Ovarian Cancer

By Peter Galvin, MD

Ovarian cancer is a malignancy of the ovary, the female reproductive organ that produces eggs. Among women worldwide, ovarian cancer is the eighth most common malignancy and cause of cancer death. In 2022, ovarian cancer was diagnosed in about 325,000 women and caused 206,839 deaths worldwide. In 2025, it was estimated that 20,890 U.S. women were diagnosed with it and 12,730 died of it. Risk factors include older age (the most common age at diagnosis is 63 years), a family history of breast or ovarian cancer, endometriosis (a chronic inflammatory disease in which uterine lining cells are found outside of the uterus), and never having given birth. About 25% of ovarian cancers are due to inherited genetic variants, primarily in BRCA1 and BRCA2 genes.

At the time of diagnosis, most patients with ovarian cancer have non-specific symptoms such as abdominal pain, bloating, urgent or frequent urination, and/or increased abdominal size. Symptoms of advanced disease may include a mass in the abdominal area, weight loss, and trouble breathing due to abdominal swelling or fluid surrounding the lungs. Ovarian cancer is often diagnoses and staged based on findings from a pelvic ultrasound, abdominal computerized tomography (CT) scan, and/or abdominal magnetic resonance imaging (MRI). Total body positron emission tomography (PET) can detect cancer that has spread to more distant sites in the body. To help with staging, some patients may undergo diagnostic laparoscopy, a minimally invasive surgical procedure, in which clinicians look for a tumor within the abdomen and can perform biopsies to assess for ovarian cancer.

Stage I ovarian cancer is limited to the ovary or fallopian tube. Stage II cancer has spread beyond the ovaries and fallopian tubes but is still confined within the pelvis. Stage III cancer involves sites outside of the pelvis such as nearby lymph nodes or other areas of the abdomen. Stage IV cancer involves organs or tissues outside of the abdominal cavity, such as liver, spleen, or lungs. All patients diagnosed with ovarian cancer should undergo genetic testing, including for BRCA1/2 variants, to help guide treatment and counseling.

First line treatment for early-stage disease (stages I and II) is surgery to remove both ovaries, fallopian tubes, the uterus, lymph nodes, and fatty tissue covering the abdominal organs, followed by chemotherapy. Women with stage I disease who are considering children may undergo more limited surgery, removing only the cancerous ovary and fallopian tube and leaving in place the other ovary, fallopian tube, and uterus. Treatment of stage III and IV (advanced) cancer includes both surgery and chemotherapy, often combined with individual targeted therapies such as bevacizumab (Avastin, a monoclonal antibody) and/or poly-ADP ribose polymerase (PARP) inhibitors (plays a role in repairing damaged DNA, can be effective in treating heritable cancers).

Those with stage I and II disease have a five-year overall survival rate of 70% to 95%. The five-year overall survival rate for stages III and IV is 10% to 40%. However, the five-year survival is about 70% among patients with advanced-stage disease who have BRCA variants and are treated with PARP inhibitors.

For more information go to the website of the American Cancer Society at www.cancer.org

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