Ovarian Cancer – Causes, Signs and symptoms

Ovarian Cancer

Also called: Ovary Cancers

Reviewed By:
Martin E. Liebling, M.D., FACP
Mark Oren, M.D., FACP

Summary

Ovarian cancer is an overgrowth of malignant, abnormal cells in one or both of a woman’s ovaries. The ovaries are female reproductive organs that produce eggs and hormones called estrogen and progesterone. Unlike healthy cells, which divide and grow in an organized manner, cancer cells continue to divide until they form a mass called a tumor.

The ovaries contain three types of tissue:

  • Germ cells (reproductive cells)
  • Stromal cells (supporting cells that make hormones)
  • Epithelial cells (surface cells)

Although ovarian cancer can originate in any of these cells, most cases begin in the epithelial cells. Other related conditions include primary peritoneal carcinoma (a type of cancer) and ovarian cysts, which are rarely cancerous.

According to the American Cancer Society, ovarian cancer is the eighth leading cancer among women (excluding non-melanoma skin cancers). The exact cause of this disease is not known. However, risk factors such as advanced age, a history of breast cancer, family history of ovarian cancer and obesity may increase a woman’s likelihood of developing the disease. Early ovarian cancers tend to cause vague symptoms or no symptoms at all. The most common symptom of this disease is back pain. However, guidelines were developed recently to help identify early symptoms.

Patients with an increased risk of developing epithelial ovarian cancer may choose to have screening tests and examinations to help identify the disease. There are no screening tests for detecting germ cell tumors or stromal tumors.

Individuals believed to have ovarian cancer will typically be referred to a gynecologic oncologist, a physician who specializes in treating women’s reproductive cancers. Tests such as an ultrasound and a biopsy may be performed. Common treatments for ovarian cancer include surgery (e.g., oophorectomy), radiation therapy and chemotherapy. When ovarian cancer is detected and treated early, there is a very good chance of survival. Many cases are not detected until later stages, reducing a woman’s chance of survival. Researchers are investigating a variety of new ways to prevent, detect and treat this disease.

About ovarian cancers

Ovarian cancer, also called carcinoma of the ovary, is a type of cancer that begins in one or both ovaries. The ovaries are female reproductive organs that produce eggs (ova). They are also the primary source of estrogen and progesterone, the female reproductive hormones. The ovaries are located in the pelvis on both sides of the uterus (womb).

The ovaries contain three distinct types of tissue:

  • Germ cells. Cells that produce the ova. Every month from puberty until menopause, women usually produce an egg that travels to the surface of the ovary, where it is shed into their fallopian tube.

  • Stromal cells. Cells that produce the majority of a woman’s estrogen and progesterone.

  • Epithelial cells. Cells that cover the ovaries.

Although ovarian cancer can begin in any of these cells, 85 to 90 percent of cases begin in the epithelial cells, according to the American Cancer Society (ACS).

Normal cells divide, grow and die in an organized manner. Cancer cells continuously multiply until they form a growth or tumor (a mass of excess tissue). This occurs because the DNA, which directs all of the cell’s activities, becomes damaged by any of a variety of factors. In some cases, the cancer cells become invasive, spreading to tissues and organs outside of the ovaries (metastasis). Organs that are most likely to be affected include those of the abdomen, such as the intestines, liver and stomach. However, ovarian cancer can also spread to other organs such as the brain, lungs, breast and lymph nodes.

The ACS estimates that a woman’s chance of getting ovarian cancer in her lifetime is roughly 1 in 71, or 1.5 percent. Approximately 21,650 new cases of ovarian cancer will be diagnosed in 2008 in the United States. However, the incidence rate for ovarian cancer has been declining since 1985. The likelihood of developing ovarian cancer increases with age and about two-thirds of cases are diagnosed in women over age 55. 

According to the ACS, ovarian cancer is the eighth leading cancer among women, excluding non-melanoma skin cancer. The disease ranks fifth among cancer deaths in women and claims more lives than any other female reproductive cancer. In 2008, an estimated 15,520 women will die from ovarian cancer.

