View All Pages

Ovarian Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Ovarian Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the ovaries

The ovaries are glands that contain the germ cells, also called eggs. Every woman has two ovaries as part of her reproductive system, one located on each side of the uterus. They are almond shaped and about one and a half inches long. Every month, during ovulation, an egg is released from an ovary and travels to the uterus through a structure called the fallopian tube.

Ovaries are the primary source of estrogen and progesterone. These hormones influence breast growth, body shape, body hair, and regulate the menstrual cycle and pregnancy. During menopause, the ovaries stop releasing eggs and producing certain hormones.

About ovarian cancer

Ovarian cancer begins when healthy cells in an ovary change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Removing the ovary or the part of the ovary where the tumor is located can treat a noncancerous ovarian tumor. An ovarian cyst, which forms on the surface of the ovary, is different than a noncancerous tumor and usually goes away without treatment. A simple ovarian cyst is not cancerous. They often occur during the normal menstrual cycle.

Types of ovarian cancer include:

Epithelial carcinoma. Epithelial carcinoma makes up 85% to 90% of ovarian cancers. While historically considered to start on the surface of the ovary, new evidence suggests at least some ovarian cancer begins in special cells in a part of the fallopian tube. The fallopian tubes are small ducts that link a woman’s ovaries to her uterus that are a part of a woman’s reproductive system. Every woman has two fallopian tubes, one located on each side of the uterus. Cancer cells that begin in the fallopian tube may go to the surface of the ovary early on. The term 'ovarian cancer' is often used to describe epithelial cancers that begin in the ovary, in the fallopian tube, and from the lining of the abdominal cavity, call the peritoneum.

The majority of patients with epithelial ovarian cancer have a histologic type of cells called “high grade serous carcinoma.” See the Latest Research section for specific information regarding targeted therapies being developed for the less common “low grade serous carcinoma.”   Most of the Treatment Options described in this guide apply to epithelial ovarian cancer. 

Germ cell tumor. This uncommon type of ovarian cancer develops in the egg-producing cells of the ovaries. This type of tumor is more common in females ages 10 to 29.

Stromal tumor. This rare form of ovarian cancer develops in the connective tissue cells that hold the ovaries together, which sometimes is the tissue that makes female hormones called estrogen. Over 90% of these tumors are adult or childhood granulosa cell tumors. Granulosa cell tumors may secrete estrogen resulting in unusual vaginal bleeding at the time of diagnosis.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics and it helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.   

Ovarian Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find information about how many women are diagnosed with this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 21,290 women in the United States will be diagnosed with ovarian cancer. It is estimated that 14,180 deaths from this disease will occur this year. It is the fifth most common cause of cancer-related death in women.

The overall five-year survival rate is the percentage of women who survive at least five years after the cancer is found. The overall five-year survival rate is 45%, but this varies widely depending on the extent or stage of the cancer and the age of the woman.

If the cancer is diagnosed and treated before it has spread outside the ovaries, the five-year survival rate is 92%. If the cancer has spread to the surrounding organs or tissue (regional spread), the five-year survival rate is 72%. If the cancer has spread to parts of the body far away from the ovary (distant spread), the five-year survival rate is 27%. The overall 10-year survival rate for ovarian cancer is 35%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of women with this type of cancer in the United States each year, so the actual risk for a particular individual may be different. It is not possible to tell a woman how long she will live with ovarian cancer. Because survival statistics are often measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2015.

The next section in this guide is Medical Illustrations and it offers drawings of body parts often affected by this disease. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find a basic drawing about the main body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Women's Cancers Anatomy

Larger image

The next section in this guide is Risk Factors and Prevention and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person's chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a woman's risk of developing ovarian cancer:

  • Age. A woman’s risk of developing ovarian cancer increases with age. Women of all ages have a risk of ovarian cancer, but women over 50 are more likely to develop it. Sixty-eight percent (68%) of women with ovarian cancer are older than 55, and 32% are younger than 55.
  • Family history. Women with a first-degree relative (mother, daughter, or sister) with ovarian cancer have about a three times higher risk of developing the disease. This risk increases when two or more first-degree relatives have been diagnosed with ovarian cancer. If you are concerned ovarian cancer may run in your family, it is important to get an accurate family history, including breast cancers in the family. Both breast cancer and ovarian cancers can run together in families so it’s important to tell your doctor about what you discover. By understanding your family history, you and your doctor can take steps to reduce your risk and be proactive about your health (see below).
  • Genetics. About 10% to 15% of ovarian cancers occur because a genetic mutation (change) has been passed down within a family. A mutation in the BRCA1 or BRCA2 gene is associated with an increased risk of ovarian cancer; there is also an increased risk of fallopian tube cancer and primary peritoneal (the membrane lining the abdomen) cancer, which are similar to ovarian cancer. While less common, it is possible that BRCA-related ovarian cancer can occur in women who do not have a family history of either breast or ovarian cancer. It is now recommended that all women with ovarian cancer under the age of 70 should consider genetic testing even if they don’t have a family history. Read more about the BRCA1 and BRCA2 genes in the section on hereditary breast and ovarian cancer.
  • Obesity. Recent studies have shown that women who were obese in early adulthood are 50% more likely to develop ovarian cancer. Women who are obese are also more likely to die from the disease.
  • Endometriosis. This is when the inside lining of a woman’s uterus grows outside of the uterus, affecting other nearby organs. This condition can cause several problems, but effective treatment is available. Researchers are continuing to study whether endometriosis is a risk factor for ovarian cancer but it may increase the risk of certain types of ovarian cancer which include clear cell and endometrioid ovarian cancers.
  • Genetic conditions. There are several other genetic conditions linked to an increased risk of ovarian cancer. Some of the most common include:

Only genetic testing can determine whether a woman has a genetic mutation. Most experts strongly recommend that women considering genetic testing first talk with a genetic counselor, which is an expert trained to explain the risks and benefits of genetic testing.

