Ovarian cancer

Overview

Ovarian cancer is a disease in which malignant cells are found in an ovary. While some cancers are hereditary, meaning someone is more likely to be afflicted if they have a family history with that particular cancer, 90 percent of women with ovarian cancer have no direct hereditary link to the disease.

Ovarian cancer usually affects women ages 40 or older, with the greatest number of cases affecting women older than 60. There are several kinds of ovarian tumors, but they fall into three main types, named for the tissues in which they are found:

  • Epithelial tumors — the most common type of ovarian cancer, epithelial tumors form in cells that line or cover the ovaries
  • Germ cell tumors — these form from reproductive (egg) cells
  • Sex cord-stromal — sex cord-stromal cell tumors form in the tissues that support the ovaries and produce female hormones. This is a very rare type of ovarian cancer

Causes and risks

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

  • Genetics — 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, or BRCA1, and breast cancer gene 2, or 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
  • Obesity
  • Smoking

Taking birth control, having a hysterectomy or having tubal litigation (tying of the fallopian tubes) may lower your risk of developing ovarian cancer.

Symptoms

According to the National Cancer Institute, obvious symptoms may not occur with early ovarian cancer. But, as the cancer grows, ovarian cancer symptoms may include:

  • Pressure or pain in the abdomen, pelvis, back or legs
  • A swollen or bloated abdomen
  • Nausea, indigestion, gas, constipation or diarrhea
  • Feeling very tired all the time

Less common ovarian cancer symptoms include: 

  • Shortness of breath
  • Feeling the need to urinate often
  • Unusual vaginal bleeding (heavy periods, or bleeding after menopause)

These symptoms could be due to other conditions, so it’s important to see a doctor immediately in order to get an accurate ovarian cancer diagnosis.

Diagnosis and testing

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
  • Your doctor 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
  • Your doctor 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.

Pelvic exam to diagnose ovarian cancer

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 doctor may use a speculum, a tool that holds open the sides of the vagina, to examine your cervix.

Exams and diagnostic tests for ovarian cancer

Your doctor will issue a number of tests and exams for diagnosing for ovarian cancer, which may include:

  • Ultrasound — Ultrasound uses high-frequency (but safe and painless) sound waves aimed at the pelvis 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 a number of 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, a doctor can view these areas to determine whether cancer has spread there
  • Laparotomy — When tissue needs to be removed for examination (see biopsy, above), a doctor performs 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

Multidisciplinary Ovarian Cancer Treatment

Within the first several days of a visit, the team of cancer experts in the Gynecologic Oncology Center 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 your treatment approach for each specific situation during weekly teleconferences. This allows the physicians to share ideas and best practices for delivering highly specific and fully explored collaborative care. Each phase of your treatment is reviewed to ensure that treatment milestones are reached.

Our aggressive, holistic approach to ovarian cancer may involve many different treatments. Depending on the stage of the cancer, your specialist may recommend the following:

  • Surgical removal of the ovaries, fallopian tubes and uterus. Depending on what the team finds during surgery, it may be necessary to remove additional tissue and lymph nodes
  • Chemotherapy to remove any remaining cancer following surgery
  • Immunotherapy, which boosts your immune system to help your body fight the cancer

Hyperthermic chemotherapy, which is done during surgery, consists of delivering heated chemotherapy directly into your abdomen. This treatment is highly concentrated, reduces the side effects of chemotherapy and reduces the treatment’s exposure to the rest of your body

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