Ovarian cancer

There are different types of ovarian cancer, depending on where the cancer starts:

• Epithelial tumors (most common, ~90%)
• Germ cell tumors (rare, often in younger patients)
• Stromal tumors (rare, hormone-producing)
• Ovarian cancer often develops slowly and may spread before it is detected.

Risk factors

The risk of ovarian cancer is influenced by a combination of factors:

• Increasing age, with most cases occurring after menopause
• Family history or inherited gene mutations (e.g. BRCA1/2)
• Reproductive and hormonal factors affecting the number of ovulations:
  • not having children, early start of menstruation, or late menopause are associated with higher risk
  • use of oral contraceptives is associated with reduced risk
• Endometriosis or diabetes
• Lifestyle factors, such as obesity and smoking

Symptoms and early detection

There is no screening program for ovarian cancer in people without symptoms, and it cannot be detected by Pap smears or routine pelvic exams. Early-stage disease often causes few or no symptoms, and when symptoms occur, they are usually vague.

Possible symptoms include:

• Persistent abdominal pain or discomfort
• Bloating or increased abdominal size
• Frequent urination
• Feeling full quickly
• Unexplained weight loss
• Fatigue or shortness of breath

These symptoms are common but should be evaluated if they are new, persistent, or unusual.

Diagnosis and treatment

If ovarian cancer is suspected, several tests are used to confirm the diagnosis and assess how far the disease has spread.

Diagnosis is based on:

• Clinical examination, including a pelvic exam
• Imaging tests, such as ultrasound or CT scan
• Blood tests, including tumor markers such as CA-125
• In some cases, surgery to confirm diagnosis and stage of the disease

Treatment depends on the type and stage of the disease, but usually involves a combination of:

• Surgery
• Chemotherapy
• In some cases, targeted treatments

Living with and beyond ovarian cancer

Living with ovarian cancer can affect physical, emotional, and social well-being. Some people live with ovarian cancer as a long-term condition, particularly when the disease is diagnosed at a later stage.

Recovery is a continuous process, and many people experience ongoing effects from both the disease and its treatment, including:

• Physical symptoms, such as fatigue, pain, and treatment-related side effects
• Emotional challenges, such as anxiety and fear of recurrence
• Changes in daily life and relationships

Support from healthcare teams and patient organizations can play an important role in improving quality of life and well-being.

Fertility and family planning

Ovarian cancer and its treatment can affect fertility, as the ovaries have a central role in reproduction.

• Surgery may involve removing one or both ovaries
• Chemotherapy may reduce ovarian function and fertility

For some patients, fertility-preserving options may be possible, depending on the type and stage of the cancer, as well as the treatment plan:

• In selected cases, surgery that preserves one ovary and the uterus
• Fertility preservation, such as egg freezing, before treatment starts

Early discussions with healthcare providers are important to support informed choices about future family planning

Reducing inequalities in ovarian cancer care

Ovarian cancer is often diagnosed at a later stage because its symptoms can be difficult to recognize. Differences in access to healthcare, specialist treatment, and information can contribute to unequal outcomes.

Key factors include:

• Awareness of symptoms, which influence how quickly people seek medical care
• Access to timely diagnosis, including referral and diagnostic investigations
• Access to specialist care, as outcomes are generally better when treatment is
• provided by specialist multidisciplinary teams
• Socioeconomic and geographic factors, including differences related to income, education, and place of residence
• Access to new treatments and clinical trials, which may vary between regions and healthcare settings

These differences can affect when ovarian cancer is diagnosed and the treatment and support people receive. Improving access to information, diagnostic services, specialist care, and new treatment options is important for reducing inequalities and improving outcomes for all.