    • Breast cancer. Having a diagnosis of breast cancer increases the risk for ovarian cancer, even when the BRCA genetic mutation test is negative (see above).
    • Ethnicity. Women of North American, Northern European, or Ashkenazi Jewish heritage have an increased risk of ovarian cancer.
    • Reproductive history. Women who have never had children, have unexplained infertility (the inability to bear children), have not taken birth control pills, or had their first child after the age of 30 have an increased risk of ovarian cancer. Also, women who started menstruation before age 12 and/or go through menopause later in life have an increased risk of ovarian cancer.
    • Hormones. Women who have taken estrogen-only hormone replacement therapy (HRT) after menopause may have a higher risk of ovarian cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Research has shown that certain factors may reduce a woman's risk of developing ovarian cancer:

  • Taking birth control pills. Women who took oral contraceptives for three or more years are 30% to 50% less likely to develop ovarian cancer.
  • Breastfeeding
  • Pregnancy

Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian cancer. A hysterectomy is the removal of the uterus and, sometimes, the cervix. Tubal ligation is having the fallopian tubes tied surgically to prevent pregnancy. A salpingectomy, which is the removal of the fallopian tubes, is also sometimes recommended for women with a risk of ovarian cancer.

For women with mutations in the BRCA1 or BRCA2 mutation, which cause 5% to 10% of all breast cancer and 15% of all ovarian cancer. Having the ovaries and fallopian tubes removed after childbearing is sometimes done to prevent breast and ovarian cancer. This can help with risk reduction ranging from a 70% to 96% reduction in ovarian cancer, and a 40% to 70% reduction in breast cancer. It is very important for women considering this surgery to talk with their doctor and a genetic counselor to fully understand the risks and side effects of this surgery compared with the risk of developing ovarian cancer.

The next section in this guide is Symptoms and Signs and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Ovarian cancer was once thought to cause no symptoms. However, recent studies have shown that women with ovarian cancer are more likely to have the following symptoms or signs, even if the cancer is in an early stage. Sometimes, women with ovarian cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Abdominal bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms such as urgency or frequency

For many women with ovarian cancer, these symptoms occur often and are different from what is normal for their bodies. Women who have these symptoms almost daily for more than a few weeks should see either a primary care physician or a gynecologist, which is a doctor who specializes in treating diseases of the female reproductive organs. Early medical evaluation may help detect the cancer at the earliest possible stage of the disease when it is easier to treat.

Women with ovarian cancer may also have the following symptoms:

  • Fatigue
  • Indigestion
  • Back pain
  • Pain with intercourse
  • Constipation
  • Menstrual irregularities

However, these symptoms are equally as likely to be caused by another medical condition. If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

If your doctor suspects that you might have ovarian cancer, you should see a gynecologic oncologist, which is a doctor who specializes in treating cancer of the female reproductive system. Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective.

For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. This is often done as part of surgery for ovarian cancer. The doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

As with all cancers, early detection and treatment is important. However, early detection of ovarian cancer is difficult. There are no effective screening methods before cancer is suspected. Often, women don’t have any symptoms until the tumor is large or in later stages of the disease. In fact, 70% of epithelial ovarian cancers are not found until the disease is in an advanced stage and has spread to other parts of the body, most commonly the abdomen.

In addition to a physical exam, the following tests may be used to diagnose ovarian cancer:

