Ovarian cancer
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What is ovarian cancer?
The ovaries are 2 small, oval-shaped organs in the pelvis. The pelvis is the lower area between the hips. They are part of the reproductive system.
About 7,500 women are diagnosed with cancer of the ovary each year in the UK.
The ovaries are very close to other parts in the pelvis called the fallopian tubes and peritoneum. Doctors now think most ovarian cancers start in the cells at the end of the fallopian tubes and travel to the ovaries or the peritoneum.
Doctors often group cancers of the ovary, fallopian tube or peritoneum together because they have similar symptoms, risk factors and treatments.
Ovarian cancer can affect anyone who has ovaries. This includes women, transgender (trans) men and people assigned female at birth.
Related pages
Booklets and resources
Types of ovarian cancer
There are different types of ovarian cancer.
Epithelial ovarian cancer
The most common type of cancer to start in the ovary is called epithelial ovarian cancer. It starts in cells called epithelial cells. There are different subtypes.
High grade serous cancer is the most common type of epithelial ovarian cancer. High grade means this type can grow more quickly.
About 1 in 20 epithelial ovarian cancers (5%) are low grade serous cancers. Low grade means they grow more slowly.
Other types of epithelial ovarian cancer are much less common. They are more likely to be diagnosed at an early stage:
- clear cell (up to 10% of cases)
- endometrioid (10% of cases)
- mucinous (3 to 4% of cases).
Borderline tumours
Borderline ovarian tumours are made up of abnormal epithelial cells that are not cancer cells. Borderline tumours grow slowly. They are not invasive. This means that although they may spread to nearby tissue, they do not grow in these tissues. They can spread to other parts of the body.
Borderline tumours usually occur at a younger age. They are usually diagnosed at an early stage when the abnormal cells are still within the ovary.
Non-epithelial ovarian cancers
These cancers make up about 1 in 10 ovarian cancers (10%). They usually start in cells specific to the ovaries. There are different types, including sex cord-stromal tumours and germ cell tumours. Germ cell ovarian tumours usually occur at a younger age.
Symptoms of ovarian cancer
Cancer of the ovary usually causes symptoms that are similar to common non-cancerous conditions. This can make it difficult to diagnose early. Symptoms can include a persistent or long-lasting bloated or swollen tummy or pain in the lower tummy or back (pelvic or abdominal pain).
We have more information about the signs and symptoms of ovarian cancer.Related pages
Causes and risk factors of ovarian cancer
Doctors do not know what causes cancer to start in the ovary. But some risk factors may increase the chances of it developing. For example, getting older or having a family history of ovarian cancer.
Having a risk factor does not mean you will get cancer. And if you do not have any risk factors, this does not mean you will not get cancer.
We have more information about the causes and risk factors of ovarian cancer.
Diagnosis of ovarian cancer
If you have symptoms, you usually start by visiting your GP.
Your GP may do an internal (vaginal) examination to check for any lumps or swelling. They will usually arrange for you to have the following tests:
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CA125 blood test
CA125 is a protein in the blood. It is normal to have some CA125 in your blood, but the levels may be higher if you have ovarian cancer.
CA125 levels can remain normal if you have ovarian cancer. Other cancers and non-cancerous conditions can raise the level of CA125.
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Ultrasound scan
An ultrasound ultrasound scan uses sound waves to create an image of the organs in the pelvis and tummy area (abdomen). The ultrasound probe produces the sound waves. A computer converts the sound waves into images on a screen.
If the ultrasound results show any abnormal areas, your GP will arrange for you to see a specialist doctor. This will be a gynaecologist, who treats problems with the female reproductive system. Your GP or the hospital may also arrange for you to have a CT scan.
If your CA125 and ultrasound results are normal, but your symptoms continue or get worse, your GP can still refer you to a gynaecologist.
If your GP finds a lump in your pelvis, or fluid in your tummy (ascites), they will refer you to a gynaecologist straight away.
