Ovarian Cancer Awareness

Symptoms & Risks

Ovarian cancer is the most fatal gynecological disease, and with no screening test, knowing the symptoms and risk factors can save your life. So, if you experience:

Bloating
Pelvic or abdominal pain
Difficulty eating or feeling full quickly
Urinary symptoms (Urgency or frequency)

for more than two weeks, it’s time to speak up!

People with ovarian cancer reported symptoms that were persistent and represented a change from what was normal for them. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer.

Even early-stage ovarian cancer can produce these symptoms.

People with ovarian cancer have commonly reported several other symptoms. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation, and menstrual irregularities. However, these other symptoms are not as helpful in identifying ovarian cancer because they are also found in equal frequency in people with a uterus in the general population who do not have ovarian cancer.

People with these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early-stage diagnosis is associated with an improved prognosis.

Knowing your own personal risk factors is essential. Having a risk factor for ovarian cancer does not necessarily mean that a woman will get Ovarian Cancer. We encourage people with risk factors to talk to their doctor. If you have a personal or family history, speak to your doctor about referral for genetic risk assessment by a Certified Genetic Counselor.

Age: Your risk increases with your age; most people with Ovarian Cancer are diagnosed over the age of 55.
Family History: Your risk is higher if you have a close blood relative (i.e., parent, child, sibling, grandparent, grandchild, aunt, uncle, niece, or nephew) on either your mother’s or father’s side of the family, who has had breast cancer before age 50, ovarian cancer at any age, or male breast cancer at any age.
Personal History: People who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
Reproductive History: If you have never had children or have a history of difficulty getting pregnant, you are at increased risk.
Hormone Replacement Therapy: If you have taken Hormone Replacement Therapy, you may be at higher risk.
Ethnicity: Persons of European and North American descent have a higher risk, as do Jewish people of Eastern European (Ashkenazi) descent.
Endometriosis: If you have had a history of endometriosis, you are at a higher risk of ovarian cancer.
Genetic Testing: Genetic testing indicating you have BRCA 1 or 2, or Lynch Syndrome, also known as HNPCC, puts you at a much higher risk for ovarian cancer.
Obesity: Being obese can put you at higher risk for some types of ovarian cancer.

Testing, types & treatments

If your doctor suspects Ovarian Cancer, they will order some tests, including a CA125 blood test and a transvaginal ultrasound. Once Ovarian Cancer is suspected, it is crucial to see a Gynecological Oncologist (a specialist in diagnosing and treating ovarian cancer). Studies have shown improved outcomes for people treated by Gynecological Oncologists compared to those cared for by general gynecologists or doctors.

Gynecological oncologists are doctors who specialize in the treatment of ovarian cancer. The Society for Gynecologic Oncology (SGO) has a Specialist Finder Tool on its website that you can use to find a Gynecological Oncologist near you quickly. The link for it is below.

SGO Specialist Finder Tool

In a review article published in Frontiers in Oncology by authors Minig et al., from the Valencian Institute of Oncology (IVO) in Valencia, Spain, it states that “When women with gynecological cancers are treated by gynecologic oncologists in referral cancer centers, they are able to live longer and with a better quality of life. Therefore, patients should be ideally referred to high-volume physicians/hospitals to increase their life expectancy as well as its quality.” ¹⁵

There is no definitive screening test for ovarian cancer; your doctor may use multiple tests to diagnose you properly. These tests may include:

Transvaginal ultrasound^2,6
CA 125 blood test^2,8
CT or PET scan
Surgical biopsy

There are many different types of ovarian cancer, and knowing what type you have is important because that tells your doctor what the best treatments for you are. The types are divided into epithelial and non-epithelial, with many different subtypes of each. The following list includes all the types of ovarian cancer⁵.

Epithelial:
- High-grade serous carcinoma
- High-grade endometrioid carcinoma
- Low-grade serous carcinoma
- Low-grade endometrioid carcinoma
- Carcinosarcoma (malignant mixed Mullerian tumors)
- Clear cell carcinoma
- Mucinous carcinoma
- Borderline epithelial tumor (low malignant potential tumors)
Non-epithelial:
- Malignant sex cord-stromal tumors
- Malignant germ cell tumors

Treatment options vary depending on each person’s medical history and diagnosis, and they can range from surgery to chemotherapy to immunotherapy.

The traditional treatment for ovarian cancer is surgery (uterus, cervix, ovaries & fallopian tubes are removed)⁵
Chemotherapy⁵
Immunotherapy⁵
Radiation therapy (which is rarely used)⁷
Targeted therapy: Poly (ADP-ribose) polymerase (PARP) inhibitors which blocks the PARP-1 enzyme, which is what allows cancer to grow and survive^2,5
Targeted therapy: An example of this therapy is Bevacizumab (Avastin), which stops the growth of blood vessels to the tumor ^2,5
Hormone therapy: aromatase inhibitors, leuprolide acetate, megestrol acetate, tamoxifen⁷

The National Comprehensive Cancer Network (NCCN) is a well-known and great resource for cancer patients. Each year, the NCCN publishes an updated set of guidelines for patients to use for multiple cancers. The document of the most up-to-date guidelines for ovarian cancer patients is below.

NCCN Guidelines for Patients: Ovarian Cancer

Disclaimer: The information on this website is designed to aid people in making decisions about appropriate gynecologic care and does not substitute for evaluations with qualified medical professionals familiar with you.

Citations

²Memorial Sloan Kettering Cancer Center. (n.d.). Ovarian Cancer. Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/types/ovarian

⁵NCCN Guidelines for Patients Ovarian Cancer. National Comprehensive Cancer Network . (2023). https://www.nccn.org/patients/guidelines/content/PDF/ovarian-patient.pdf

⁶PDQ® Adult Treatment Editorial Board. PDQ Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <12/02/2022>. Available at: https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq. Accessed <01/30/2024>. [PMID: 26389163]

¹⁵Minig, L., Padilla-Iserte, P., & Zorrero, C. (2016). The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer. Frontiers in oncology, 5, 308. https://doi.org/10.3389/fonc.2015.00308