Ovarian Cancer

Tanja Pejovic, M.D., Ph.D. examining a patient.
Dr. Tanja Pejovic (right) is a gynecologic oncologist (treating women's reproductive cancers) who focuses on new treatments and early detection of ovarian cancer. Dr. Pejovic holds both a medical degree and a doctorate.

The OHSU Knight Cancer Institute offers advanced care for ovarian cancer, including:

  • The latest diagnostic imaging, with results often available within two days.
  • Advanced genetic testing to guide treatment for every patient.
  • Fellowship-trained doctors who focus on treating patients with gynecologic cancers.
  • Team-based care, with a treatment plan tailored to your needs and wishes.
  • A welcoming environment at the OHSU Center for Women’s Health.
  • A wide range of support services including clinical trials and fertility services.

Go to our Gynecologic Cancers page to:

  • See illustrations of women’s reproductive anatomy.
  • Learn more about our gynecologic cancer care.

Understanding ovarian cancer

What is ovarian cancer?

Cancer cells can form on the thin tissue covering the ovaries, the almond-sized organs on either side of the uterus. The ovaries produce eggs and female hormones. The cells can form on the ovaries themselves or spread there from nearby parts of the reproductive system.





Who gets ovarian cancer?

About 22,200 women are expected to be diagnosed with ovarian cancer in 2018. That would make up about 1 percent of all new cancer cases. Anyone who has one or both ovaries, regardless of gender identity, has some risk.

The rate of ovarian cancer cases has been falling over the past two decades. More women are also living at least five years after diagnosis, according to National Cancer Institute statistics.

Although the cause is unknown in most cases, several factors may increase risk:

  • Age: It’s most common in women ages 50 to 60.
  • Other conditions: Having had breast cancer or endometriosis raises risk.
  • Treatments: Estrogen replacement therapy, especially for long periods and in large amounts; fertility treatments; and use of intrauterine devices increase risk.
  • Other: Smoking, obesity and never having been pregnant raise risk.
  • Inherited gene: A small percentage of cases are linked to inherited genetic mutations called BRCA1 and BRCA2, which are also linked to breast cancer. OHSU offers genetic counseling, risk assessment and testing to help you learn about and manage any genetic risk.

Women may be at lower risk if they:

  • Have had multiple children
  • Use oral contraceptives
  • Have breast-fed
  • Had tubal ligation

Symptoms of ovarian cancer

Ovarian cancer may not have symptoms in early stages, making it difficult to detect. Later stages may produce few or vague symptoms that can be mistaken for something common, such as constipation. At the same time, the following symptoms usually are not a sign of ovarian cancer. See your doctor if symptoms last for more than two weeks and don’t respond to exercise, laxatives or a change in diet.

  • Bloating
  • Pain, swelling or pressure in the pelvic area or abdomen
  • Trouble eating, or feeling full quickly
  • Frequent or urgent need to urinate
  • Heavy or irregular vaginal bleeding, especially after menopause
  • Vaginal discharge
  • Weight loss
  • Fatigue
  • Upset stomach or heartburn
  • Back pain
  • Pain during sex
  • Constipation

Dr. Tanja Pejovic speaking with a patient in an exam room.

Dr. Tanja Pejovic has done extensive research on how ovarian cancer develops at the cellular level, giving her uncommon expertise.

Diagnosing ovarian cancer

Only about 20 percent of ovarian cancers are found in early stages. This is in part because symptoms are nonexistent or vague, the ovaries are deep in the abdomen, and there’s no routine screening test. If your doctor suspects ovarian cancer, tests may include:

Pelvic exam: The doctor looks at the inside of the vagina and cervix and presses on the ovaries and uterus to check for abnormalities. This exam, though important for overall health, is considered unreliable as a screening tool for ovarian cancer, however.

Ultrasound: A device emits sound waves to create pictures of the pelvic organs. It may be done externally (abdominal ultrasound) or with a small probe inserted in the vagina (transvaginal ultrasound).

CA-125 blood test: This measures the level of a protein called cancer antigen 125, which can be higher in women with ovarian cancer. It’s not used for general screening because it misses many ovarian cancers and tests positive for many other conditions.

PET scan: The positron emission tomography test uses a special camera and a small amount of injected radioactive material to highlight cancer cells.

CT scan: A computed tomography scan uses an X-ray beam that circles the body to create cross-section and three-dimensional views.

MRI: The magnetic resonance imaging scan uses a powerful magnetic field and radio waves to generate detailed computer images of structures inside the body.