If ovarian cancer is diagnosed and treated in its earliest stages, the five-year survival rate is 94 percent, according to the ACS. Only 19 percent of ovarian cancers are detected at an early stage. An estimated 45 percent of women diagnosed with ovarian cancer live longer than five years after the diagnosis.

Many women develop ovarian cysts in their lifetime. These growths form when fluid collects in a sac inside the ovary. A large percentage of ovarian cysts are not cancerous and are a regular part of the ovulation process. Known as functional cysts, these growths usually disappear once the fluid inside the cyst is absorbed by the body. If the growth is large, occurs in childhood or does not disappear, a physician may recommend certain tests. In a small number of cases, ovarian cysts may become cancerous.

Types and differences of ovarian cancers

Many types of growths or tumors can form in the ovaries. Some are noncancerous (benign) and never spread outside of the ovary. For example, women who are still menstruating can develop benign cysts on their ovaries that can be felt during a pelvic examination or seen with use of imaging tests such as x-rays.

Women with noncancerous tumors can be successfully treated by removing one of their ovaries (unilateral oophorectomy) or the portion of the ovary that houses the tumor (partial oophorectomy). Other types of tumors that begin in the ovaries are cancerous (malignant) and can potentially invade other parts of the body.

Ovarian tumors are generally named according to the type of cells in which they originate and whether or not the tumor is cancerous. The three main types of ovarian tumors include germ cell tumors, stromal cell tumors and epithelial tumors.

Germ cell tumors originate in the cells that produce the eggs (ova). They account for about 5 percent of ovarian cancers, according to the American Cancer Society (ACS). There are numerous subtypes of these tumors, the majority noncancerous. However, some germ cell tumors are malignant and may be life-threatening. Types of germ cell ovarian tumors include:

  • Teratoma. The benign form of this germ cell tumor is called mature teratoma, and it is the most common type of ovarian germ cell tumor. It typically affects women in their childbearing years. The malignant germ cell tumor is called immature teratoma. This type usually affects girls under age 18. These rare cancers resemble fetal or embryonic tissue, such as respiratory passages, connective tissue and the brain.

  • Dysgerminoma. Although this cancer is rare, it is the most common ovarian cancer that arises in the germ cells. Dysgerminoma typically affects women in their teens and 20s. These tumors are considered malignant but they usually do not develop or spread quickly. Women with dysgerminoma usually have a good prognosis (predicted outlook or chance of survival), regardless of the stage of the cancer.

  • Endodermal sinus tumor (or yolk sac tumor) and choriocarcinoma. These tumors are very rare and usually affect girls and young women. They tend to develop and spread quickly, but are often sensitive to treatment.

    Choriocarcinomas typically begin during pregnancy in the placenta instead of the ovary, and these tumors are normally more responsive to treatment than ovarian choriocarcinomas.

Stromal cell tumors begin in the cells of connective tissue that keep the ovary intact and produce estrogen and progesterone, the female hormones. More than half of stromal tumors are found in patients older than 50 years of age, according to the ACS. However, some of these tumors affect young girls. Some stromal tumors produce female hormones, and occasionally some may produce male hormones. Granulosa cell tumors are a cancerous type of stromal tumor. Other malignant stromal tumors include granulosa-theca tumors and Sertoli-Leydig cell tumors, which are generally considered low-grade cancers. Benign stromal tumors include thecomas and fibromas.

Epithelial tumors begin in the cells that cover the ovary’s outer surface. Types of epithelial tumors include:

  • Benign epithelial ovarian tumors. The majority of epithelial ovarian tumors are noncancerous, do not spread to other parts of the body and typically do not cause serious illness. There are a variety of these tumors, including mucinous adenomas, serous adenomas and Brenner tumors.

  • Malignant epithelial ovarian cancers. These carcinomas account for about 85 to 90 percent of ovarian cancers, according to the ACS. Several features of epithelial ovarian carcinoma cells can be viewed under a microscope. These features are used to categorize malignant epithelial ovarian carcinomas into four differentiated subtypes: mucinous, serous, endometrioid and clear cell. Undifferentiated epithelial ovarian carcinomas do not resemble any of these four subtypes, and tend to develop and spread more quickly.