At the hospital
The gynaecologist may examine you and do an internal examination. If you have not had a cervical screening test recently, you may also have this. This is to check the cells of the cervix for any abnormal changes.
If you have not had a CA125 blood test and ultrasound scan, the gynaecologist will arrange these tests. They may also arrange other blood tests called CEA and CA19-9.
Risk of Malignancy Index (RMI)
The gynaecologist may use your test results to check your Risk of Malignancy Index (RMI) score. This is a scoring system that checks how likely it is that cancer is causing your symptoms.
Further tests
If your test results show there may be cancer, your doctors will arrange further tests. You may have some of the following tests.
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CT scan
A CT scan takes a series of x-rays, which build up a 3D picture of the inside of the body. If you have not had a CT scan already, it is likely your doctors will arrange to scan your chest, tummy and pelvic area.
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Removing fluid from the tummy
Sometimes fluid can build up in the tummy and cause swelling or bloating. This is called ascites. It can be caused by cancer and some non-cancerous conditions. If you have ascites, your doctor may want to take a sample of the fluid. They send the sample to a laboratory, where it is checked for cancer cells. If the sample contains cancer cells, the laboratory may send it on for genetic testing (below).
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Biopsy
A biopsy means taking a sample of cells or tissue. A doctor at a laboratory will look at the sample under a microscope. If it contains cancer cells, the doctor should be able to tell the type and grade of ovarian cancer and use the sample for genetic testing. If your scan or blood tests results are not typical for ovarian cancer, you may have a biopsy first. This is so your doctors can be sure of the diagnosis before surgery.
There are different ways of taking the biopsy.
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Genetic testing
Your gynaecologist and specialist nurse may talk to you about genetic testing. They can explain about the different tests and what the results might mean for you. They may offer you a blood test to find out whether you have an inherited change (variant) in a number of genes, including the BRCA genes Having this variant can increase your risk of ovarian cancer.
Your gynaecologist may also talk to you about testing for a gene change called homologous recombination deficiency (HRD). HRD testing only checks for changes in the cancer cells. It is not a test for gene changes that are inherited. It can be done on the cells taken during a biopsy. If you have a positive HRD result, some cancer treatments may be more effective than others.
We have more information about cancer and genetic changes.
Waiting for tests results can be a difficult time. We have more information that can help.
Related pages
Staging and grading of ovarian cancer
The stage describes where the cancer started and other areas it may have spread to. Grading describes how the cancer cells look under the microscope compared with normal cells. Knowing the stage and grade of the cancer helps your doctors and nurses plan your treatment
If you are having surgery, your doctor will usually not know the exact stage until the cancer has been removed. If you are not having surgery, doctors use tests and CT scan to decide the stage of the cancer.
We have more information about staging and grading of ovarian cancer.
Treatment for ovarian cancer
A team of specialists will meet to discuss the best possible treatment for you. They are called a multidisciplinary team (MDT).
Your doctor or cancer specialist or nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.
Your cancer team may also give you advice about preparing for your treatment. This is sometimes called prehabilitation. It helps to improve your fitness and diet before treatment. It also helps to get you ready mentally.
The main treatments for ovarian cancer are:
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Surgery
You usually have surgery to remove as much of the cancer as possible. If the cancer has spread to other areas in the pelvis, you may need more surgery.
If you have very early stage cancer and want to get pregnant in the future, it may be possible to have only the affected ovary and fallopian tube removed. This is called fertility-sparing surgery.
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Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You usually have a combination of the chemotherapy drugs carboplatin and paclitaxel.
You may have chemotherapy before or after surgery. You may have it to treat any cells that cannot be removed during surgery. Sometimes chemotherapy is given during surgery to help treat cancer cells in the tummy area (HIPEC).
Chemotherapy may be given as your main treatment if surgery is not the best option for you.