  • Pelvic examination. Usually, the first exam is the abdominal pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual changes. A Pap test, usually done with a pelvic examination, is not likely to find or diagnose ovarian cancer using traditional methods, as is used for detection of cervix precancer and cervical cancer. However, advances in DNA testing has provided new evidence that one day cells trapped in the cervix could be studied for changes that reflect ovarian or uterine cancers. Currently, these findings are considered experimental but are promising as a new way to find these types of cancers earlier.
  • Transvaginal ultrasound. An ultrasound wand is inserted in the vagina and aimed at the ovaries. An ultrasound uses sound waves to create a picture of the ovaries, including healthy tissues, cysts, and tumors. Researchers are currently studying whether this test can help with early detection of ovarian cancer.
  • Blood tests/CA-125 assay. There is a blood test that measures a substance called CA-125, a tumor marker, which is found in higher levels in women with ovarian cancer. Woman younger than 50 with conditions such as endometriosis, pelvic inflammatory disease, and uterine fibroids may also have an increased CA-125 level. This test is more accurate in women who have had menopause. Other tumor marker tests are available, such as HE4 and OVA-1, and may help evaluate women with ovarian cysts who may have ovarian cancer.
  • X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.
  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. A CT scan can also be used to measure the tumor’s size. While the technology of CT scanning has continued to evolve, tumors or abnormalities under about five millimeters (1/5th of an inch) are difficult to see.
  • Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.
  • Lower gastrointestinal (GI) series. This is a series of x-rays of the colon and rectum taken after the patient has a barium enema, which is a procedure that delivers a special dye into the rectum and colon through the anus. The barium highlights the colon and rectum on the x-ray, making it easier to identify a tumor or abnormal area in those organs. This test is used occasionally particularly if there is concern for a blockage in the large intestine by cancer.
  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. If the doctor suspects ovarian cancer, surgery is usually recommended to remove as much of the tumor as possible (see Treatment Options), and a tumor sample will be analyzed afterwards. A biopsy is sometimes used if the diagnosis is uncertain or if there is too much tumor to remove initially with surgery. This is usually done when chemotherapy is planned as the first treatment, with possible surgery afterwards.
  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

After diagnostic tests are done, your doctor will review all of the results with you. As noted above, surgery and an examination of the lymph nodes may be needed before results are complete. If the diagnosis is ovarian cancer, these results also help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages and Grades, and it explains the system doctors use to describe the extent of the disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition, this section covers the grades which describes the difference between cancerous tissue and healthy tissue. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Staging is when the doctor maps out where the cancer is in your body. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. In addition, treatment recommendations may vary even for ovarian cancer of the same stage due to other important factors.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?
  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are four stages: stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for ovarian cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no tumor in the ovary.

T1: The tumor is limited to one or both ovaries.

T1a: The tumor is contained within one ovary. No part of the tumor has spread to the surface of the ovary, and no cancer cells are found in the abdominal fluid.

T1b: There are encapsulated (self-contained) tumors in both ovaries, but no tumor is touching an ovarian surface. No cancer cells are found in the abdominal fluid.

T1c: The tumor is in one or both ovaries, but the capsule has ruptured (burst), or the tumor has spread to the ovarian surface, or cancer cells are found in the abdominal fluid.

T2: The tumor involves one or both ovaries and has spread into the pelvis.

T2a: The tumor has grown into the uterus and/or fallopian tubes, but no cancer cells are found in the abdominal fluid.

T2b: There is cancer in other pelvic tissue, but no cancer cells are found in the abdominal fluid.

T2c: The tumor has grown into the pelvic area, such as in T2a or T2b, but cancer cells also are detected in the abdominal fluid.

T3: The tumor involves one or both ovaries and has spread microscopically (cancerous cells can be seen when tissue or fluid sample is viewed under a microscope) into the abdominal area outside the pelvis or has spread to pelvic lymph nodes.

T3a: Microscopic metastasis is in the peritoneal area (the tissue that lines the abdominal wall and covers most of the organs in the abdomen) beyond the pelvis.

T3b: Metastasis measuring 2 centimeters (cm), which is a little less than one inch, or smaller is discovered outside the pelvis.

T3c: Metastasis larger than 2 cm is in areas outside the pelvis and/or the cancer has spread to the regional nodes (pelvic or paraortic) lymph nodes.

Node (N)

The "N" in the TNM staging system stands for the lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes in the pelvis are called regional nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): No cancer was found in the regional lymph nodes.

N1: The cancer has spread to the regional nodes (pelvic or paraortic) lymph nodes. T3, T3a, and N1 are sometimes used interchangeably.

Metastasis (M)

The "M" in TNM system indicates whether the cancer has spread to other parts of the body, called a distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no cancer beyond the peritoneal area.

M1: The cancer has spread beyond the peritoneal area.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications. In addition, the FIGO system, or the Federation Internationale de Gynecologie et d'Obstetrique, is another standard system used by most doctors to stage ovarian cancer. This system uses Roman numerals.

Stage I: This stage describes cancer that is located only in the ovaries (T1, N0, M0).

Stage IA: The cancer is encapsulated and is located in only one ovary with no spread to pelvic lymph nodes or other parts of the body (T1a, N0, M0).

Stage IB: The cancer is encapsulated and is located in both ovaries with no spread to pelvic lymph nodes or other parts of the body (T1b, N0, M0).

Stage IC: The cancer is in one or both ovaries with either a ruptured capsule or tumor spread to the ovarian surface or cancerous cells in the abdominal fluid (T1c, N0, M0).

Stage II: The cancer is in one or both ovaries and has grown into the pelvis (T2, N0, M0).

Stage IIA: The cancer has grown into the uterus or fallopian tubes, but not to the pelvic lymph nodes or distant organs (T2a, N0, M0).

Stage IIB: The cancer has spread to other pelvic tissue, but not to lymph nodes or distant organs (T2b, N0, M0).

Stage IIC: The cancer has spread into the pelvic area and is shedding cancer cells into the abdominal fluid (T2c, N0, M0).

Stage III: The cancer is located in one or both ovaries and the pelvis and has spread into the peritoneum (T3, N0, M0).

Stage IIIA: The cancer has spread microscopically into the peritoneal cavity (T3, N0, M0).

