Ovary

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Revised Nov 2020

The basics

Guidelines for treating this cancer have been developed by the Gynecology Tumour Group.
For health professional information on treating this cancer, please see our Cancer Management Guidelines (Epithelial Ovary and Non-epithelial Ovary cancers).
Patients can view online videos of presentations from the annual Gynecologic Cancer Education Forum.
The ovaries are two glands in the reproductive system. They are located in the pelvis, one on each side of the uterus.
They are almond-shaped, measuring about 4 cm (1.5") in length.
Ovaries produce and release the eggs that are needed for reproduction.
They are the main source of the hormones, estrogen and progesterone.
There are three main types of tumours which can occur in the ovaries. They are named for the types of cells that they are made of:

Epithelial is the most common and comes from the surface cells of the ovaries. This type of cancer mostly affects middle-aged and older individuals. Epithelial ovarian cancer is the cancer referred to by patients and doctors as "ovarian cancer."
Germ cell tumours are another type of cancer, which may rarely occur in the ovary. These cancers start in the egg-producing cells of the ovary and affect mostly younger people. Surgery can maintain the potential of fertility. They are also very responsive to chemotherapy. These tumours behave and are treated in a similar way to testicular germ cell tumours.
Sex-cord stromal tumours are also rare. They are not associated with any particular age group.

What causes it and who gets it?

Some of the known risk factors for this cancer are listed below. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

The exact cause of ovarian cancer is unknown.
Most cases are not caused by inherited genes.
Most cases of ovarian cancer occur after age 50.
Having a family history of cancer (ovarian, breast, uterus, colon and rectum) increases the risk of the disease.
BRCA1 or BRCA2 gene

People with a BRCA1 or BRCA2 gene mutation are more at risk for ovarian cancer.
People of European (Ashkenazi) Jewish ancestry have a higher than average chance of having a BRCA gene mutation.
There is more information on hereditary cancer and genetic testing from our Hereditary Cancer Program.

People who have had breast cancer are more likely to get ovarian cancer.
It is more common in people who did not give birth or had their first child after age 30.
People who have early menstruation (before age 12) and late menopause (after age 50) have a higher risk.
Hormonal medicines may raise a person's risk:

Menopausal hormone replacement therapy (HRT)
Hormones taken by transgendered / transsexual persons
Fertility drugs

A diet with high levels of saturated fat may increase risk.
Exposure to asbestos seems to increase the risk of ovarian cancer.
Statistics:

BC
Canada
^{NOTE: Available statistics do not have information about the inclusion of transgender and gender diverse participants. Unless specified, it is unknown how these statistics apply to transgender and gender diverse people. Patients are advised to speak with their primary care provider or specialists about their individual considerations and recommendations.}

Can I help to prevent it?

Since the causes of ovarian cancer are not understood well, prevention is difficult to discuss with any certainty.

Birth control medications can reduce risk by up to 50% if used for 5 or more years. However, these medications do have possible side effects and are usually only recommended for the prevention of ovarian cancer in people known to have a hereditary ovarian cancer gene.
Pregnancy and breast-feeding can also reduce risk.
If you are at high risk because of a hereditary ovarian cancer gene, a prophylactic oophorectomy may protect against future cancers. This is the surgical removal of both ovaries before any cancer appears. The oopherectomy should also include the removal of the fallopian tubes.
If you are having a hysterectomy for non-cancer reasons, including the removal of the fallopian tubes during this procedure should reduce your risk.
Eating a diet high in vegetables can help prevent ovarian cancer.

Screening for this cancer

No effective screening program exists for this cancer yet.

Pap smears are not effective for ovarian cancer screening. They test the cervix, not the ovaries.

There have been trials which tested screening methods based on physical examination, ultrasound imaging, and a biomarker called CA 125. These methods of screening proved unreliable. They produced a high rate of false positives, which means many healthy people would be wrongly diagnosed with ovarian cancer and have unnecessary surgery.

Signs and Symptoms

Ovarian cancer is difficult to find in its early stages.
It usually has vague, non-specific symptoms, such as:

Abdominal discomfort or pain
Lower abdominal swelling or bloating
Indigestion, gas, nausea, constipation, diarrhea
Unusual bleeding (heavy periods or bleeding after menopause)
Frequent and urgent need to urinate
Loss of appetite
Feeling full even after a light meal
Pain in lower back or legs
Pain during sex

Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

Physical examination including an internal pelvic examination to feel the ovaries.
CA 125 and CEA blood tests.
Other blood tests to measure specific proteins.
Barium enema.
Ultrasound.
Chest X-ray.
Exploratory surgery in order to perform a biopsy. Only a biopsy can give a definite diagnosis of epithelial ovarian cancer.

