Ovarian Cancer
Often called the "silent cancer," ovarian cancer is difficult to detect early. This guide explains types, staging, BRCA connections, treatment options, and questions to ask your care team.
Quick Overview
New Cases Per Year
Approximately 314,000 new ovarian cancer cases are diagnosed globally each year, making it the eighth most common cancer in women worldwide. [WHO, 2024]
Leading Cause of Cancer Death
Ovarian cancer is the fifth leading cause of cancer death in women in developed countries. It has the highest mortality of any gynecologic cancer. [ACS, 2024]
Diagnosed at Late Stage
Roughly 60% of ovarian cancers are diagnosed at Stage III or IV because early symptoms are vague and there is no reliable screening test for the general population. [NCI, 2024]
Genetic Risk Factor
BRCA1 mutations carry a 39-44% lifetime risk of ovarian cancer; BRCA2 mutations carry an 11-17% risk. The general population risk is approximately 1.2%. [NCCN, 2024]
5-Year Survival (All Stages)
The overall 5-year relative survival rate is approximately 49%. When caught early (Stage I), the 5-year survival rate exceeds 90%. Research is steadily improving outcomes. [ACS, 2024]
What Is Ovarian Cancer?
Ovarian cancer is a group of diseases that begins in or near the ovaries — the two small, almond-shaped organs on either side of the uterus that produce eggs (ova) and the hormones estrogen and progesterone. Recent research has shown that many cases of "ovarian cancer" actually originate in the fallopian tubes or the peritoneum (the lining of the abdominal cavity), so you may hear your care team refer to "ovarian, fallopian tube, and primary peritoneal cancer" as a group. [NCI, 2024]
The ovaries contain three types of tissue, and cancer can develop in any of them:
- Epithelial cells — the outer surface layer of the ovary. About 90% of ovarian cancers start here.
- Germ cells — the cells that produce eggs. Germ cell tumors are rare and more common in younger women.
- Stromal cells — the connective tissue that holds the ovary together and produces estrogen and progesterone. Stromal tumors are also rare.
Ovarian cancer is often called the "silent cancer" because its early symptoms — bloating, pelvic discomfort, changes in urination — are vague and mimic many everyday conditions. There is currently no reliable screening test for ovarian cancer in women at average risk (unlike the Pap smear for cervical cancer or mammograms for breast cancer). This is one reason the disease is so frequently diagnosed at advanced stages. [Matulonis et al., 2016]
Understanding what kind of ovarian cancer you have, and what biomarkers are present, is critical — because it determines your treatment path and your options. That is what this guide will walk you through.
Types of Ovarian Cancer
Not all ovarian cancers are the same. The type determines prognosis and treatment. Here are the major categories.
Epithelial Ovarian Cancer (~90%)
The most common type, arising from the surface (epithelial) cells of the ovary or the fallopian tube lining. Subtypes include high-grade serous (the most common and aggressive), low-grade serous, endometrioid, clear cell, and mucinous carcinomas. High-grade serous carcinoma accounts for roughly 70% of all ovarian cancer cases and is frequently linked to BRCA mutations. [Matulonis et al., 2016]
Germ Cell Tumors (~2-3%)
These rare tumors arise from the egg-producing cells of the ovary and are most commonly diagnosed in teenagers and women in their 20s. Types include dysgerminomas, immature teratomas, and yolk sac tumors. The good news: germ cell tumors generally respond very well to chemotherapy, and most women are cured even at advanced stages. Fertility can often be preserved. [NCI, 2024]
Sex Cord-Stromal Tumors (~1-2%)
These tumors develop in the connective tissue cells that hold the ovary together and produce hormones. The most common subtype is the granulosa cell tumor, which often produces excess estrogen and may cause unusual vaginal bleeding. Stromal tumors tend to be diagnosed earlier and generally have a better prognosis than epithelial ovarian cancer. [ACS, 2024]
Fallopian Tube & Primary Peritoneal Cancer
Research now shows that many high-grade serous "ovarian" cancers actually originate in the fallopian tubes. Primary peritoneal cancer starts in the lining of the abdominal cavity. Because these three cancers behave similarly and are treated the same way, they are now grouped together in clinical guidelines and staging systems. [NCI, 2024]
Risk Factors
Having one or more risk factors does not mean you will develop ovarian cancer — and many women diagnosed have no known risk factors at all. But understanding risk helps guide screening and prevention decisions.
