Ovarian Cancer

A doctor and patient are talking in a medical office. The doctor is reassuring the patient about her treatment.
Dr. Tanja Pejovic (right) is an expert on new treatments and early detection of ovarian cancer.

The OHSU Knight Cancer Institute offers advanced care for ovarian cancer. This includes:

  • The latest diagnostic imaging, with results often available within two days.
  • 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.

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Understanding ovarian cancer

What is ovarian cancer?

The ovaries are a pair of almond-sized organs that flank the uterus. They produce eggs and female hormones. Sometimes cells in the ovaries start to divide and multiply out of control, forming tumors. The tumors can grow on the ovaries themselves or spread there from nearby parts of the reproductive system.

Who gets ovarian cancer?

An estimated 20,000 women are expected to be diagnosed with ovarian cancer in 2022. That would make up about 1% of all new cancer cases. Anyone who has ovaries, regardless of gender identity, is at risk.

The rate of ovarian cancer 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 your risk:

  • Age: It’s diagnosed more often in older women.
  • Other conditions: Having had breast cancer or endometriosis raises risk.
  • Hormone therapy: Hormone replacement therapy after menopause has been linked to increased risk. 
  • Family history: Having relatives who've had ovarian, breast or pancreatic cancer raises risk.
  • Inherited gene: Inherited mutations in the BRCA1 or BRCA2 gene raise risk. Mutations in these genes are also linked to breast cancer. Having an inherited cancer syndrome such as Lynch syndrome also increase risk. OHSU offers genetic counseling and testing to help you learn about and manage any risk.
  • Other: Smoking, obesity and never having been pregnant may raise risk.

You may be at lower risk if you:

  • Have had a child
  • Have used oral contraceptives (the pill)
  • Have breast-fed
  • Have had a hysterectomy or 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 else.

Ovarian cancer may cause these symptoms, but they are 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

Diagnosing ovarian cancer

Less than 20% of ovarian cancers are found before they have spread. This is in part because:

  • Symptoms are nonexistent or vague.
  • The ovaries are deep in the abdomen.
  • 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.
  • 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 images of structures inside the body.
  • Biopsy: A sample from the ovary may be removed using a needle or minimally invasive surgery. The sample is analyzed for signs of cancer.
  • Genetic testing: If you are diagnosed with ovarian cancer, your care team will recommend testing for inherited mutations, such as in the BRCA1 and BRCA2 genes, with a blood test or cheek swab. They can use results to guide your care plan.

Ovarian cancer types

Epithelial ovarian tumors: This type accounts for about 90% of ovarian cancers. It occurs in the cells that make up the thin layer of tissue that surrounds the ovary.

Sex cord-stromal tumors: These tumors arise in two types of cells inside the ovary. Sex cord cells and stromal cells support the ovary from the inside. 

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

This diagram illustrates tumor sizes compared with everyday items - a pea, a peanut, a grape, a walnut, a lime, an egg, as well as a pencil tip, a crayon tip, and a pencil eraser.

Ovarian cancer stages

Your doctors assign a stage to your cancer. The stage will guide your treatment decisions.

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 IIIA: Cancer has spread to nearby lymph nodes, or microscopic cancer has spread beyond the pelvis.
  • Stage IIIB: A tumor no larger than 2 centimeters is in the peritoneum beyond the pelvis. Cancer may or may not be in lymph nodes.
  • Stage IIIC: A tumor larger than 2 centimeters is in the peritoneum beyond the pelvis. Cancer may or may not be in lymph nodes.

Stage IV: Cancer has spread to distant parts of the body. 

Treatment

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

Surgeons remove as much of the cancer as possible. Our team is skilled in the latest tools and techniques in robotic and minimally invasive surgery. We use smaller incisions for better outcomes, less pain and faster recovery.

Depending on the stage of your cancer, surgeons may also remove ovaries, fallopian tubes, uterus and/or lymph nodes.

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

Chemotherapy

Chemotherapy drugs kill cancer cells circulating nearly anywhere in your body. In most cases, drugsare given by IV every three or four weeks for a few months after surgery. 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 uses high-energy beams to pinpoint any cancer cells that may remain after the tumor was removed. For ovarian cancer patients, radiation therapy is usually used for palliative care.

Targeted therapy

In targeted therapy, drugs lock onto receptors on cancer cells and knock them out, minimizing damage to healthy cells. These medications may be given as pills or by IV.

Additional services

For patients

Call 503-494-7999 to:

  • Request an appointment
  • Seek a second opinion
  • Ask questions

Location

Parking is free for patients and their visitors.

Kohler Pavilion
Center for Women’s Health, seventh floor
808 S.W. Campus Drive
Portland, OR 97239
Map and directions

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