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Targeted therapies
You may have targeted therapies with or after chemotherapy, to help control the cancer. This is called maintenance treatment.
You may have a targeted therapy drug called bevacizumab.
Or you may have a type of targeted therapy drug called a PARP inhibitor. You have these if the cancer has responded to chemotherapy. You may have bevacizumab with a PARP inhibitor called olaparib.
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Radiotherapy
Radiotherapy is occasionally used to treat ovarian cancer itself. If the cancer has only spread to 1 place in the body, you may have a high dose of radiotherapy which aims to cure the cancer. You may have this as a course of daily treatments over 3 to 5 weeks.
You may have a type of radiotherapy called stereotactic ablative radiotherapy (SABR). SABR uses many smaller, focused rays. The radiotherapy machine directs these rays from different angles which meet at the tumour. This means that the tumour receives a high dose of radiation while surrounding healthy tissues receive a much lower dose. This lowers the risk of damage to normal cells.
You may have some treatments as part of a clinical trial.
We have more information about how treatments are used to treat ovarian and fallopian tube cancer.
Treating ovarian cancer that comes back
If cancer of the ovary, fallopian tube or peritoneum comes back (recurs), it can usually be treated again. The treatment you have will depend on:
- the treatment you had before
- how long after treatment the cancer came back
- whether you had any difficult side effects from previous treatments.
You may have more chemotherapy or targeted therapy. Sometimes you may need more surgery.
If you do not want chemotherapy or want to delay it, it may be possible to have hormonal therapy drugs such as tamoxifen or letrozole. This is usually given for low grade cancers which grow more slowly.
You may continue to have different treatments over many years. Your cancer doctor and specialist nurse may also talk to you about having treatments as part of a clinical trial.
It can be very hard to learn that the cancer has come back again. You may feel shocked and find it difficult to think of having treatment again. Your doctor and specialist nurse are there to help and support you.
Managing symptoms
Sometimes ovarian cancer can cause symptoms. Your cancer doctor and specialist nurse will help to make sure any symptoms are controlled. This is called supportive or palliative care. You may see a specialist palliative care doctor or nurse for expert help with your symptoms.
Treatments can help. For example, you may have radiotherapy to reduce pain or bleeding in the pelvis.
We have information about the following symptoms of ovarian cancer. Or you may find our information about coping with advanced cancer helpful.
Fluid build-up
Cancer that starts in the ovary can cause a build-up of fluid in the tummy or lung. This can make you feel uncomfortable or breathless. The fluid can be drained to make you feel more comfortable. Find out more about managing fluid build-up:
- in the tummy (called ascites)
- in the lung (called a pleural effusion) if the cancer has spread to the lung.
Blocked bowel (bowel obstruction)
Sometimes the cancer can put pressure on the bowel. This may gradually narrow the bowel, which stops stools (poo) passing through. This is called a blocked bowel or bowel obstruction.
Sometimes a bowel obstruction happens because surgery to the abdomen (tummy area) has caused tissues to stick together. These are called adhesions.
Treatments for the cancer may improve bowel obstructions. But you may need surgery to remove the blocked section of bowel. This may mean you have a temporary or permanent stoma after surgery. Surgery is only suitable for some people and only if the obstruction affects 1 area of bowel.
Sometimes bowel obstructions are managed by resting the bowel. During this time, you have fluids through a drip. If you are unable to eat and drink, you may need nutrients through a tube into your tummy or a vein. This is called artificial feeding or artificial nutritional support.
After ovarian cancer treatment
Follow-up after treatment for ovarian cancer
Depending on your treatment, you may have regular check-ups. These usually happen every few months to start with.
During a check-up, your doctor or nurse will ask you how you are recovering from treatment. They will also ask if you have any new symptoms. If needed, they may arrange for you to have a CT scan or blood tests.
At a check-up, you can talk to your doctor or nurse about any problems or worries you have.
If you notice new symptoms or have problems between appointments, contact your doctor or nurse for advice. Do not wait for your next check-up.