Age
Ovarian cancer can occur at any age, but is most commonly diagnosed in women between ages 55 and 64. The median age at diagnosis is 63. Germ cell tumors are an exception, occurring more often in younger women. [ACS, 2024]
Family History
Having a first-degree relative (mother, sister, or daughter) with ovarian cancer increases your risk. A family history of breast cancer also raises ovarian cancer risk, especially if the breast cancer was linked to BRCA mutations. About 20-25% of ovarian cancers are associated with hereditary genetic mutations. [NCCN, 2024]
BRCA1 and BRCA2 Mutations
BRCA1 and BRCA2 are tumor suppressor genes that help repair damaged DNA. Inherited mutations in these genes dramatically increase ovarian cancer risk. Women with a BRCA1 mutation have a 39-44% lifetime risk of ovarian cancer. Women with a BRCA2 mutation have an 11-17% lifetime risk. By comparison, the average woman's lifetime risk is about 1.2%. These mutations also increase breast cancer risk. If you have a family history suggesting hereditary cancer, genetic testing and counseling are strongly recommended. [NCCN Genetic/Familial Assessment, 2024]
Lynch Syndrome (Hereditary Nonpolyposis Colorectal Cancer)
Lynch syndrome is caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2, or EPCAM deletion). Women with Lynch syndrome have a 6-12% lifetime risk of ovarian cancer, compared to 1.2% in the general population. Lynch syndrome also increases the risk of colorectal, endometrial, and other cancers. [NCCN, 2024]
Endometriosis
Endometriosis — a condition where tissue similar to the uterine lining grows outside the uterus — is associated with a modestly increased risk of ovarian cancer, particularly endometrioid and clear cell subtypes. If you have endometriosis, discuss your individual risk with your gynecologist. [Matulonis et al., 2016]
Never Having Been Pregnant (Nulliparity)
Women who have never been pregnant have a slightly higher risk of ovarian cancer. Each full-term pregnancy appears to reduce risk, and breastfeeding may offer additional protection. Using oral contraceptives (birth control pills) for five or more years reduces ovarian cancer risk by approximately 50%, even in BRCA carriers. [ACS, 2024]
Hormone Replacement Therapy (HRT)
Long-term use of estrogen-only hormone replacement therapy after menopause has been associated with a modestly increased risk of ovarian cancer. The risk appears to decrease after stopping HRT. Combination estrogen-progesterone therapy may carry a smaller increase. Discuss the risks and benefits of HRT with your doctor based on your individual situation. [ACS, 2024]
Symptoms of Ovarian Cancer
Ovarian cancer symptoms are real, but they are often subtle and easily mistaken for other, less serious conditions. That is what makes early detection so challenging.
The following symptoms are common in ovarian cancer. They are also common in many other conditions that are not cancer. The key difference is persistence — if these symptoms are new for you and occur almost daily for more than two to three weeks, see your doctor.
How Ovarian Cancer Is Diagnosed
There is no single test that definitively diagnoses ovarian cancer. Diagnosis typically involves a combination of physical exams, imaging, blood tests, and ultimately surgery to confirm.
