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Overview

What is ovarian cancer?

Ovarian cancer happens when cells in or near your ovaries grow abnormally. The cancer cells can spread to other parts of your body. Some women who get ovarian cancer have a family history of breast cancer or have inherited certain gene changes, such as BRCA. But many women with ovarian cancer have no risk factors.

Our approach

With one of the largest gynecologic oncology programs in the New York metropolitan region, Northwell Health Cancer Institute takes a comprehensive approach to treating women with cancer of the reproductive organs, including ovarian cancer. Our specialists work together with you to plan the most effective course of ovarian cancer treatment using the latest research-backed therapies available.

Highlights of our ovarian cancer treatments and services include:

  • The latest surgical innovations with an emphasis on minimally invasive and fertility-sparing techniques
  • Innovative ovarian cancer treatments, including the latest chemotherapies and targeted therapies
  • Genetic testing for women at high risk of ovarian cancer
  • An extensive clinical trials program

Within the first several days of a visit, the team will conduct a complete array of tests and develop a personalized ovarian cancer treatment program. Each ovarian cancer diagnosis is unique, so the team meets regularly to discuss the individual treatment approach for each specific case during weekly teleconferences. These meetings allow the physicians to share ideas and best practices for delivering highly specific, collaborative patient care. Each phase of your treatment is reviewed to ensure that treatment milestones are reached.

Research at Northwell

As part of your ovarian cancer treatment plan, you may have opportunities to participate in clinical trials. These trials study new chemotherapy drugs, radiation technologies and surgical approaches. While not every patient is a candidate for clinical trials, your care team will work with you to determine eligibility. Learn more about clinical trials at Northwell Health.

 

Symptoms & Causes

Symptoms

In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian cancer include:

  • Frequent bloating
  • Pain in your belly or pelvis
  • Trouble eating or feeling full quickly
  • Urinary problems, such as an urgent need to urinate or urinating more often than usual

Other symptoms that affect some women with ovarian cancer include:

  • Fatigue
  • Indigestion
  • Back pain
  • Pain with intercourse
  • Constipation
  • Menstrual cycle changes

These symptoms are common for some women and do not necessarily mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a pattern: they start suddenly, they feel different than your normal digestive or menstrual problems, and they happen daily for long periods of time. If you have one or more of these symptoms and they occur almost daily for more than two or three weeks, talk with your doctor.

Causes

The cause of ovarian cancer is unknown, though there are several factors that may put you at a higher risk of developing ovarian cancer:

  • Genetics—Approximately 10 percent of ovarian cancers are linked to a genetic mutation that is passed down in a family. About 90 percent of ovarian cancers are not related to family history, but having an inherited genetic mutation does put you at a slightly higher risk. Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are linked to Lynch syndrome and multiple different forms of cancer, including ovarian cancer.
  • Hormonal therapies—High amounts of estrogen and low amounts of progesterone can increase your risk. Taking estrogen alone without progesterone can lead to this hormonal imbalance.
  • Age—Most cases of ovarian cancer occur in women over the age of 50, though it can occur at any age.
  • Never carrying a pregnancy. Women who have never carried a pregnancy or given childbirth are more likely to get ovarian cancer than those who have. 
  • Obesity—Obesity has been linked to higher risk for ovarian cancer.
  • Smoking—Carcinogens in cigarettes can increase your risk of getting a variety of cancers, including ovarian. 3
  • Ethnicity—Women of North American, Northern European or Ashkenazi Jewish heritage have a higher risk of ovarian cancer

If you think you have a family history of ovarian cancer, you may want to consider genetic testing to determine if you have a genetic mutation that increases your chance of developing the disease. Learn more about genetic counseling at Northwell Health.

Diagnosis & treatment

Diagnosis

The first step to diagnosing any cancer, including ovarian cancer, is usually a physical. Your doctor:

  • Will check overall physical health while considering medical history, ovarian cancer risk factors and any related medical or precancerous conditions.
  • May press on the abdomen to check for tumors or an abnormal buildup of fluid (ascites). A sample of fluid can be taken to look for ovarian cancer cells.
  • Will likely perform a pelvic examination (see below) to detect symptoms of ovarian cancer, such as masses or growths in the ovarian wall or pelvis.

If your physician suspects you might be experiencing ovarian cancer symptoms, you will be referred to a specialist who can give an accurate ovarian cancer diagnosis.

Diagnostic tests for ovarian cancer, as well as other gynecological cancers, usually include an examination of the vulva, vagina, cervix, uterus, ovaries and fallopian tubes and rectum. Your specialist may use a speculum, a tool that holds open the sides of the vagina, to examine your cervix.

Exams and diagnostic tests for ovarian cance include:

  • Ultrasound—Ultrasound uses high frequency (but safe and painless) sound waves to measure activity inside the organs. In some cases, a doctor will require a better view of the ovaries provided by a transvaginal ultrasound, in which a small probe is placed inside the vagina.
  • Blood tests—Blood tests check for substances in the blood, such as certain proteins that are found in cases of ovarian cancer. However, because blood tests can result in several false positives due to other conditions, blood tests are used less as diagnostic tests for ovarian cancer and more for monitoring patients who have already been diagnosed through other methods.
  • CT scans—A computed tomography (CT) scan is an x-ray procedure that records several detailed pictures of organs and tissues in the abdomen and pelvis from different angles. The pictures are made by a computer linked to an x-ray machine. Sometimes this is used in conjunction with a pyelogram (see below) to determine the staging of the ovarian cancer.
  • Biopsy—A sample of cells or tissues needs to be removed for examination by a pathologist, who can check for signs of cancer. This examination process, called a biopsy, is crucial for an accurate ovarian cancer diagnosis. The procedure to remove tissue is called a laparotomy (see below).
  • Barium enema—In order to examine the lower gastrointestinal tract (colon, rectum, intestine), a liquid containing barium sulfate is inserted into the rectum via an enema. The liquid coats the area, making it easier for x-rays to detect blockages or cancer.
  • Colonoscopy—By inserting a long, lighted tube into the rectum and colon, your doctor can view these areas to determine whether cancer has spread there.
  • Laparotomy—When tissue needs to be removed for examination, your doctor may perform a laparotomy, also known as a laparoscopy. A thin, lighted tube (a laparoscope) is inserted through a small incision in the abdomen, and a small, benign cyst or an early ovarian cancer can be removed. The procedure can also be used to learn whether cancer has spread.
  • Intravenous pyelogram (IVP)—A special liquid called a contrast dye is injected into a vein and travels to the organs, which helps an X-ray determine whether there are any tumors or blockages.

Treatment types

Ovarian cancer is most commonly treated with the following methods: 

  • Surgery—Surgery to remove the ovaries, as well as the uterus, fallopian tubes and cervix is the most common treatment for ovarian cancer. If there are signs that more aggressive cancer may be in the lymph system, lymph nodes may also be removed.
  • Chemotherapy—Chemotherapy is commonly used to treat ovarian cancer. It may be used prior to surgery to shrink a tumor, or after surgery to reduce the risk of cancer recurring. In some cases, chemotherapy can reduce symptoms or treat cancer that has recurred.
  • Radiation therapy—Radiation therapy is typically not used as a first treatment for ovarian cancer. In some cases, it can be used to treat small or localized recurrent cancer.
  • Targeted therapy—New treatments are being developed to target ovarian cancer’s specific genes, proteins or tissue environment. These targeted therapy drugs may improve the effectiveness of other ovarian cancer treatments and keep the cancer from recurring.
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