Stage IIIB: The cancer has spread into the peritoneal area with areas of tumor growth that are 2 cm or smaller (T3b, N0, M0).

Stage IIIC: This stage describes any cancer that has spread into the peritoneal area with areas of tumor growth larger than 2 cm (T3c, N0, M0). Or, the cancer has spread to the lymph nodes in the retroperitoneal or inguinal areas (any T, N1, M0).

Stage IV: This stage describes any cancer that has spread to distant organs (any T, any N, M1).

FIGO Ovarian Cancer Staging

Another way to The Roman numerals are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO. The FIGO system is the standard system used by most doctors to stage ovarian cancer.

FIGO Stage I: The cancer is only in the ovaries.

FIGO IA – The cancer is limited to one ovary. No cancer found on the surface of the ovary and no cancer found in the abdominal area. (T1a, N0, M0)

FIGO IB – The cancer is limited to one ovary. Not cancer found on the surface of the ovary and no cancer found in the abdominal area. (T1b, N0, M0)

FIGO IC – The cancer is limited to one ovary. (T1c, N0, M0)

IC1 – The cancer spreading during surgery

IC2 – The cancer is found on the outside of the ovary or the ovary has burst.

IC3 – Cancer cells found in the abdominal area.

FIGO Stage II: The cancer is in one or both of the ovaries and spread below the pelvis.

FIGO IIA – The cancer has spread to the outside of the uterus or fallopian tubes. (T2a, N0, M0)

FIGO IIB – The cancer has spread to other tissues below the pelvis. (T2b, N0, M0)

FIGO Stage III: The cancer is in one or both of the ovaries and it spread outside the pelvis and surrounding lymph nodes.

FIGO IIIA – The cancer has spread to the lymph nodes behind the abdomen, with or without cancer found in the abdomen. (T3a, N0 or N1, M0)           

FIGO IIIB – The cancer has spread past the pelvis to the abdomen and is less than 2 centimeters (cm), with or without spreading to the abdominal area. (T3b, N0 or N1, M0)

FIGO IIIC – The cancer has spread past the pelvis to the abdomen and is more than 2 centimeters (cm) long, with or without spreading to the abdominal area. (T3c, N0 or N1, M0)

FIGO IV: The cancer has spread to organs beyond the ovaries except for the abdominal area.

FIGO IVa – The cancer has spread to fluid around the lungs. (any T, any N, M1)

FIGO IVb – The cancer has spread beyond the abdominal organs. (any T, any N, M1)

Recurrent cancer. Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the extent of cancer will be re-evaluated (see Diagnosis) and there may be more biopsies. Ovarian cancer re-evaluations usually include a pelvic exam, diagnostic imaging (such as CT scan, PET/CT scan, MRI, or ultrasound) and blood work (such as CA-125). Occasionally, it may include surgery, such as laparoscopy, in which a doctor inserts a thin, lighted, scope to look inside the abdominal cavity to check for recurrent disease. The goal of these procedures is to learn as much as possible about the disease’s return and to start treatment planning for recurrent disease care. See the Treatment Options section for more about the treatment of women with recurrent ovarian cancer.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. This helps the doctor to predict how quickly the cancer may spread and can factor into making treatment decisions. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

However, a specific type of epithelial ovarian cancer called serous ovarian cancer is not graded this way and only considers a Low-grade and a High-grade classification, which is not necessarily the same as G1 and G2-3. They are specific histologies that also have a different biology and natural history.

GX: The grade cannot be evaluated.

GB: The tissue is considered borderline cancerous. This is commonly called low malignant potential (LMP).

G1: The tissue is well-differentiated (contains many healthy-looking cells).

G2: The tissue is moderately differentiated (more cells appear abnormal than healthy).

G3 to G4: The tissue is poorly differentiated or undifferentiated (all or most cells appear abnormal).

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat women with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best known treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Ovarian cancer is treated with one or a combination of treatments, most commonly surgery and chemotherapy. Each treatment option is described below, followed by an outline of the treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, the patient’s preferences and overall health, and personal considerations, such as the woman's age and if she is planning to have children.

Women with ovarian cancer may have concerns about if or how their treatment may affect their sexual health and fertility, and these topics should be discussed with the health care team before treatment begins.

Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is usually an important treatment for ovarian cancer. A gynecologic oncologist is a doctor that specializes in gynecological cancer surgery, including ovarian cancer and chemotherapy.

As mentioned in Diagnosis, surgery is often needed to find out the complete extent of disease. The goal is to provide an accurate stage, because in up to 30% of women with apparently early disease after imaging tests, there is actually spread to other organs.

To determine whether the cancer has spread, the surgeon will remove lymph nodes, tissue samples, and fluid from the abdomen for testing. If, during the surgery, it is clear that the cancer has spread, the surgeon will remove as much of the cancer as possible. This has been shown to provide the best benefit when combined with chemotherapy after surgery.