Tissue analysis: Part of the tumor may be removed in a biopsy, using a needle or minimally invasive laparoscopic procedure. Most of the time, though, tissue is analyzed after it’s surgically removed as part of cancer treatment.

Genetic testing: If you are diagnosed with ovarian cancer, your care team will recommend testing for inherited mutations such as BRCA1 and BRCA2 with a blood test or cheek swab. They can use results to help develop your care plan.

Ovarian cancer types

Ovarian epithelial: This type, accounting for about 90 percent of ovarian cancers, occurs when cancer cells grow on the thin tissue that covers the ovary.

Fallopian tube: Cancer cells can form at the end of the fallopian tubes, which connect the ovaries to the uterus, and spread to the ovaries.

Primary peritoneal cancer: The tissue that lines the abdominal cavity, called the peritoneum, can develop cancer cells that sometimes spread to the ovaries.

Ovarian germ cell tumor: This uncommon type occurs when a tumor forms on the egg cells in the ovary.

Tumor Size Illustration (click to see full size image)

Ovarian cancer staging

Staging, which determines the extent of ovarian cancer, helps guide treatment decisions. Your care team will also consider the grade of your cancer, or how normal or abnormal the cancer cells look under a microscope.

Stage I:

  • Stage IA: The tumor is confined to the inside of one ovary or fallopian tube. No cancer cells are found in fluid collected in or flushed through the abdomen.
  • Stage IB: The tumor is in both ovaries or fallopian tubes but not on their surfaces. No cancer cells are found in fluid collected from or flushed through the abdomen.
  • Stage IC: The tumor is in one or both ovaries or fallopian tubes and any of the following:
    • The capsule (tissue) around the tumor broke during surgery, letting cancer cells “spill” out (surgical spill).
    • The capsule broke before surgery, or cancer is on the surface of an ovary or fallopian tube.
    • Cancer cells are found in fluid collected from or flushed through the abdomen.

Stage II: Cancer is in one or both ovaries or fallopian tubes and has spread into pelvic tissues or to the peritoneum.

  • Stage IIA: The cancer extends to the uterus, ovaries or fallopian tubes.
  • Stage IIB: The cancer extends to other tissues in the pelvis.

Stage III: Cancer is in one or both ovaries or fallopian tubes, and:

  • Stage IIIA1: Cancer has spread to nearby lymph nodes. It also may extend to pelvic tissues or the peritoneum.
  • Stage IIIA2: Microscopic cancer is in the peritoneum outside the pelvis. It may or may not be in lymph nodes.
  • Stage IIIB: A tumor no larger than 2 centimeters is in the peritoneum outside the pelvis. Cancer may or may not be in lymph nodes.
  • Stage IIIC: A tumor larger than 2 centimeters is in the peritoneum outside the pelvis. Cancer may or may not be in lymph nodes.

Stage IV: Cancer has spread to distant parts of the body. In Stage IVA, cancer has spread to fluid around the lungs. In Stage IVB, it has spread to the liver or spleen, to organs or lymph nodes outside the abdomen, or through the wall of intestines.

Treatments

Your care team will recommend a treatment plan that takes into account the extent of your cancer, your general health and your desire to have children. Recommendations may include:

Surgery

As much of the cancer as possible is removed. Depending on stage, the ovaries, fallopian tubes, uterus and/or lymph nodes may also be removed.

Specialists: Studies show surgeries done by gynecologic oncologists such as those at the Knight Cancer Institute are more likely to be successful.

Minimally invasive surgery: Our team is skilled in the latest robotic and minimally invasive techniques. These use smaller incisions for less pain and shorter recoveries.

Chemotherapy

In most cases, two or more medications are given intravenously every three or four weeks for a few months after surgery. The medications kill cancer cells circulating nearly anywhere in your body. With ovarian cancer, chemotherapy also may be delivered directly to the abdomen with a surgically placed catheter (thin tube).

Radiation therapy

You may receive radiation therapy, which is usually given five days a week for several weeks. This therapy uses high-energy beams to pinpoint cancer cells that may remain in the area where the tumor was removed. For ovarian cancer patients, radiation therapy is given with equipment outside the body, not unlike receiving an X-ray.

Targeted therapy

In some cases, medications can target specific molecules, such as proteins, in cancer cells. Matching medications to molecules can stop the growth of cancer cells while limiting damage to other cells. These medications may be given as pills or intravenously. 

Additional services

Learn more