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

Types

Epithelial Cell Tumours

Adenocarcinomas make up 90% of ovarian malignancies.
There are different adenocarcinoma cell types. They include serous, mucinous, endometrioid, clear cell and undifferentiated.

Germ Cell Tumours

These tumours include: dysgerminomas, immature teratomas and endodermal sinus tumours.
Germ cell tumours are particularly sensitive to treatment, so cures are anticipated. The treatment can be designed to preserve fertility in younger patients.

Stromal Tumours

These are relatively uncommon tumours, and occur in the connective tissue within the ovary.

Krukenberg Tumours

This is a historical term for cancers that have spread from the tissue where they actually started, e.g. stomach cancer spreading to the ovaries (ie. not a primary ovarian cancer). The treatment and prognosis for such a cancer depends on the organ where the cancer first started.

Stages
Staging describes the extent or size of a cancer. In general a lower number means a better prognosis. The stage of the cancer is used to plan the treatment.

Stage I The cancer is limited to the ovaries.

Stage II The cancer is in one or both ovaries and extends into the pelvis.

Stage III
The cancer has spread within the abdomen to the surface of tissues outside the pelvis, or to the regional lymph nodes.

Stage IV The cancer has spread into tissues outside the pelvis and abdomen. Cancer cells may be found inside the liver, in the lungs, or in other organs.

Grade
Grade describes how aggressive the cancer cells appear under a microscope.

Cells under the microscope can look a little abnormal to very abnormal. Grade sometimes also refers to how fast these abnormal cells multiply. Higher grade cancer cells are more aggressive.
It is important not to confuse grade with stage. Prognosis and treatment are mainly related to the stage, but grade can also help with treatment planning in an early stage cancer.
Some ovarian tumours have a much lower likelihood of spreading and relapsing, and may be cured by surgery only. They are sometimes called borderline tumours of the ovary, or tumours of low malignancy potential. Borderline ovarian cancers can be in any of the types listed above.

Treatment

Cancer therapies can be highly individualized – your treatment may differ from what is described below. The treatment team recommends a treatment plan for a particular patient's situation, often combining surgery, chemotherapy and/or radiotherapy.

Surgery

Surgery is the usual first treatment for ovarian cancer. When a cure is not possible, surgery can often relieve symptoms and offer a better quality and quantity of life.
The choice of what type of surgery is performed depends on the type of ovarian cancer and the stage of disease.
Some surgeries affect fertility. If having children after cancer treatment is a concern, please discuss fertility options with your oncologist or surgeon before the surgery.
If both ovaries are removed in a premenopausal patient, menopause happens soon after surgery. This type of premature menopause (early menopause before the average age of 50) can have challenging side effects. The doctor or oncologist may offer helpful strategies to control side effects.
Types of surgery

Hysterectomy is the surgical removal of the uterus.
Unilateral salpingo-oophorectomy is the surgical removal of one ovary and one fallopian tube.
Bilateral salpingo-oophorectomy is a surgery to remove both ovaries and the fallopian tubes.
Omentectomy is a surgery to remove fatty tissue which attaches to the stomach and transverse colon.
Debulking is surgery to remove as much of the tumour as possible.

Patients are usually advised not to have sexual intercourse for several weeks following hysterectomy.

Chemotherapy

Chemotherapy is the most usual post-operative treatment.
The chemotherapy drugs are usually given intravenously with a needle in a vein (IV). The treatment team will choose which drugs will be used, depending on the type and stage of the cancer.
Chemotherapy, like surgery, may cause infertility and premature menopause.
Sometimes chemotherapy drugs are given intraperitoneally – by putting them directly into the abdominal cavity using a tube (IP).
New treatments for ovarian cancer are being studied, such as targeted (non-chemotherapy) drugs and immune therapies. At this time, there is no clear proof that these improve or can replace standard chemotherapy, but research continues very actively. If you are interested in participating in research, ask your cancer doctor whether any Clinical Trials are available for your condition.

Radiotherapy

Radiation therapy can be part of curative treatment for some early stage epithelial ovarian tumours.
Sometimes the radiation oncologist advises the patient to not have sexual intercourse during their course of treatment with radiation therapy.
Brachytherapy, placing radioactive 'seeds' in or near the tumour, is not part of standard treatment for epithelial ovarian cancer and is not recommended at BC Cancer.
Intraperitoneal radiotherapy is not offered at the BC Cancer due to excessive side-effects.

Follow-up after Treatment

Guidelines for follow-up after treatment are covered on our website:

Epithelial ovarian cancer
Non-epithelial ovarian cancer

You will be returned to the care of your family physician or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
Follow-up testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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