There are several surgical options for ovarian cancer, with sometimes two or more procedures done during the same surgery:

  • Salpingo-oophorectomy. This surgery involves removal of the ovaries and fallopian tubes. If both ovaries and both fallopian tubes are removed, it is called a bilateral salpingo-oophorectomy. If the woman wants to become pregnant in the future and has early-stage cancer, it may be possible to remove only one ovary and one fallopian tube if the cancer is located in only one ovary. That surgery is called a unilateral salpingo-oophorectomy. For women with a germ cell tumor, surgery often only needs to remove only the ovary with the tumor, which preserves the woman’s ability to bear children.
  • Hysterectomy. This surgery focuses on the removal of a woman’s uterus and, if necessary, surrounding tissue. If only the uterus is removed, it is called a partial hysterectomy. A total hysterectomy is when a woman’s uterus and cervix are removed.
  • Lymph node dissection. The surgeon may remove lymph nodes in the pelvis and paraortic areas.
  • Omentectomy. This is surgery to remove the thin tissue that covers the stomach and large intestine.
  • Cytoreductive/debulking surgery. For women with later-stage ovarian cancer, the goal of this surgery is to remove as much tumor as is safely possible. This may include removing tissue from nearby organs, such as the spleen, gallbladder, stomach, bladder, or colon. This may involve removing part of all of these organs. It is felt such a procedure can reduce a person’s symptoms and can help increase the effectiveness of treatment, such as chemotherapy, given after surgery to control the disease that remains. If the disease has spread beyond the ovaries, sometimes chemotherapy is done to shrink the tumor before cytoreductive/debulking surgery. This is called neoadjuvant chemotherapy.

Debulking surgery should be performed by an experienced gynecologic oncologist. Talk with your doctor before surgery about the risks and benefits of this procedure and ask about the surgeon’s experience with debulking surgery for ovarian cancer.

Side effects of ovarian cancer surgery

Surgery causes short-term pain and tenderness. If a patient is experiencing pain, the doctor will prescribe an appropriate medication. For several days after the operation, the patient may have difficulty emptying her bladder (urinating) and having bowel movements. Talk with your surgeon about what side effects to expect from your specific surgery and how they can be relieved. Learn more about the basics of cancer surgery.

Studies have shown that women who have their surgeries performed by a gynecologic oncologist are more likely to be successfully treated with surgery and have fewer side effects.

If both ovaries are removed, a woman can no longer become pregnant. The loss of both ovaries also eliminates the body's source of sex hormones, resulting in premature menopause. Soon after surgery, the patient is likely to have menopausal symptoms, including hot flashes and vaginal dryness. Women are encouraged to talk with their doctors about sexual and reproductive health concerns and coping with gynecologic surgery, including ways to address these concerns before and after cancer treatment

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a gynecological oncologist or a medical oncologist.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Most of the treatment options described in this guide apply to this epithelial ovarian cancer.  For ovarian cancer, chemotherapy type depends on the treatment setting:

  • Neoadjuvant chemotherapy. This is done to reduce the size of the tumor before surgery. It will usually follow a biopsy so the doctors can determine where the tumor began. This type of chemotherapy is usually given for three to four cycles before considering surgery, called interval surgery. This treatment typically consists of carboplatin (Paraplatin) chemotherapy given with paclitaxel (Taxol) or docetaxel (Taxotere, Docefrez) intravenously, which is through the vein.  Typically, the treatment cycle is to give these drugs every 3 weeks. Some recent studies suggest a weekly schedule for the paclitaxel. Talk with your doctor about which scheduling option is best for your situation.
  • Adjuvant chemotherapy. This is done to destroy cancer remaining after surgery. Similar to neoadjuvant chemotherapy, this treatment typically consists of carboplatin (Paraplatin) given with paclitaxel (Taxol) or docetaxel (Taxotere, Docefrez) intravenously, which is through the vein. Typically, doctors recommend giving these drugs every three weeks, though some studies are looking at a weekly dosing schedule for the paclitaxel. Talk with your doctor about which scheduling option is best for your situation.

An alternative way to give adjuvant chemotherapy is to infuse it directly into the abdomen called intraperitoneal or IP chemotherapy. The National Cancer Institute has recommended this approach be considered for stage III disease after a successful surgical debulking procedure.  In the IP approach, carboplatin is replaced with cisplatin (Platinol) which is infused directly into the abdomen which has more side effects. In previous studies, IP treatment was more effective when compared to intravenous treatment on the every three week schedule. With this approach, a variety of factors such as age, kidney function, and other existing health problems must be considered. This is something that should be discussed with your doctor.

In addition, studies are underway to see if giving the paclitaxel intravenously on a weekly schedule, and/or adding other newer agents such as PARP inhibitors should be used.  Several studies have evaluated whether adding bevacizumab (Avastin) to standard chemotherapy following initial surgery is helpful.  In general, bevacizumab used for ovarian cancer has prolonged the time before the cancer may return in some patients. Based on these findings, bevacizumab does not currently have U.S. Food and Drug Administration (FDA) approval for use in the initial treatment of ovarian cancer.  For more information about bevacizumab and the FDA approval for ovarian cancer, see Latest Research.

