms should not be ignored. Today, treatment is becoming increasingly personalized through surgery, chemotherapy, targeted therapies, and genetic testing. The best approach is an individualized treatment and follow-up plan created by an experienced multidisciplinary team.
This article is for general informational purposes only. Diagnosis, treatment, and follow-up decisions must be made by the patient’s own physician, based on individual medical findings.
