Ovarian cancer: symptoms, diagnosis, treatment, prevention

Ovarian cancer is relatively uncommon compared to other forms of cancer, such as lung and colorectal cancer. It’s the second most diagnosed gynecological cancer, however, and causes more deaths than cervical, vaginal, vulvar, or uterine cancer.

One reason: Ovarian cancer is too often found after it's already reached an advanced stage.

“Unfortunately, while screening tests exist for a number of cancers out there—a mammogram for breast cancer, a pap smear for cervical cancer—a reliable screening test doesn’t yet exist for ovarian cancer,” says John Elkas, MD, a gynecological oncologist in Fairfax, Virginia.

That’s why it’s so important to get the facts about ovarian cancer and to seek help if you’re having symptoms. Here’s what everyone should know.

What’s ovarian cancer?

Ovarian cancer develops in the ovaries, the almond-sized glands attached to either side of the uterus. Your ovaries carry your eggs and make the sex hormones estrogen and progesterone.

While younger people may develop the disease, most are diagnosed in their 50s or 60s—typically after menopause. Ovarian cancer is rare before age 40.

People with certain genetic mutations or a family history of ovarian cancer are at increased risk for the disease. Women and people assigned female at birth who have never been pregnant have greater chances, as well. That may be because you don’t ovulate when you’re pregnant, says Dr. Elkas.

“When you ovulate, a cyst forms in one of your ovaries, and then the cyst ruptures to release the egg. That constant inflammation and repair has been potentially linked to cancer,” Elkas explains. “That’s why decreasing the number of times you ovulate in your lifetime through pregnancy or birth control pills may decrease your risk.”

Speak with a healthcare provider (HCP) before deciding to take birth control pills to lower ovarian cancer risk, since oral contraception may carry other risks.

Why are the symptoms of ovarian cancer so easy to miss?

There’s no reliable screening test for ovarian cancer, so it’s up to you to tell your HCP if you’re having any of these symptoms of ovarian cancer:

• Bleeding from your vagina that happens after menopause or that’s off-schedule for your period
• Bloating, even though you might be losing weight or eating less
• A poor appetite
• Feeling full quickly
• Pain in your back or lower abdomen
• Constipation, diarrhea
• Having to urinate often or urgently

Ovarian cancer tends to get brushed off because its symptoms can seem like they’re caused by premenstrual syndrome (PMS) or diet changes. But don’t ignore your body. Keep track of your symptoms and tell your HCP if they happen daily for a few weeks. If you’re having bleeding from your vagina that’s not normal for you, call your HCP immediately.

Ovarian cancer diagnosis

If you experience any of the symptoms listed above, your obstetrician-gynecologist (OBGYN) may do a pelvic exam. To do a pelvic exam, they’ll insert gloved, lubricated fingers into your vagina, while gently pressing on your belly so they can feel your ovaries.

“Usually, suspicion is raised if your doctor can feel a mass on your pelvic exam or they see a mass on any of your scans,” says Elkas.

If your OBGYN notices a change to the shape of your ovaries and you’re having concerning symptoms, they’ll most likely do a trans-vaginal ultrasound and a CA-125 blood test. A trans-vaginal ultrasound involves placing a lubricated wand, called a transducer, inside your vagina. The transducer sends out sound waves, which create images of your ovaries on a computer. The CA-125 test measures a protein called CA-125. High levels of this protein in your blood can be a sign of ovarian cancer.

Your HCP may also send you for a CT scan, which involves lying down inside a large tube, while a powerful X-ray machine takes pictures of your ovaries from different angles.

To make a true diagnosis of ovarian cancer, however, you’ll need to undergo a biopsy so that samples of the mass can be looked at under a microscope, explains Elkas.

Your HCP will probably recommend surgery so that the mass or tumor can be removed when the surgeon goes in to take the biopsy samples. That way, your healthcare team can both confirm your diagnosis and remove as much of the cancer as possible.

Ovarian cancer treatment

The stage of cancer will help decide whether you need chemotherapy after surgery. Chemotherapy (or chemo) is a type of drug that’s used to kill any cancer cells that are left behind after the tumor is removed. It’s usually given by IV in a series of doses that are spread out over several weeks to months.

Targeted drug therapy, in which medication is given to attack certain cancer cells, is another common treatment for ovarian cancer. Monoclonal antibodies and poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) are kinds of targeted therapies. These are often used with chemotherapy or as maintenance therapy, to prevent cancer from recurring.

If ovarian cancer is caught early enough, you might not need chemo. Instead, your HCP may just keep an eye on your symptoms, blood tests, and imaging tests over time to see if the cancer comes back. In some cases, an HCP may recommend a maintenance therapy once treatment has concluded.

“If you’re undergoing treatment for ovarian cancer, studies have repeatedly shown that working with an experienced gynecological oncologist or medical oncologist is one of the most important treatment decisions you can make,” says Elkas. “Their special interest and experience will really go a long way in treating this disease.”

Is there any way to prevent ovarian cancer?

There’s no known way to prevent ovarian cancer, but there are some things you can do to lower your risk:

Maintain a healthy weight. Women with a body mass index, or BMI over 30, have a higher risk of ovarian cancer.

Birth control might help. “Women who have taken birth control pills for at least three-to-six months have a lower risk of ovarian cancer,” says Elkas. If you’re trying to decide on a birth control method, ask your OBGYN how the different options might also lower your ovarian cancer risk.

For example, if you’ve already had children or have chosen not to have children and wish to pursue a permanent method of sterilization, ask your HCP about having your fallopian tubes removed.

This procedure is called a bilateral salpingectomy. Although it leaves the ovaries in place, some evidence suggests that salpingectomy may help reduce the risk of ovarian cancer, because some types of the disease may start in the fallopian tubes. Having a salpingectomy may also be appropriate if you need to have your uterus removed.

Quit smoking. Quitting tobacco can decrease your risk of one type of ovarian cancer and many other diseases, including heart disease and lung cancer.

Additionally, if you are postmenopausal, you may want to speak with an HCP about the relationship between taking menopausal hormone therapy and ovarian cancer risk.

If you’d like to learn more about lowering your risk or if you’re experiencing any ovarian cancer symptoms, call your HCP. A false alarm is always better than a late diagnosis.