  • Ovarian tumors of low malignant potential (LMP tumors). Ovarian epithelial tumors that do not clearly appear as cancerous under a microscope. These tumors are also known as epithelial borderline ovarian cancer. LMP tumors differ from normal ovarian cancers because they do not grow into the tissue that supports the ovary. LMP tumors tend to be less invasive to surrounding areas and affect women at a younger age. These tumors grow slowly and are less life-threatening than other forms of ovarian cancer.

Primary peritoneal carcinoma, also called extraovarian primary peritoneal carcinoma (EOPPC), is a type of cancer closely related to epithelial ovarian cancer. Primary peritoneal carcinoma originates in cells from the peritoneum, the membrane lining the organs and walls of the pelvis and abdomen. These cells resemble the epithelial cells that coat the surface of the ovaries. Because this condition usually spreads along the surfaces of the abdomen and pelvis, it is normally difficult to determine exactly where the cancer started. EOPPC looks the same as epithelial ovarian cancer when examined under a microscope. Women who have had their ovaries removed can still develop this form of cancer.

Risk factors and causes of ovarian cancers

The exact cause of ovarian cancer is unknown. Researchers have identified certain risk factors that may increase a patient’s chances of developing epithelial ovarian cancer, which accounts for about 85 to 90 percent of all ovarian cancers, according to the American Cancer Society (ACS). These risk factors do not pertain to other, less common ovarian cancers, such as germ cell tumors and stromal tumors.

It is important to note that only a small number of patients with risk factors for epithelial ovarian cancer will develop the disease. Risk factors for epithelial ovarian cancer include:

  • Age. Most ovarian cancers develop after menopause, with two-thirds of all ovarian cancers affecting women over age 55.

  • Reproductive history. There is a higher risk for women who:

    • Begin menstruation before age 12
    • Have no children
    • Give birth to their first child after age 30
    • Enter menopause after age 50

The risk factors listed above and certain studies indicate a relationship between ovarian cancer risk and the number of menstrual cycles a woman experiences in her lifetime. The greater number of total cycles, the higher the risk of ovarian cancer. Hence, a female who begins menstruating at an early age and enters menopause at an older age is at the greatest risk. Pregnancy interrupts menstrual cycles, so women who have never been pregnant and thus have never had their cycle interrupted are also at greater risk.

  • Fertility drugs. Some studies indicate that extended use of the fertility drug clomiphene citrate may increase a woman’s risk of developing ovarian tumors, especially if she does not become pregnant while taking the medication. Patients taking fertility drugs should discuss any potential risks with their physician. Because infertility itself also increases the risk of ovarian cancer, further studies are needed to clarify these relationships.
  • Family history of certain cancers. Women whose mothers, sisters or daughters have had ovarian cancer have an increased risk of developing the disease. According to the ACS, about 10 percent of ovarian cancers are inherited. Women with a personal or family history of breast cancer caused by an inherited mutation of the BRCA1 or BRCA2 gene also have a high risk of developing cancer of the ovaries – about 45 percent for BRCA1 and 25 percent for BRCA2. These genetic mutations are responsible for 9 percent of ovarian cancers.

    The lifetime risk of ovarian cancer for women with mutations of the BRCA1 or BRCA2 gene is estimated to be between 40 and 50 percent by age 70. However, recent research has indicated that women with a family history of breast cancer who do not have the BRCA genes are not at an increased risk for ovarian cancer. In addition, ovarian cancer can increase a patient’s risk of developing breast cancer. Ovarian cancer also affects larger numbers of women with a family history of colorectal cancer.

  • Obesity. Recent studies have indicated an increased risk of ovarian cancer developing among women who are obese or have a sedentary lifestyle. Research also indicates that obese women with ovarian cancer have a poorer chance of survival.

Some studies suggest that hormone replacement therapy (HRT) and the application of talcum powder to the genital area may increase a woman’s risk of ovarian cancer. However, further research is necessary to confirm these findings.

