Ovarian Cancer
Ovarian cancer has been called "the cancer that whispers" — its symptoms are quiet and easy to dismiss. The honest reality is that it is often diagnosed late, but treatment has changed dramatically with modern surgery, platinum chemotherapy and PARP inhibitor maintenance, and many women now live well for many years.
What ovarian cancer is — in plain words
Ovarian cancer most commonly arises from the surface (epithelium) of the ovary, or — as more recent science has shown — from the fallopian tube and only secondarily involves the ovary. The most common and important type is high-grade serous carcinoma. Less common types (clear cell, endometrioid, mucinous, germ cell, sex-cord stromal) behave differently and are managed differently.
Ovarian cancer carries a strong inherited risk in some families. BRCA1, BRCA2 and other genes raise lifetime risk substantially, and genetic testing should be offered to every patient.
Signs and symptoms to take seriously
The symptoms are subtle and easy to attribute to "indigestion" or "ageing." Persistence is the key — if any of these are new and last more than a few weeks, get checked.
Persistent bloating
Abdominal bloating that doesn't come and go with the menstrual cycle, lasting most days for more than three weeks.
Pelvic or abdominal pain
A dull ache or pressure that doesn't settle.
Feeling full quickly
Difficulty eating a normal-sized meal, or feeling full unusually fast.
Urinary frequency or urgency
Needing to pass urine more often or more urgently, without an infection.
"Every woman over 45 with persistent bloating for three weeks deserves a pelvic ultrasound and a CA-125 test. Most will be reassured. The few who aren't will be glad they didn't wait."
How ovarian cancer is diagnosed
- Pelvic ultrasound — transvaginal and transabdominal — looks at the ovaries and any pelvic mass.
- CA-125 blood test — often elevated in epithelial ovarian cancer. Not perfect (raised in many benign conditions too), but very useful in context.
- CT scan of chest, abdomen and pelvis — for staging.
- MRI of the pelvis — sometimes added to better characterise a complex mass.
- Diagnostic surgery or image-guided biopsy — to confirm the diagnosis and assess the spread.
- Genetic testing — BRCA1, BRCA2 and a broader panel (HRD testing on the tumour) should be offered to every patient with high-grade ovarian cancer.
Stages — what the numbers mean
Stage I
Confined to one or both ovaries. Surgery often curative; chemotherapy added for higher-risk features. Five-year survival above 80%.
Stage II
Spread to other pelvic organs. Surgery plus chemotherapy.
Stage III
Spread to the abdominal cavity or lymph nodes — the most common presenting stage. Surgery plus chemotherapy plus PARP maintenance in selected patients.
Stage IV
Spread to distant organs (liver parenchyma, lungs). Treated with chemotherapy and surgery in selected cases.
How we treat ovarian cancer
Cytoreductive (debulking) surgery
The cornerstone of treatment. The surgeon's goal is to remove all visible tumour — from the ovaries, omentum, peritoneal surfaces and any other involved sites. The completeness of cytoreduction is one of the strongest predictors of long-term outcome, which is why ovarian cancer surgery is best done by a specialist gynaec-oncology team.
Timing of surgery
- Primary debulking surgery — surgery first, then chemotherapy. Preferred when complete cytoreduction is feasible.
- Interval debulking surgery — three cycles of chemotherapy first to shrink disease, then surgery, then more chemotherapy. Used when initial complete debulking would be too difficult or too risky.
Chemotherapy
Carboplatin and paclitaxel given for six cycles is the standard first-line treatment. For advanced disease, bevacizumab (an anti-angiogenic antibody) is often added and continued as maintenance. Read more about chemotherapy →
PARP inhibitor maintenance
One of the biggest advances in ovarian cancer. After response to platinum-based chemotherapy, daily tablets of olaparib, niraparib or rucaparib taken for 1–3 years dramatically delay recurrence. The benefit is largest for BRCA-mutated and HRD-positive tumours, but most patients with high-grade serous disease benefit to some degree.
Treatment of recurrent disease
Recurrent ovarian cancer is treated as a chronic disease for many women. Platinum-sensitive recurrences (more than six months after the last platinum) respond well to further platinum-based regimens. Platinum-resistant recurrences use single agents (liposomal doxorubicin, weekly paclitaxel, gemcitabine, topotecan) often with bevacizumab.
Immunotherapy
Less established than in many other cancers, but emerging in specific subtypes and clinical trials. Read more about immunotherapy →
What the outlook honestly looks like
Stage I ovarian cancer has five-year survival above 80%. Stage III, treated with complete surgery, modern chemotherapy and PARP maintenance, has a five-year survival approaching 50% — a major improvement on the last generation of care. Even recurrent disease is now treated over many years, often with good quality of life. Outcomes depend on stage, the completeness of surgery, the biology of the tumour, and access to maintenance therapy.
Screening and prevention
- No effective screening for the general population. CA-125 and ultrasound have been studied and don't reduce deaths in average-risk women.
- For high-risk women (BRCA carriers, strong family history), six-monthly CA-125 and pelvic ultrasound, with risk-reducing salpingo-oophorectomy after childbearing, are the standard.
- Oral contraceptives taken for several years reduce lifetime risk modestly — a benefit worth knowing about, though not a reason on its own to use them.
Life during treatment
Surgery is significant, with recovery measured in weeks. Chemotherapy — particularly the combination of carboplatin and paclitaxel — causes hair loss, fatigue and some numbness in fingers and toes, mostly reversible. PARP inhibitor maintenance is taken at home; the main side effects are nausea, fatigue and changes in blood counts, all of which are usually manageable with dose adjustments.
After treatment — survivorship
Surveillance includes clinic visits, examination, CA-125 trends and selective imaging. Attention to menopause-related symptoms (in younger women after surgery), bone health, and emotional well-being are all part of long-term care. Read about survivorship care →
Just been diagnosed with ovarian cancer?
Bring the scans, the operative report (if you've had surgery already), the pathology, the CA-125 trend and any genetic results. We'll go through the staging, the next steps and the maintenance options together.
Medically reviewed by
Dr. Rehan Abdullah
Dr. Rehan Abdullah is a dual-trained clinical and radiation oncologist with over a decade of experience treating both solid tumours and hematologic malignancies. He serves as Consultant Oncologist at INMOL Hospital and sees patients at Farooq Hospital and Healthnox Medical Center, Lahore. Read full profile →
This page is patient education, not a substitute for an in-person consultation. Cancer care must be individualised. Read our medical disclaimer →