  • Maintenance chemotherapy. This is done to slow a tumor’s growth and/or reduce the risk of its recurrence.  There are currently no FDA approved treatments specifically for maintenance chemotherapy for people with ovarian cancer in the United States. 
  • Recurrence chemotherapy. This is done to treat the cancer if it comes back, called a recurrence.  A primary goal of the treatment of recurrent disease is to reduce or prevent symptoms of the disease while keeping the side effects of treatment to a minimum.  Treatment for women with recurrent disease is generally organized by the time since her last treatment using a platinum chemotherapy drug. Platinum chemotherapy drugs include carboplatin or cisplatin.  Studies are being done to see if surgery is an option for recurrent disease.
  • Platinum resistant disease: If the cancer has returned in less than six months since using platinum chemotherapy, it is called “platinum resistant.” In general, the choice of chemotherapy at this point is selected from a variety of medications that have all shown similar ability to shrink cancer but are chosen based on possible side effects and a desired schedule of dosing. These agents may include, but are not limited to: paclitaxel, docetaxel, nab-paclitaxel (Abraxane), liposomal doxorubicin, topotecan (Hycamtin), gemcitabine, vinorelbine (Navelbine), pemetrexed (Alimta), irinotecan (Camptosar), oral etoposide (Toposar, VePesid) or oral altretamine (Hexalen). For platinum resistant cancer, single and sequential use of these medications is recommended.

    Recently, the FDA approved the use of bevacizumab with paclitaxel, liposomal doxorubicin, or topotecan for platinum resistant cancer.  Best candidates for this approach are those who have received two or less treatments, have not previously received bevacizumab, and do not have evidence of significant bowel involvement by a CT scan.  By adding bevacizumab to the chemotherapy, the time to disease recurrence was lengthened when compared to those patients receiving chemotherapy alone.  The risks and possible benefits of this approach should be discussed with your doctor. Clinical trials are always reasonable to consider if available.

  • Platinum sensitive disease: If the cancer has returned more than six months since platinum chemotherapy, it is called “platinum sensitive.”  If it returns to one specific spot, additional surgery may be beneficial and this can be discussed with your doctor. (Surgery is usually only considered if the time period between chemotherapy has been at least 12 months.) If the cancer comes back to more than one place in the body, chemotherapy is the appropriate next step. For patients with platinum sensitive disease, clinical trials have suggested the benefit of using carboplatin again intravenously and combining it with paclitaxel, gemcitabine (Gemzar) or liposomal doxorubicin (Doxil).  The advantage of the latter two agents is they can be given without causing hair loss or aggravating neuropathy symptoms.

    In addition, a clinical trial evaluated adding bevacizumab, which is an anti-vascular or “blood vessel growth blocking” antibody, to the gemcitabine and carboplatin combination. This showed to extend the time before the disease came back but did not change overall survival outcome. The risks and possible benefits of this approach should be discussed with your doctor. 

For germ cell tumors, treatment initially includes surgery, which can be done in a way to preserve fertility in some cases. Chemotherapy following surgery is generally recommended with the exception of stage IA dysgerminoma or stage I, grade 1 immature teratoma. Chemotherapy usually consists of a combination of intravenous (IV) bleomycin (Blenoxane), etoposide (Toposar, VePesid) and cisplatin (Platinol). The overall approach and medications given are similar to those used in male germ cell, which is a type of testicular cancer.

To learn more about this type of cancer, find more information the Cancer.Net guides to testicular cancer and childhood germ cell tumors.     

Stromal tumors are considered a rare form of ovarian cancer and are found in the connective tissue that holds the ovaries together. For a stage I stromal tumor, treatment usually consists of surgery only. For high-risk, early stage tumors or stage III/IV disease, combination chemotherapy is often considered. The risks and potential benefits should be discussed with your doctor. For information about staging, visit the staging section of this guide.

Chemotherapy for a stromal tumor usually involves the combination of bleomycin (Blenoxane), etoposide (Toposar, VePesid) and cisplatin (Platinol). It can be often used after surgery or for recurrent tumors. Clinical trials are looking at chemotherapy with carboplatin (Paraplatin) and paclitaxel (Taxol) as another alternative. For recurrent disease, the hormonal therapy leuprolide (Eligard, Lupron, Viadur) is also used. Clinical trials are evaluating the effectiveness of bevacizumab (Avastin), which is an anti-vascular antibody to block the growth of blood vessels. Studies are being done to test tumors molecularly to find other, more targeted drugs for this type of cancer. 

For any type of ovarian cancer, the side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, neuropathy (tingling and numbness in the hands and feet), constipation or diarrhea. These side effects usually go away once treatment is finished. In addition, possible side effects of chemotherapy include difficulty with cognitive (brain) functions such as issues with attention span or memory, or neuropathy, a disorder where nerves are damaged causing numbness or pain.

Other possible side effects include both the inability to become pregnant and premature menopause. Rarely, certain drugs may cause some hearing loss or kidney damage. Patients may be given extra fluid intravenously for kidney protection. Before treatment begins, patients are encouraged to talk with their health care team about possible short-term and long-term side effects of the specific drugs being given. It is important to note that many side effects can be reduced by adjusting the dose and/or schedule and most chemotherapy side effects are typically managed by your health care team.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Treatment options by stage

Below are some of the possible treatments based on the stage of the cancer. Your doctor will have the best information about which treatment plan is recommended for you.