Pelvic Exam
Your doctor will feel the ovaries and surrounding organs for any masses, lumps, or abnormalities. While a pelvic exam is important, most early-stage ovarian cancers cannot be detected this way. [ACS, 2024]
Transvaginal Ultrasound (TVUS)
A small ultrasound probe is inserted into the vagina to create detailed images of the ovaries. This can reveal masses, cysts, and other abnormalities. It is often one of the first imaging tests performed when ovarian cancer is suspected. However, ultrasound alone cannot determine whether a mass is cancerous. [NCI, 2024]
CA-125 Blood Test
CA-125 is a protein found on the surface of many ovarian cancer cells. Elevated CA-125 levels (above 35 U/mL) may suggest ovarian cancer, but CA-125 can also be elevated in many non-cancerous conditions including endometriosis, fibroids, pelvic inflammatory disease, and even normal menstruation. CA-125 is more useful for monitoring treatment response and detecting recurrence than for initial screening. [ACS, 2024]
CT Scan and MRI
A CT (computed tomography) scan of the abdomen and pelvis helps determine the extent of disease and whether cancer has spread to nearby organs or lymph nodes. An MRI (magnetic resonance imaging) may be used to get more detailed images of specific areas. These scans are critical for treatment planning. [NCI, 2024]
Surgical Biopsy
The only way to confirm ovarian cancer is to examine tissue under a microscope. Unlike many cancers where a needle biopsy is performed first, ovarian cancer is usually confirmed during surgery. The surgeon removes the suspicious mass (or the entire ovary) and a pathologist examines it. In some cases, a laparoscopic biopsy may be performed before a major operation. [NCCN, 2024]
Genetic Testing
All women diagnosed with epithelial ovarian cancer should be offered genetic testing for BRCA1, BRCA2, and other relevant mutations, regardless of family history. This is recommended by NCCN guidelines because the results directly influence treatment decisions — particularly whether PARP inhibitors may be effective. Genetic testing can also have important implications for family members. [NCCN Genetic/Familial Assessment, 2024]
Staging (FIGO System)
Ovarian cancer is staged using the FIGO system (International Federation of Gynecology and Obstetrics). Staging is determined during surgery, when the surgeon can directly see and sample tissue throughout the abdomen.
Stage I — Confined to the Ovaries
Cancer is found in one or both ovaries (or fallopian tubes) only. It has not spread to lymph nodes or distant sites. Stage IA: cancer in one ovary, capsule intact. Stage IB: cancer in both ovaries. Stage IC: cancer in one or both ovaries with surgical spill, capsule rupture, or cancer cells in abdominal fluid. The 5-year survival rate for Stage I is approximately 90% or higher. [ACS, 2024]
Stage II — Spread to the Pelvis
Cancer has spread from the ovary to other pelvic organs — such as the uterus, fallopian tubes, bladder, or rectum — but is still contained within the pelvis. Stage IIA: spread to the uterus or fallopian tubes. Stage IIB: spread to other pelvic tissues. The 5-year survival rate for Stage II is approximately 70-75%. [ACS, 2024]
Stage III — Spread to the Abdomen or Lymph Nodes
Cancer has spread beyond the pelvis to the lining of the abdomen (peritoneum) and/or to retroperitoneal lymph nodes. This is the most commonly diagnosed stage. Stage IIIA: microscopic spread to the abdomen or positive lymph nodes only. Stage IIIB: visible deposits up to 2 cm. Stage IIIC: deposits larger than 2 cm, including those on the surface of the liver or spleen. The 5-year survival rate for Stage III is approximately 30-40%. [ACS, 2024; NCI, 2024]
Stage IV — Distant Spread (Metastasis)
Cancer has spread to organs beyond the abdomen — such as the lungs, liver (inside the tissue, not just the surface), bones, or distant lymph nodes. Stage IVA: cancer cells found in fluid around the lungs (pleural effusion). Stage IVB: spread to the inside of the liver, spleen, distant lymph nodes, or other distant organs. The 5-year survival rate for Stage IV is approximately 15-20%, though this is improving with new treatments. [ACS, 2024; NCI, 2024]
Key Biomarkers in Ovarian Cancer
Biomarkers are measurable substances in your blood or tumor tissue that help your care team understand your cancer's behavior and choose the best treatment.