Researchers are also investigating whether tests to identify certain genetic mutations, such as the HER2 oncogene or the p53 tumor suppressor gene, may help predict a woman’s prognosis for ovarian cancer. The effectiveness of these tests remains uncertain, and some specialists believe that further research is warranted.

Signs and symptoms of ovarian cancers

Early ovarian cancers tend to cause vague symptoms that can make the disease difficult to recognize. The most common symptom of this disease is back pain, which is often followed by:

  • Fatigue
  • Bloating
  • Abdominal pain
  • Constipation
  • Urinary urgency

In 2007, several organizations, including the American Cancer Society, formalized a list of early symptoms for ovarian cancer, including bloating, feeling full quickly after eating, abdominal pain and urinary urgency. Any woman who experiences these symptoms daily for more than a few weeks should consult her physician. Additional symptoms, which tend to occur in more advanced stages of ovarian cancer, include:

  • Swelling of the abdomen for a prolonged period (due to fluid accumulation or a mass)
  • Abdominal cramping
  • Abnormal vaginal bleeding
  • Leg pain

Additionally, patients with stromal tumors may experience the following symptoms associated with excess female and male hormones:

  • Vaginal bleeding after menopause
  • Menstrual periods in young girls
  • Development of breasts in young girls
  • Disrupted menstrual periods
  • Growth of facial and body hair

Many of these symptoms can be caused by other, less serious disorders. However, women who experience any of these symptoms should immediately notify their physician.

Diagnosis methods for ovarian cancers

Ovarian cancer is not often diagnosed in its early stages because it presents so few symptoms, or presents symptoms that are attributed to other conditions. There are few standard screening tests for ovarian cancer. However, the first tests a woman would probably experience to diagnose ovarian cancers include:

  • Transvaginal ultrasound. An ultrasound test that is performed with an instrument placed inside the vagina. Transvaginal sonography can find a mass in an ovary, and may be able to detect if the mass is malignant (cancerous) or benign (noncancerous).

  • Tumor marker tests. A tumor marker is a substance that can be detected in elevated amounts in the urine, blood or body tissue of some individuals with certain cancers. Women at risk of developing ovarian cancer may have a tumor marker blood test that measures the patient’s CA-125 (also called OC-125) level. Elevated levels of this protein are often present in women with ovarian cancer. However, other noncancerous diseases of the ovaries and some cancers of other organs may also increase CA-125 level. Some ovarian cancers may not produce enough of the protein to register a positive test result. When CA-125 results are positive, further testing may be necessary to determine if cancer exists. This test is typically recommended only for women with strong risk factors, and even then there is much doubt about its usefulness.

These tests are usually conducted during routine gynecological examinations. The standard pelvic examination and Pap smear are useful for detecting cervical cancer, but are not generally useful in detecting ovarian cancer.

If cancer is suspected after an examination and screening tests, the patient may be referred to a gynecologic oncologist, who is trained in treating female reproductive cancers. The oncologist may order the following diagnostic tests:

  • Imaging studies. These tests cannot confirm that a mass is cancerous. However, they may be useful in determining if a mass is indeed present and if a cancer has spread to other parts of the body. Common imaging studies for ovarian cancer include:

    • Ultrasound. During an ultrasound, a small probe is placed on a patient’s abdomen or inside the vagina (transvaginal). Ultrasound may be useful in identifying tumors because healthy ovarian tissue and tumors reflect sound waves differently. This test may also be helpful in determining whether a tumor is solid (more likely to be malignant) or fluid-filled (more likely to be benign).

    • CAT scan (computed axial tomography). This test allows for multiple x-rays to be taken from different angles around the patient. The cross-sectional images of the patient’s body are analyzed by a computer. This test gives the treatment team information about the size of a tumor and may help  identify enlarged lymph nodes that may be cancerous.

    • Chest x-ray. This test allows the physician to determine if the cancer has spread to the lungs.

  • Other tests. The following tests may also be performed:

    • Laparoscopic examination. During this procedure, the physician inserts a slender, lighted tube through an incision in the patient’s abdomen and examines the ovaries and other pelvic organs as well as tissue near the bile duct. This procedure provides a view of the patient’s organs that can help the physician plan surgery or other treatments. It can also help the physician confirm the stage of the cancer. Additionally, laparoscopy allows physicians to manipulate small instruments through the patient’s incision to perform a biopsy for microscopic examination.