After treatment, it can take time to work out what feels normal for you. You may worry that every ache or pain is a sign of cancer returning. Your specialist nurse can give you information about symptoms to be aware of.
You may not have regular check-ups. Instead, you may be asked to contact your cancer team if you have any concerns. Your cancer doctor or specialist nurse will explain what to be aware of.
If you do not have regular check-ups and you are worried about something, contact your cancer team. They may arrange for you to see your cancer doctor. Or they may advise you to see your GP.
We have more information about follow-up care after treatment.
Sex, menopause and fertility
Cancer of the ovary and its treatments can affect your sexual wellbeing – physically, emotionally and practically. This may include changes such as menopausal symptoms, or changes to how you feel about your body (your body image).
We have more information about cancer and sex, coping with your feelings and cancer and relationships.
If you have not been through the menopause, cancer treatment may cause it to start. If you have had surgery to remove the ovaries, this will cause the menopause straight away. We have more information about coping with menopausal symptoms.
Some cancer treatments affect your ability to get pregnant (fertility). Fertility problems may develop after chemotherapy or radiotherapy. If you have surgery to remove both ovaries, fallopian tubes and the womb, you will not be able to become pregnant. If you have early stage cancer, you may have treatment to preserve your fertility.
Your surgeon, cancer doctor or specialist nurse can give you advice if you are thinking about trying to get pregnant.
We have more information about cancer and fertility.
Booklets and resources
Well-being and recovery
Taking good care of yourself can help speed up your recovery after ovarian cancer treatment. Even small lifestyle changes may improve your wellbeing and long term health.
Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.
More information and advice
We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:
Ovarian cancer support
You may have many different feelings during and after ovarian cancer treatment. If you have finished treatment, you may feel relieved it has ended but worried about what might happen in the future.
It is important to know where to get support or information if you need it. People often need support even some time after ovarian cancer treatment. But sometimes it is difficult to know who to ask for help.
To find support:
- ask your GP or someone from your cancer team for advice about support in your area
- find cancer support services near you
- call the Macmillan Support Line free on 0808 808 0000
- chat to our cancer information specialists online
- visit our Online Community ovarian cancer forum to talk to people who have been affected by ovarian cancer, share your experience, and ask questions.
The HOPE programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer. Topics include goal setting, fatigue management, and wellbeing. You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk
Other organisations who offer information and support
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Eve appeal
Eve Appeal offers information and support for anyone affected by gynaecological cancers. Also provides information about cervical screening and for trans, non-binary and intersex people.Helpline 0808 802 0019
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Ovacome
Ovacome offers information and support for anyone affected by ovarian cancer, including patients, families, friends, carers and health professionals.Tel 0800 008 7054
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Ovarian Cancer Action
Ovarian Cancer Action offers information and support for anyone affected by ovarian cancer.Tel 0207 380 1730
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Daisy Network
Daisy Network is a support group for women who have early ovarian failure. The website gives information about premature menopause and related issues.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our ovarian cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Ovarian cancer: recognition and initial management. Clinical guideline [CG122] Published: 27 April 2011 Last updated: 02 October 2023 www.nice.org.uk/guidance/cg122 (accessed May 2024)
Ovarian cancer: identifying and managing familial and genetic risk. NICE guideline [NG241]. Published: 21 March 2024 www.nice.org.uk/guidance/ng241 (accessed May 2024)
A. González-Martín, P. Harter, A. Leary, D. Lorusso, R. E. Miller, B. Pothuri, I. Ray-Coquard, D. S. P. Tan, E. Bellet, A. Oaknin & J. A. Ledermann, on behalf of the ESMO Guidelines Committee. Newly diagnosed and relapsed epithelial ovarian cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Published August 17, 2023. www.annalsofoncology.org/article/S0923-7534(23)00797-4/fulltext (accessed May 2024)
Date reviewed
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