CA-125
A protein often elevated in epithelial ovarian cancer. Used to monitor treatment response, detect recurrence, and sometimes aid diagnosis. Normal is below 35 U/mL, but elevations can occur in many benign conditions. Not reliable as a standalone screening tool. [ACS, 2024]
HE4 (Human Epididymis Protein 4)
Another blood marker that may be elevated in ovarian cancer. Sometimes used alongside CA-125 in the ROMA (Risk of Ovarian Malignancy Algorithm) score to help distinguish between benign and malignant pelvic masses. Less likely than CA-125 to be elevated in benign conditions. [NCI, 2024]
BRCA1 / BRCA2
Genetic mutations tested from blood or saliva. If your tumor carries a BRCA mutation (germline or somatic), you may be a strong candidate for PARP inhibitor therapy, which has shown significant survival benefits. Testing is recommended for all epithelial ovarian cancer patients. [NCCN, 2024]
HRD (Homologous Recombination Deficiency)
HRD testing examines whether the tumor has a defect in a specific DNA repair pathway. Tumors that are "HRD-positive" — even without a BRCA mutation — may respond well to PARP inhibitors. HRD status is increasingly used in treatment planning for advanced ovarian cancer. [Matulonis et al., 2016]
PD-L1
A protein that may be expressed on tumor cells. When PD-L1 is present, it can help cancer hide from the immune system. PD-L1 testing is used to determine whether immunotherapy (checkpoint inhibitors) might be effective. Its role in ovarian cancer is still being studied in clinical trials. [NCI, 2024]
MSI (Microsatellite Instability)
MSI testing detects defects in DNA mismatch repair genes. MSI-high tumors may respond to immunotherapy with checkpoint inhibitors like pembrolizumab. MSI-high status is also associated with Lynch syndrome. Testing is recommended for all ovarian cancers, especially clear cell and endometrioid subtypes. [NCCN, 2024]
Treatment for Ovarian Cancer
Treatment depends on the type, stage, grade, and biomarker profile of your cancer, as well as your overall health and personal preferences. Most treatment plans combine surgery and chemotherapy, often with targeted therapies.
Surgery: Debulking / Cytoreduction
Surgery is usually the first step in ovarian cancer treatment. The goals are to confirm the diagnosis, determine the stage, and remove as much cancer as possible (called "debulking" or "cytoreduction"). A standard operation typically includes removal of both ovaries, both fallopian tubes, the uterus (hysterectomy), the omentum (a fatty apron of tissue in the abdomen), and any visible tumor deposits. The surgical goal is "no residual disease" or "optimal debulking" (less than 1 cm of remaining tumor), because the amount of cancer remaining after surgery is one of the strongest predictors of outcome. [NCCN, 2024]
In some cases, particularly with very advanced disease, your doctor may recommend neoadjuvant chemotherapy — three to four cycles of chemotherapy before surgery to shrink the tumor and make the operation more effective. This is followed by completion surgery and then additional chemotherapy. [NCI, 2024]
For young women with early-stage disease who wish to preserve fertility, fertility-sparing surgery may be an option. This typically involves removing only the affected ovary and fallopian tube while leaving the uterus and the other ovary intact. This approach is generally limited to Stage IA, Grade 1 tumors and certain germ cell tumors. [NCCN, 2024]
Chemotherapy
Most women with ovarian cancer receive chemotherapy after surgery. The standard first-line regimen for epithelial ovarian cancer is a combination of a platinum-based drug (usually carboplatin) and a taxane (usually paclitaxel), given intravenously every three weeks for six cycles. This combination has been the backbone of ovarian cancer treatment for over two decades. [NCCN, 2024]
Intraperitoneal (IP) chemotherapy delivers drugs directly into the abdominal cavity through a surgically placed catheter. Studies have shown improved survival with IP chemotherapy in optimally debulked Stage III disease, though it can cause more side effects. Newer approaches include hyperthermic intraperitoneal chemotherapy (HIPEC), which delivers heated chemotherapy directly into the abdomen during surgery. [NCI, 2024]
Targeted Therapy: PARP Inhibitors
PARP inhibitors represent one of the most significant advances in ovarian cancer treatment in recent years. PARP (poly ADP-ribose polymerase) is an enzyme that helps cells repair DNA damage. By blocking PARP, these drugs prevent cancer cells from repairing themselves, causing them to die. PARP inhibitors are especially effective in cancers with BRCA mutations or HRD-positive tumors, because these cancers already have one DNA repair pathway disabled. [Matulonis et al., 2016; NCCN, 2024]
FDA-approved PARP inhibitors for ovarian cancer include:
- Olaparib (Lynparza) — approved for maintenance therapy and treatment of BRCA-mutated ovarian cancer