    • Biopsy. The only way for a physician to be certain that a growth in the pelvic region is cancerous is to surgically remove a tissue sample for microscopic analysis. This is called a biopsy. In patients with fluid accumulation inside their abdomen (ascites), cancer may also be diagnosed with fluid samples. Biopsies are typically performed surgically, with a goal of obtaining samples of tissue for diagnosis and staging (determining the extent of the cancer). Cancer deposits that exceed half an inch (1 centimeter) may be surgically removed during a biopsy.

      CAT scans also can be used to accurately guide a needle into a possible metastasis. This procedure is called a CAT-guided needle biopsy. During the CAT-guided needle biopsy, the patient remains on the CAT table while a radiologist inserts the biopsy needle into the mass. CAT scans are repeated until the medical team is certain the needle is in the correct place. A biopsy sample is then removed and examined with a microscope.

If ovarian cancer is diagnosed, other tests may be performed to see if cancer has spread into other parts of the pelvic region or other parts of the body.

Treatment options for ovarian cancers

After ovarian cancer is diagnosed, the physician will recommend one or more options for treatment. Treatment is based on a variety of factors, including the woman’s age and health status, as well as the stage of the cancer. A treatment plan is typically designed by the patient’s cancer care team, which is composed of several specialized physicians and healthcare professionals. Patients may choose to get a second opinion about their condition prior to beginning treatment. The basic types of treatment for ovarian cancer include:

  • Surgery. The amount of surgery a patient has depends on her general health and how far the cancer has spread (metastasized) in the body. For patients of childbearing age with certain types of tumors and whose cancer is not too advanced, the physician will make an effort to treat the disease without removing both ovaries and the uterus. Surgical techniques used to treat ovarian cancer include:

    • Unilateral oophorectomy. Surgical removal of one ovary.

    • Bilateral oophorectomy. Surgical removal of both ovaries.

    • Unilateral salpingectomy. Surgical removal of one fallopian tube, one of two tubes that transport eggs from the ovaries to the uterus.

    • Bilateral salpingectomy. Surgical removal of both fallopian tubes.

    • Unilateral and bilateral salpingo-oophorectomy. Surgical removal of one or both ovaries and the corresponding fallopian tube.

    • Radical hysterectomy. Surgical removal of the uterus, both ovaries, both fallopian tubes, neighboring lymph nodes and the omentum, a fatty tissue fold where ovarian cancer frequently spreads. The removal of the uterus and/or both ovaries means that that the woman will be unable to become pregnant. This surgery will also induce menopause in premenopausal women. Most women will be hospitalized for three to seven days after this procedure and can typically resume normal activities in four to six weeks.

    • Cytoreduction. Surgical removal of as much of the tumor as possible.

  • Chemotherapy. The use of powerful drugs administered to kill cancer cells. Chemotherapy drugs are typically administered either intravenously or orally. Once the drugs enter the patient’s bloodstream, they begin to spread throughout the body. Recent studies have indicated that ovarian cancer also may be effectively treated when the drugs are injected directly into the abdominal cavity in addition to being given intravenously.

    Chemotherapy is potentially beneficial in treating cancer that has spread to other organs in the body. Most patients with epithelial ovarian cancer receive a combination of drugs. Different drug combinations are used to treat patients with germ cell tumors. A typical course of chemotherapy for patients with epithelial ovarian cancer is six treatment cycles, with each cycle lasting three to four weeks. A cycle is a period of treatment followed by a period of rest.

  • Radiation therapy. Kills malignant cells with precise high-energy radiation beams. Though effective for many types of cancers, it is not typically used to treat ovarian cancer.
  • Clinical trials. Women may choose to participate in clinical trials or studies involving promising new or experimental treatment methods for ovarian cancer. These may include other therapies such as biological therapy or other targeted therapies. A woman’s physicians can best determine whether she is a candidate for a clinical trial and assist in locating a study.

