Ovarian cancer

What is ovarian cancer?

The ovaries are two small, oval-shaped organs in the pelvis.

About 20 women a day are diagnosed with cancer of the ovary (ovarian cancer) in the UK. That is about 7,000 a year.

The most common cancer to start in the ovary is called epithelial cancer.

The different types of epithelial cancer are:

serous
mucinous
endometrioid
clear cell.

High-grade serous cancer is the most common type.

Germ cell ovarian tumours

This rare type of ovarian tumour starts in the cells that produce eggs. It usually affects younger women and may be treated differently to epithelial cancer.

We have separate information about germ cell ovarian tumours.

Boderline tumours

Borderline tumours are made up of abnormal epithelial cells, but they are not true cancers. They usually grow slowly and are unlikely to spread. They can sometimes behave more like a low-grade cancer, but this is rare.

Symptoms of ovarian cancer

Cancer of the ovary often causes symptoms that are similar to other more common and less serious conditions. This can make it difficult to diagnose early, before the cancer has spread.

We have more information about the signs and symptoms of ovarian cancer.

Causes and risk factors of ovarian cancer

We do not know what causes ovarian cancer. But we know some of the risk factors that may increase the chances of it developing.

Having one or more risk factors does not mean you will get cancer. Also, having no risk factors does not mean you will not develop cancer.

We have more information about the causes and risk factors of ovarian cancer.

Diagnosis of ovarian cancer

You usually start by seeing your GP. The GP will ask about your symptoms and do an internal (vaginal) examination to check for any lumps or swelling in the ovaries or womb.

They may also arrange for you to have:

a CA125 blood test
This blood test checks for raised levels of a protein called CA125.

an ultrasound scan
You may have ultrasound scans to check the organs inside the abdomen (tummy area) and the pelvis.

If your GP is worried about cancer, they will arrange for you to see a specialist doctor within 2 weeks. This specialist is usually a gynaecologist (a doctor who treats female reproductive system problems).

Some people are admitted directly to hospital if they have a symptom that is making them very unwell.

At the hospital

The specialist doctor will ask you about your general health, any previous health problems, and whether you have any history of cancer in your family. They will do an internal (vaginal) examination again. If you have not already had a CA125 blood test and ultrasound, they will usually arrange for you to have these tests.

The doctor may use the results of your tests to check your Risk of Malignancy Index (RMI) score. This is a system that checks how likely it is that your symptoms are caused by cancer. It takes into account:

whether you have gone through the menopause
the level of CA125 in your blood
the results of your ultrasound.

Further tests

The specialist doctor may also organise further tests. These may help your team diagnose the cancer but also help them plan your treatment. You may have the following:

CT scan
A CT scan takes a series of x-rays, which build up a 3D picture of the inside of the body.
Fluid taken from the abdomen
Sometimes swelling or bloating in the tummy is caused by a build-up of fluid. This is called ascites. If you have ascites, your doctor may want to take a sample of this fluid to check for cancer cells.
The doctor injects some local anaesthetic into the skin on your tummy (abdomen) to make it numb. They gently pass a small needle through the skin and collect some fluid in a syringe. The fluid is sent to the laboratory to be examined.
Biopsy
This is when the doctor removes a small sample (biopsy) from the lump or abnormal area. The sample is then sent to the laboratory and looked at under a microscope.
Genetic testing
Your doctor may talk with you about having a blood test to look for genetic changes that are linked to cancer. This is only done if you have certain types of cancer, such as high-grade serous or endometrioid cancer.

Waiting for tests results can be a difficult time. We have more information that may help.

Staging and grading of ovarian cancer

The stage of a cancer describes where the cancer has been found and other places it has spread to. Grading describes how the cancer cells look under the microscope compared with normal cells. Knowing the stage and grade helps your doctors plan the best treatment for you.

Your doctor will not usually know the exact stage of the cancer until it has been removed with surgery. If you have not had surgery, they can use the results of your tests 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. This is called a multidisciplinary team (MDT).

Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.

Treatments for ovarian cancer include:

Surgery
Surgery is one of the main treatments for ovarian cancer. The aim is to remove all of the cancer.
Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Carboplatin is the main chemotherapy drug used to treat ovarian cancer. It may be given in combination with paclitaxel.

Targeted therapies may be used to treat ovarian cancer that has come back or advanced ovarian cancer. Targeted therapies interfere with the way cells grow.

Radiotherapy is sometimes used to treat an area of cancer that has come back when other treatments are no longer possible. It may also be used to control symptoms, such as bleeding, pain or discomfort. This is known as palliative radiotherapy.

Other treatments are also used to control symptoms caused by advanced cancer. This may include a procedure to drain fluid called ascites, that can build-up in the tummy.

We have more information about how different treatments are used to treat ovarian cancer.

You may have some treatments as part of a clinical trial.

After ovarian cancer treatment

After your treatment, you will have regular check-ups. These are usually every few months to start with. If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our ovarian cancer forum to talk with people who have been affected by ovarian cancer, share your experience, and ask an expert your questions.

CA125 blood test

CA125 blood tests are sometimes done as part of your follow-up, but this is not always needed. A rising CA125 level may be a sign that the cancer has returned. But for most people, it is just as effective to wait for symptoms of cancer to develop and then start treatment again.

Starting treatment before you have symptoms:

is no more effective at controlling the cancer
means you will have side effects of treatment sooner.

Your cancer doctor or nurse can give you more information about this.

Symptoms

After treatment, it can take time to work out what feels normal for you. You may worry that every ache or pain you have is a sign of cancer returning.

If you develop any new symptoms, do not wait for a follow-up appointment. Contact your specialist nurse or see your GP. They can arrange for you to be seen by your cancer doctor if needed.

Ovarian cancer that comes back

Ovarian cancer that comes back can usually be treated again with more chemotherapy, targeted therapies and sometimes more surgery. Some people will have several courses of chemotherapy or other treatments spaced over a few years. The aim of treatment is to control the cancer for as long as possible and to manage any symptoms.

Finding out you have advanced cancer can be difficult to cope with. You may feel shocked and find it hard to understand. Or you may have questions about what to expect. Your doctor and specialist nurse are there to help.

We have more information about coping with advanced cancer that you may find helpful.

Your sex life after ovarian cancer

Cancer and cancer treatment can cause physical and emotional changes that may affect your sex life. For example, if you have not been through the menopause already, your cancer treatment may cause it.

Well-being and recovery

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.

About our information

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 cancerinformationteam@macmillan.org.uk

Fotopoulou C, et al. British Gynaecological Cancer Society (BGCS) epithelial ovarian/ fallopian tube/ primary peritoneal cancer guidelines: recommendations for practice. European Journal of Obstetrics, gynecology, and reproductive biology. 2017. 213: 123-139.

National Institute for Health and Care Excellence. Ovarian cancer: recognition and initial management. Clinical guideline (CG122). April 2011. Available from: www.nice.org.uk/Guidance/CG122 (accessed June 2017).

Reviewers

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. It has been approved by Senior Medical Editor, Professor David Luesley, Professor of Gynaecological Oncology.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.