- Niraparib (Zejula) — approved for maintenance therapy regardless of BRCA status
- Rucaparib (Rubraca) — approved for BRCA-mutated ovarian cancer after two or more prior chemotherapies
These drugs are most commonly used as maintenance therapy — taken daily after completing chemotherapy to delay or prevent recurrence. Clinical trials have shown that PARP inhibitors can significantly extend the time before cancer returns, particularly in BRCA-mutated and HRD-positive disease. [NCCN, 2024]
Targeted Therapy: Bevacizumab
Bevacizumab (Avastin) is an anti-angiogenesis drug that works by blocking the growth of new blood vessels that tumors need to grow. It may be added to chemotherapy for advanced ovarian cancer and continued as maintenance therapy. Bevacizumab is an option for both first-line and recurrent settings. [NCI, 2024]
Immunotherapy
Immunotherapy drugs called checkpoint inhibitors (such as pembrolizumab) help the immune system recognize and attack cancer cells. In ovarian cancer, immunotherapy has a more limited role compared to some other cancer types. However, it may be effective in specific subsets — particularly tumors that are MSI-high or have high tumor mutational burden (TMB). Research is actively ongoing in clinical trials. [NCI, 2024]
Maintenance Therapy
After completing initial treatment (surgery and chemotherapy), many women are offered maintenance therapy — ongoing treatment to keep cancer from coming back. Options include PARP inhibitors, bevacizumab, or a combination. Maintenance therapy has been shown to significantly improve progression-free survival and is now a standard part of care for many ovarian cancer patients. [NCCN, 2024]
Clinical Trials
Clinical trials are research studies testing new treatments or new ways of using existing treatments. They are a critical option to discuss with your care team, especially for recurrent ovarian cancer. Clinical trials offer access to cutting-edge therapies and contribute to advances that benefit future patients. You can search for ovarian cancer clinical trials at ClinicalTrials.gov. [NCI, 2024]
Side Effects of Treatment
All cancer treatments have side effects. Knowing what to expect helps you prepare and allows your care team to manage them proactively. Not everyone experiences all side effects, and severity varies.
Nausea & Vomiting
Common with platinum-based chemotherapy. Anti-nausea medications (antiemetics) are given before and after treatment and are very effective. Tell your team if nausea persists — there are multiple medication options.
Hair Loss (Alopecia)
Paclitaxel commonly causes hair loss, which typically begins 2-3 weeks after treatment starts. Hair almost always grows back after treatment ends, sometimes with a different texture or color. Scalp cooling caps may reduce hair loss for some patients.
Peripheral Neuropathy
Tingling, numbness, or pain in the hands and feet, caused by chemotherapy (especially paclitaxel and platinum drugs) damaging nerves. It may improve after treatment but can sometimes be long-lasting. Report symptoms early so your team can adjust doses.
Fatigue
The most commonly reported side effect across all treatments — surgery, chemotherapy, and targeted therapy. It can persist for weeks or months after treatment. Gentle exercise, good sleep hygiene, and pacing your activities can help. Ask your team about fatigue management programs.
Early Menopause & Hormonal Changes
Surgical removal of both ovaries causes immediate menopause, regardless of age. Symptoms include hot flashes, night sweats, mood changes, vaginal dryness, and bone density loss. Your care team can help manage these symptoms with non-hormonal options or, in some cases, HRT. [ACS, 2024]
Fertility Impact
Standard surgery for ovarian cancer removes both ovaries, ending the ability to become pregnant naturally. If fertility preservation is important to you, discuss options before treatment begins — including egg or embryo freezing, fertility-sparing surgery (in select early-stage cases), or referral to a reproductive endocrinologist. [NCCN, 2024]
Emotional & Psychological Toll
Anxiety, depression, fear of recurrence, grief over lost fertility, body image changes, and relationship stress are all real and valid. Psychological support — whether through counseling, support groups, or psychiatric care — is a medical need, not a luxury. Ask your team for referrals. [Foundation for Women's Cancer, 2024]
PARP Inhibitor Side Effects
PARP inhibitors can cause fatigue, nausea, anemia (low red blood cells), thrombocytopenia (low platelets), and, less commonly, myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Regular blood tests are required during PARP inhibitor therapy. Report unusual bruising, bleeding, or fatigue to your team promptly. [NCCN, 2024]
Living With Ovarian Cancer
Cancer treatment does not end when chemotherapy does. Here are important aspects of life during and after ovarian cancer that deserve your attention and your care team's support.