Patients who receive treatments for ovarian cancer should consult their physician regarding follow-up visits, and report any new symptoms or side effects as soon as they arise. There is a significant risk of recurrence of ovarian cancer after patients have been treated.

Prevention methods for ovarian cancers

To date, there is no known method for preventing ovarian cancer. However, individuals can take certain steps to reduce the likelihood of developing epithelial ovarian cancer, the most common form of the disease. There is little information known about reducing the risk of germ cell tumors and stromal tumors in the ovaries. Therefore, the following strategies apply only to epithelial ovarian cancer:

  • Birth control pills. Women who use oral contraceptives (birth control pills) for at least three years have approximately a 30 to 50 percent lower risk of developing ovarian cancer, according to the American Cancer Society (ACS). Recent studies have indicated that taking oral contraceptives for as little as six months may decrease woman’s risk of ovarian cancer.

  • Gynecologic surgery. According to the ACS, women who have their fallopian tubes surgically “tied” to prevent pregnancy after giving birth to children reduce their risk of developing cancer of the ovaries by up to 67 percent. This procedure has also been effective in lowering the risk of ovarian cancer in patients with a BRCA1 gene mutation, which is associated with breast cancer and ovarian cancer. Whether tubal ligation can reduce cancer risk in patients with a BRCA2 mutation is uncertain. Having a hysterectomy (surgical removal of the uterus) can also reduce a woman’s risk of ovarian cancer. It is important to note that both of these surgeries should be performed for valid medical reasons and not solely for the purpose of reducing ovarian cancer risk. Some women who carry the BRCA1 gene mutation may decide in agreement with their physicians to have their ovaries removed. Recent research has shown that women with both the BRCA1 and BRCA2 gene mutations who had their ovaries removed had lower rates of ovarian, fallopian tube and peritoneal cancers.

  • Diet. Numerous studies have shown a reduced rate of ovarian cancer in patients who ate a diet rich in vegetables. In addition, recent research has suggested that milk products may increase the risk of ovarian cancer. The link between dairy products and ovarian cancer remains inconclusive. The ACS recommends consuming a variety of healthful foods, especially those derived from plants, and limiting the consumption of red meats and unhealthy fats. 

  • Exercise. Moderate physical activity may lower the chances of developing ovarian cancers. Researchers believe exercise may enhance the antioxidant and immune systems and lower the risk of obesity.

  • Pain relievers. Aspirin, acetaminophen and ibuprofen have been found to reduce risk of ovarian cancer in some studies. However, further research is necessary to determine the relationship between analgesics and cancer of the ovaries.

Additionally, women with a family history of ovarian cancer may choose to have genetic counseling and testing to determine whether they have a BRCA1 or BRCA2 gene mutation, which is associated with increased risk of ovarian cancer. In some cases, a woman who finds that she has such a mutation may opt for removal of both ovaries (bilateral oophorectomy). However, this does not completely eliminate the risk of ovarian cancer, according to the ACS, and is an option that should be considered only after close consultation with a physician.

Although pregnancy and breastfeeding can reduce the risk of ovarian cancer, they have not been shown to prevent the disease and physicians do not recommend planning a pregnancy solely to prevent ovarian cancer.

 Currently, there is no standard screening recommended for women at average risk for ovarian cancer. Researchers continue to study possible screening procedures for women who are not in a high-risk category.

For women who have an increased risk of ovarian cancer, such as those with a family history or BRCA gene mutations, screening tests may be appropriate. Tests that are considered for screening purposes include the CA-125 tumor marker test and/or ultrasound. A woman should consult with her gynecologist about her need for ovarian cancer screening.

Most ovarian tumors are not detected through routine pelvic examinations unless they are in an advanced stage. In addition, a Pap smear rarely detects ovarian cancer cells. However, all women should have regular Pap smears and pelvic exams because they can detect other reproductive cancers and conditions.

Ongoing research regarding ovarian cancers

Vital research is being conducted in all areas of women’s reproductive cancers. Scientists continue to study ovarian cancer to obtain information about causes, treatment and prevention of the disease.

