Ovarian Cancer Overview
Ovarian cancer begins in the ovaries, two small, oval-shaped organs in the female reproductive system. Situated on either side of the uterus, the ovaries produce and store eggs during a woman’s reproductive years. These glands also produce hormones, such as estrogen and progesterone, which control the menstrual cycle.
Ovarian cancer is relatively rare. In most cases, it is diagnosed after menopause.
Ovarian Cancer Types
Ovarian cancer is classified based on its cellular origin:
- Epithelial tumor – Forms in the thin layer of tissue that covers the outer ovaries (most common)
- Germ cell tumor – Develops in the egg-producing cells within the ovaries (more common in young women but rare overall)
- Sex cord stromal tumor – Arises in the connective tissues that support the ovary and produce hormones
Each type of ovarian cancer varies in terms of prognosis, treatment options and typical age of onset.
Ovarian Cancer Causes and Factors
Ovarian cancer arises when cells in the ovaries undergo harmful genetic mutations that cause them to grow and divide uncontrollably. The abnormal cells then build up and form tumors. As a tumor grows, it can affect ovarian function and potentially spread to other structures in the abdominal cavity and beyond.
The exact cause of the cellular changes that lead to the development of ovarian cancer is often unknown. However, scientists have identified several risk factors, including:
- Advanced age – Most cases are diagnosed after age 50.
- Family history – Women with a first-degree biological relative (parent, sibling or child) who was diagnosed with ovarian or breast cancer are at heightened risk, especially if the cancer is related to an inherited mutation of breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2).
- Personal history – A prior diagnosis of breast, uterine or ovarian cancer or a benign condition that affects the ovaries, such as endometriosis, pelvic inflammatory disease or polycystic ovary syndrome (PCOS), may increase the risk of ovarian cancer.
- Reproductive history and hormone exposure – Women who have never been pregnant, started menstruating before age 12, entered menopause after age 55 or used hormone replacement therapy (HRT) to alleviate menopause symptoms are at risk.
Ovarian Cancer Signs and Symptoms
Early symptoms of ovarian cancer are often vague and nonspecific. The first noticeable sign may be persistent abdominal bloating.
What Does Ovarian Cancer Feel Like?
In addition to abdominal bloating, ovarian cancer may cause:
- An uncomfortable feeling of fullness after eating only a small amount of food
- Pelvic pain (similar to menstrual cramps)
- Irregular menstrual cycle
- Unusual vaginal bleeding or discharge
- Frequent urination
- Low back pain
- General fatigue
These symptoms can be persistent and usually worsen over time.
What Does Ovarian Cancer Look Like?
In imaging studies, such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans, ovarian cancer may appear as a mass or tumor in an ovary. The tumor can vary in size and shape and may cause the ovary to look enlarged or irregular.
During surgery, the tumor may appear as a solid or cystic growth on the ovary or another structure in the pelvic or abdominal cavity. Additionally, fluid accumulation (ascites) in the abdomen may be visible in advanced stages.
Ovarian Cancer Diagnosis
Ovarian cancer is usually diagnosed through a combination of medical history review, physical examination and diagnostic testing. During a pelvic exam, a physician will feel the ovaries and other pelvic organs to check for palpable abnormalities.
If ovarian cancer is suspected, the physician may order imaging tests, such as ultrasound, CT or MRI scans, to visualize the ovaries and look for masses and tumors. The physician may also order blood work, such as a cancer antigen 125 (CA-125) test, to measure the level of CA-125, a blood protein that may be elevated due to ovarian cancer.
A diagnosis of ovarian cancer is confirmed with a biopsy, which involves obtaining a sample of suspicious tissue for microscopic examination by a pathologist, who can identify cancerous cells. In some cases, exploratory surgery may be performed to obtain the tissue sample.
Ovarian Cancer Stages
Ovarian cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) staging system or the American Joint Committee on Cancer (AJCC) TNM staging system. Both systems involve evaluating the extent and spread of the tumor and assigning a stage ranging from 1 to 4. A higher number indicates more advanced cancer.
Stage 1 Ovarian Cancer
At stage 1, the cancer is confined to one or both ovaries and has not spread to other pelvic or abdominal organs. Stage 1 ovarian cancer can be further classified as:
- Stage 1A – The cancer is limited to one ovary.
- Stage 1B – Cancer is present in both ovaries.
- Stage 1C – Cancer is found on the surface of an ovary, an ovary has ruptured or cancerous cells are detected in the fluid of the abdominal cavity.
Treatment for early-stage ovarian cancer usually involves surgical removal of the affected ovary or ovaries, which may be followed by chemotherapy to target any remaining cancer cells.
Stage 2 Ovarian Cancer
At stage 2, the cancer has spread from one or both ovaries to other pelvic structures, such as the fallopian tubes, uterus, bladder or rectum, but has not reached nearby lymph nodes or metastasized to distant organs. Stage 2 ovarian cancer can be further classified as:
- Stage 2A – The cancer has spread to the uterus and/or fallopian tubes.
- Stage 2B – The cancer has invaded other pelvic tissues.
Treatment typically involves surgery to remove the ovaries, uterus and affected pelvic tissues, followed by chemotherapy to target any remaining cancer cells.
Stage 3 Ovarian Cancer
At stage 3, the cancer has spread beyond the pelvis into the abdominal cavity or nearby lymph nodes. Stage 3 ovarian cancer can be further classified as:
- Stage 3A – Microscopic cancer cells are found in the peritoneum outside the pelvis.
- Stage 3B – Visible cancerous deposits smaller than 2 cm. in diameter are found in the abdomen.
- Stage 3C – Visible cancerous deposits larger than 2 cm. in diameter are found in the abdomen or the cancer has spread to nearby lymph nodes.
Treatment usually involves surgery to remove as much of the tumor as possible followed by chemotherapy to target any remaining cancer cells.
Stage 4 Ovarian Cancer
At stage 4, the cancer has spread beyond the abdominal cavity to distant organs or lymph nodes. Metastatic ovarian cancer can be further classified as:
- Stage 4A – Cancerous cells are found in the fluid around the lungs (pleural effusion).
- Stage 4B – The cancer has metastasized to organs and tissues outside the abdomen, such as the liver or bones.
Treatment for advanced-stage ovarian cancer typically involves a combination of surgery to remove as much of the cancer as possible, followed by systemic therapy, such as chemotherapy, targeted therapy or immunotherapy, to help prevent cancer progression and alleviate symptoms.
Ovarian Cancer Treatment
Ovarian cancer is typically treated with a combination of surgery and chemotherapy. The goal of surgery is to remove as much of the tumor as possible, which may involve removing the ovaries, fallopian tubes, uterus and nearby affected tissues. After surgery, chemotherapy may be administered to target any remaining cancer cells and reduce the risk of recurrence. In advanced cases, targeted therapy or immunotherapy may be added to the treatment regimen to improve the outcome.
Benefit from World-Class Care at TGH
Tampa General Hospital is a high-volume cancer center recognized by U.S. News & World Report as One of the Nation's Best Hospitals for Cancer Care for 2024-25. Our multidisciplinary team diagnoses and treats all types and stages of gynecologic cancer, including ovarian cancer and other uncommon conditions.
If you would like to learn more about ovarian cancer, contact TGH at (813) 844-7585 to request an appointment with a gynecologic oncologist at our Cancer Institute in Tampa, FL.