Fertility Preservation
If you are of reproductive age and wish to have biological children, discuss fertility preservation before any treatment begins. Options may include egg freezing (oocyte cryopreservation), embryo freezing, or fertility-sparing surgery in select early-stage cases. Time is critical — a referral to a reproductive endocrinologist should happen as quickly as possible after diagnosis. Even if you are unsure, preserving the option gives you future choices. [NCCN, 2024]
Menopause Management
Surgical menopause (from removal of both ovaries) can cause severe symptoms, especially in younger women. Hot flashes, night sweats, sleep disruption, mood changes, vaginal dryness, decreased libido, and accelerated bone loss are common. Management options include non-hormonal medications (gabapentin, venlafaxine, clonidine), vaginal moisturizers and low-dose vaginal estrogen (which may be safe in some cases — discuss with your oncologist), and lifestyle modifications like regular weight-bearing exercise for bone health. [ACS, 2024]
Genetic Counseling for Family Members
If you carry a BRCA1, BRCA2, Lynch syndrome, or other hereditary mutation, your first-degree relatives (parents, siblings, children) have a 50% chance of carrying the same mutation. Genetic counseling can help your family members understand their risk, decide about testing, and take proactive steps — including enhanced screening or risk-reducing surgery. This conversation can save lives. [NCCN Genetic/Familial Assessment, 2024]
Mental Health & Emotional Support
Fear of recurrence is one of the most commonly reported concerns among ovarian cancer survivors. Depression and anxiety rates are significantly higher than in the general population. Evidence-based approaches include cognitive behavioral therapy (CBT), mindfulness-based stress reduction, support groups (in-person or online), and medication when appropriate. Many cancer centers offer survivorship clinics with integrated psychological support. You are not "overreacting." This is hard. Get help. [Foundation for Women's Cancer, 2024]
Survivorship Care
After completing treatment, you will enter a monitoring phase that typically includes regular CA-125 blood tests and physical exams every 2-4 months for the first two years, then every 3-6 months for years three through five, and annually thereafter. Imaging is performed as clinically indicated. Your survivorship care plan should also address long-term side effects, bone health, cardiovascular risk, and emotional well-being. Ask your oncologist for a written survivorship care plan. [NCCN, 2024]
Questions to Ask Your Care Team
Walking into an appointment with written questions helps you get the answers you need and ensures nothing important is missed. Here are questions organized by topic. Copy them, print them, or save them to your phone.
At Diagnosis
Before Surgery
About Chemotherapy
About Genetic Testing
Sources & References
Every claim on this page is grounded in clinical guidelines, peer-reviewed research, and major cancer organizations. We do not make claims we cannot source.
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World Health Organization (WHO). "Ovarian Cancer Fact Sheet." WHO Global Cancer Observatory (GLOBOCAN). Accessed 2024.
https://gco.iarc.fr/ -
American Cancer Society (ACS). "Ovarian Cancer Overview." Cancer.org. Accessed 2024.
https://www.cancer.org/cancer/ovarian-cancer.html -
National Cancer Institute (NCI). "Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ) — Patient Version." Cancer.gov. Accessed 2024.
https://www.cancer.gov/types/ovarian/patient/ovarian-treatment-pdq -
National Comprehensive Cancer Network (NCCN). "NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer." Version 1.2024.
https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1453 -
Matulonis UA, Sood AK, Fallowfield L, Howitt BE, Sehouli J, Karlan BY. "Ovarian cancer." Nature Reviews Disease Primers. 2016;2:16061. doi:10.1038/nrdp.2016.61
https://doi.org/10.1038/nrdp.2016.61 -
National Comprehensive Cancer Network (NCCN). "Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic." Version 2.2024.
https://www.nccn.org/guidelines/guidelines-detail?category=2&id=1503 -
Foundation for Women's Cancer. "Ovarian Cancer." FoundationForWomensCancer.org. Accessed 2024.
https://www.foundationforwomenscancer.org/gynecologic-cancers/ovarian-cancer/
Last reviewed: January 2025. This page is regularly reviewed and updated as new evidence becomes available. StopMyCancer is not affiliated with any of the organizations cited above.