Some of the most current research in ovarian cancer includes:

  • Cancer detection. Researchers are evaluating the effectiveness of multimodal screening for early ovarian cancer detection. Such screening would combine blood tests, ultrasound and the use of newer screening guidelines to reliably detect ovarian cancer in the early stages, when it is more curable. The CA-125 blood test is being used and other blood tests are being studied. In addition, transvaginal sonography is being studied as a form of ovarian cancer screening.

  • Cancer treatment. Various treatments are being developed for ovarian cancer in several research studies. New drugs are also being evaluated that treat advanced ovarian cancer, or that block the development of new blood supply to tumors, thus preventing the tumors from growing. In addition, researchers have studied the placement of chemotherapy drugs in treatment. Studies have indicated that placing the drugs into the body cavity, not just a vein, may improve a woman’s chance of survival.


    Other studies are testing biological therapy drugs in clinical trials for ovarian cancer. These studies have included combinations of chemotherapy drugs and biological therapy drugs such as monoclonal antibodies. The biological therapy drugs can block proteins called vascular endothelial growth factors, which help blood vessels feed tumors. Additional research is continuing to evaluate the effectiveness of viruses in treating cancer of the ovaries. Other studies have investigated monoclonal antibodies combined with therapeutic vaccines made from the individual patient.

Staging of ovarian cancer

The prognosis (predicted outlook or chance of survival) of ovarian cancer depends on the cancer’s “stage” and “grade.” Staging is a system of diagnosis that indicates the extent of the cancer, or how widespread it is in the body. The grade measures how abnormal the cells look under a microscope. The grading and staging systems are combined into another system that allows the physician to discuss the pathology of the tumor in language the patient can more easily understand. Staging of ovarian cancer affects the woman’s treatment plan as well as the outlook for recovery.

Physicians use a much more complex system for staging ovarian cancer that was developed by the American Joint Committee on Cancer (AJCC). This system, which is rapidly replacing another method called the FIGO system, is commonly known as the “TNM” system, where:

  • “T” describes the extent of a tumor’s invasion into surrounding tissues and organs.

  • “N” describes whether or not the cancer has spread to surrounding lymph nodes and, if so, the extent of involvement. Lymph nodes are groups of immune system cells that help ward off infections and cancers. They are typically the size of a bean.

  • “M” describes whether or not the cancer has metastasized (spread) to distant organs, such as the lungs, or to lymph nodes that do not surround the ovaries.

These stages of ovarian cancer include:

  • Stage I. The cancer is contained within one or both ovaries.

  • Stage II.  The cancer is in one or both ovaries and has spread to other pelvic organs, such as the uterus, bladder, fallopian tubes, rectum or sigmoid colon.

  • Stage III.  The cancer is in one or both ovaries and has spread from the pelvis to the abdominal lining and/or has spread to the lymph nodes.

  • Stage IV. The most advanced stage of the disease. The cancer is in one or both ovaries and has spread to distant sites, such as the liver, lungs or other organs outside of the patient’s peritoneal cavity.

The following chart reflects the five-year survival rate of ovarian cancer patients by stage. It is important to note that many patients live much longer than five years. Additionally, every patient’s situation is unique, and statistics cannot reveal the outcome of an individual case.

StageFive-Year Survival Rate
I85 to 93 percent
II64 to 79 percent
III31 to 51 percent
IV17 percent

Questions for your doctor about ovarian cancer

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to ovarian cancer:

  1. Does my family or medical history place me at higher risk for ovarian cancer?
  2. Should I undergo any screening tests for ovarian cancer?
  3. What tests will be done to determine if I have ovarian cancer?
  4. What type of cancer do I have and in what stage?
  5. What are my treatment options?
  6. What are the risks associated with these treatments?
  7. What is my prognosis?
  8. How will I know if my treatments have been successful?
  9. What is the likelihood that my cancer will return?
  10. How will the cancer or the treatments affect my ability to have children?
  11. Will ovarian cancer increase my chances of developing other cancers?
  12. Should I have genetic testing for this or any other cancer?
  13. What are the odds that my sisters or daughters will develop ovarian cancer?
  14. Should they have any screening tests for cancer?
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