Stage I

  • Surgery  (Stage I, grade 1)
  • Surgery and chemotherapy (Stage I, grade 3). Standard adjuvant chemotherapy in this setting typically includes paclitaxel and carboplatin intravenously for three to six cycles followed by close observation.

Stage II

  • Surgery
  • Surgery and adjuvant chemotherapy. Standard adjuvant chemotherapy in this setting typically includes paclitaxel and carboplatin intravenously for six cycles followed by close observation.

Stages III and IV

  • Surgery and adjuvant chemotherapy (either intravenous or a combination of IV and IP)
  • Neoadjuvant chemotherapy followed by interval surgery
  • Chemotherapy only (if surgery is not possible)

Radiation therapy

Radiation therapy is not used as a first treatment for ovarian cancer, but less commonly it can be an option for treating recurrent ovarian cancer when confined to a small area. 

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

External-beam radiation therapy is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy depend on the dose and the area of the body being treated, but may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects usually go away soon after treatment is finished.

Learn more about the basics of radiation therapy. For more information on radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers. See more about treatment options for recurrent ovarian cancer, below.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy or surgery. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care

Metastatic ovarian cancer

If ovarian cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

New treatments for ovarian cancer include experimental combinations of chemotherapy, targeted therapy and biologic therapy, often called immunotherapy, which are designed to boost the body’s natural defenses to fight the cancer (see Latest Research). Since the benefits of these options remain unproven, their risks must be weighed against possible improvements in symptoms and survival. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. It’s important to talk with your doctor about the possibility of the cancer returning. This is particularly important after treatment for ovarian cancer, as many women experience at least one recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as surgery and chemotherapy but they may be used in a different combination or given at a different pace. In addition, radiation therapy may be used in some situations. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects

The symptoms of recurrent ovarian cancer are similar to those experienced when the disease was first diagnosed. The four most common symptoms are bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary symptoms (urgency or frequency).  However, other symptoms may include persistent indigestion, gas, nausea, diarrhea, or constipation; unexplained weight loss or gain, especially in the abdominal area; abnormal bleeding from the vagina; pain during intercourse; fatigue; and lower back pain.

In addition to monitoring symptoms, doctors can also watch for ovarian cancer recurrence by measuring the level of CA-125 in the blood. As outlined in Diagnosis, CA-125 is a cancer antigen, or a substance that is found in higher levels on the surface of ovarian cancer cells. In most (95%) women, a rise in CA-125 indicates a recurrence. However, sometimes a recurrence can happen without an elevation of this marker depending on the tumor type.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from ovarian cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for women with ovarian cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating ovarian cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with ovarian cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for ovarian cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.    

Ovarian Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about ovarian cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Screening. There are no currently effective screening methods for the general population. A screening method that estimates a woman’s risk of ovarian cancer by using her age and the results of a yearly CA-125 blood test holds promise for detecting early-stage ovarian cancer. An international study is looking into the role of serial CA-125 screening for ovarian cancer. As explained in Diagnosis, CA-125 is a substance called a tumor marker that is found in higher levels in women with ovarian cancer.

In 2012, the U.S Preventative Services Task Force released a statement saying that for the general population of women with no symptoms, screening for ovarian cancer is not helpful and may lead to harm. However, women at high risk for ovarian cancer due to family history or with a BRCA mutation(s) (see Risk Factors) are recommended to have screening with CA-125 blood tests and transvaginal ultrasound. This approach has not been proven to improve survival or detect cancers at an earlier and more curable stage. 

Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival.

Some targeted therapy is directed towards specific genes that might be found with abnormalities in certain types of epithelial ovarian cancer. For this purpose, ovarian cancer is divided into two groups:  type I and type II.  Type II cancers are the more typical high grade serous cancers, for which standard chemotherapy has been most effective. These tumors typically are diagnosed at later stages and have mutations in TP53 and BRCA genes in the tumor.  Other mutations are rarely seen.

The BRCA mutation, even if only found in the tumor and not in the blood, may increase the effectiveness of a certain classes of drugs such as PARP inhibitors (see below).  Type I tumors include the more rare types of ovarian cancer including low grade serous, endometrioid, clear cell, and mucinous cancers.  These tumors have a variety of mutations including KRAS, BRAF, PI3KCA and PTEN, which have implications for targeted treatment. Clinical trials in these groups are ongoing.    

  • Anti-Angiogenesis Inhibitors. Drugs called anti-angiogenesis inhibitors block the action of a protein called vascular endothelial growth factor (VEGF). These drugs have been shown to increase the cancer’s response to treatment and delay the time it takes for the cancer to return. VEGF promotes angiogenesis, which is the formation of new blood vessels. Because a tumor needs nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogensis therapies is to “starve” the tumor. Bevacizumab (Avastin), an antibody which binds VEGF and prevents it from being active, has been shown to be effective in ovarian cancer.  FDA approval was recently given in the United States for its use in combination with selected chemotherapy for patients with platinum resistant recurrence (see Treatment Options).
  • PARP Inhibitors. Another class of drugs, called PARP inhibitors, are being evaluated for ovarian cancer.  These drugs act on DNA repair in cancer cells, making it difficult for them to replicate.  The BRCA genes (BRCA1 and BRCA2) are also normally involved in DNA repair, and a mutation in these genes interfere with this pathway function.  PARP inhibitors make it particularly difficult for cells that otherwise have a BRCA mutation to grow and divide.  

    The PARP inhibitor olaparib (Lynparza) has received FDA approval in the United States for recurrent disease in patients who have the inherited BRCA mutation and who have received three or more lines of chemotherapy.  In the supporting study of 137 patients with a BRCA mutation, 34% of patients experienced shrinkage in tumor for an average of 7.9 months. A very small number of patients developed secondary hematologic (blood) cancers after use of these drugs. Studies are currently underway with other PARP inhibitors, which do not all require the inherited BRCA mutation. These are being tested to see if they can keep the cancer from coming back after chemotherapy. The potential benefits and risks of PARP therapy should be discussed with your doctor.

Many other new targeted treatments are also now in clinical trials. Increasingly, doctors are learning about each patient’s individual tumor's biology through direct molecular testing. This information may be useful in matching patients with a clinical trial for a specific targeted therapy.  Learn more about the basics of targeted therapy.

Immunotherapy. Immunotherapy is usually designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. Researchers are currently examining whether drugs called checkpoint inhibitors may boost the immune system's ability to destroy cancer cells.  Examples of these drugs target CTLA4 or PD-1 and have recently been shown to cause shrinkage in other cancer types such as melanoma, as well as having some activity in patients with ovarian cancer.

Cancer vaccines are another type of immunotherapy currently being tested for ovarian cancer.  In addition, some approaches called “adoptive cell therapy” take killer T cells found as part of the immune system in an individual patient and grow them in the laboratory, train them to attack certain targets such as MUC 16 (CA125) that is found on any ovarian cancer cells, and them give them back intravenously to the patient.  This approach has been tried in patients with hematologic cancers using other targets with some early success, and clinical trials are now opening for ovarian cancer.  Learn more about the basics of immunotherapy.

Hormone therapy. Research is underway about the role of estrogen, androgens, and other hormones in ovarian cancer treatment. For treatment of recurrent or later-stage ovarian cancer,  the use of tamoxifen (Nolvadex, Soltamax), aromatase inhibitors, and enzalutamide (Xtandi), a blocker of the androgen receptor, is being considered.

Gene therapy. One new area of research is discovering how damaged genes in ovarian cancer cells can be corrected or replaced. Researchers are studying the use of specially designed viruses that carry normal genes into the core of cancer cells and then replace the defective genes with the functional ones.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current ovarian cancer treatments, in order to improve a woman’s comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding ovarian cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Side Effects and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment.  Common side effects from each treatment option for ovarian cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a woman with ovarian cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for women diagnosed with ovarian cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

After treatment for ovarian cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical and pelvic examinations and/or medical tests to monitor your recovery for the coming months and years.

Although there are no specific guidelines for follow-up care for women treated for ovarian cancer, many doctors recommend a pelvic examination every two to four months for the first two years after treatment, and every six months for the following three years. Other tests may include a chest x-ray, CT scan, and blood tests, such as a CA-125 test. Women treated for ovarian cancer may have an increased risk of breast cancer or colon cancer (Lynch Syndrome with certain types of ovarian cancer), and they should talk with their doctors about screening tests for these cancers.

Any new problem should be reported to your doctor, including pain, loss of appetite or weight, changes in your menstrual cycle, unusual vaginal bleeding, urinary problems, blurred vision, dizziness, coughing, hoarseness, headaches, backaches or abdominal pain, bloating, or difficulty eating or digestive problems that seem unusual or don’t go away. These symptoms may be signs that the cancer has come back or signs of another medical condition.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.
  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,
  • Thinking through solutions,
  • Asking for and allowing the support of others, and
  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregiver

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes. 

Women recovering from cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.
  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.
  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of ovarian cancer do I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage and grade of my cancer? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?
  • How long will the operation take?
  • How long will I be in the hospital?
  • Can you describe what my recovery from surgery will be like?
  • What are the possible long-term effects of having this surgery?

Questions to ask about having chemotherapy or radiation therapy

  • What type of treatment is recommended?
  • What is the goal of this treatment?
  • How long will it take to give this treatment?
  • What side effects can I expect during treatment?
  • What are the possible long-term effects of having this treatment?
  • What can be done to relieve the side effects?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?

Questions to ask about planning follow-up care

  • What are the chances the cancer will recur?
  • Are there signs and symptoms I should watch for?
  • How can I keep myself as healthy as possible during treatment?
  • What does it mean to say ovarian cancer is a “chronic disease”?
  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?
  • What long-term side effects or late effects are possible based on the cancer treatment I received?
  • What follow-up tests will I need, and how often will I need them?
  • How do I get a treatment summary and survivorship care plan to keep in my personal records?
  • What survivorship support services are available to me/my child? To my family?
  • Should other women in my family be tested regularly for ovarian cancer?
  • Whom should I call for questions or problems?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Ovarian Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Ovarian Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Ovarian Cancer. Use the menu on the side of your screen to select another section, to continue reading this guide.