Ovarian Cancer
The most advanced treatments for gynecologic cancer
The most advanced treatments for gynecologic cancer
Scripps Cancer Center is a leader in caring for women with ovarian cancer. You’ll be cared for by a team of gynecologic cancer experts who will customize your treatment plan around your health, lifestyle and personal needs. Our oncology specialists treat ovarian cancer with advanced therapies designed to eliminate cancer and prevent recurrence, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery, and immunotherapy to harness the power of the body’s own immune system.
Our multidisciplinary, collaborative board of cancer specialists reviews every patient’s care plan to ensure you receive the best possible care from diagnosis to recovery.
About ovarian cancer
Ovarian cancer is a gynecologic cancer that begins in the ovaries. It’s the fifth leading cause of cancer death among women, and has a higher death rate than other female reproductive cancers.
About half of women diagnosed with ovarian cancer are age 65 or older. The disease will affect about 1 in 75 women during her lifetime. Fortunately, that rate has been slowly decreasing over the past two decades.
Types of ovarian cancer
A woman’s ovaries contain three types of cells, which in turn can develop into three types of tumors.
- Epithelial tumors begin in the surface cells on the outside of the ovary. Most ovarian tumors are epithelial cell tumors.
- Germ cell tumors begin in egg-producing cells.
- Stromal tumors begin in the tissue that holds the ovary together. These cells also make the female hormones estrogen and progesterone.
While most of these tumors do not turn into cancer, those that do can spread beyond the ovary and can be life-threatening. The American Cancer Society describes these tumors as follows.
Malignant epithelial ovarian tumors
Malignant epithelial tumors are cancerous tumors called carcinomas. These make up 85% to 90% of ovarian cancers. If found and treated before cancer has spread beyond the ovary, the five-year survival rate is 92%.
Epithelial ovarian carcinomas have several types. The most common type is called serous. Other types are mucinous, endometrioid and clear cell. Tumors that don’t fit into any of these four types are called undifferentiated tumors; these tend to grow and spread more quickly.
Tumors of low malignant potential
Ovarian epithelial tumors that don’t appear to be cancerous when examined under a microscope are called tumors of low malignant potential (LMP) or borderline epithelial ovarian cancer. These tumors are more common among younger women. They grow slowly and generally are less life-threatening than other ovarian cancers.
Ovarian germ cell tumors
Germ cell tumors are rare. They represent less than 2% of ovarian tumors. They generally have a good prognosis; more than 90% of patients live at least five years after they’re diagnosed. Germ cell tumors have several types. The most common include teratomas, dysgerminomas, endodermal, sinus tumors and choriocarcinomas. Some germ cell tumors contain more than one type.
Ovarian stromal tumors
Ovarian stromal tumors represent about 1% of ovarian cancers. Because these cells produce estrogen, vaginal bleeding is a common symptom. These tumors often are found early, and have a survival rate of more than 75%.
Ovarian cysts
When fluid collects inside an ovary, an ovarian cyst may form. These often occur normally during ovulation, go away on their own and are usually harmless. In some cases, they may become cancerous. If an ovarian cyst becomes larger or does not go away, or affects a woman who is not ovulating (for example, because of menopause), the physician may recommend diagnostic testing, such as imaging tests, or a biopsy.
Ovarian cancer causes, risks and family history
No one knows for sure what causes ovarian cancer. Hormonal imbalances may play a role, but that link isn’t fully understood. Researchers have identified several ovarian cancer risk factors for epithelial ovarian cancer, by far the most common type of ovarian cancer. These factors do not apply to less common ovarian cancer types.
Keep in mind that many women with these risk factors never get ovarian cancer, and some who do have the disease don’t have any of the risk factors.
The most common ovarian cancer risk factors fall into two categories: controllable and non-controllable.
Controllable risk factors
Weight
The risk seems to be higher for women who have a body mass index (BMI) of at least 30.
Reproductive history
Women who have their first full-term pregnancy after age 35, or who never had a full-term pregnancy, have a higher risk. Breastfeeding may lower the risk.
Fertility treatment
Some studies found that using the fertility drug clomiphene citrate (Clomid®) for longer than one year may increase the risk for developing ovarian tumors. The risk was higher in women who did not become pregnant while taking it.
Androgens
Some studies have found that women who take drugs to increase their level of androgens (male hormones) may have a higher risk of ovarian cancer.
Hormone therapy
Women who take estrogen replacement therapy after menopause may have an increased risk of ovarian cancer, especially if they take estrogen only (instead of combined with progesterone) for at least five years. Combined therapy appears to have a lower increased risk.
Talcum powder
Before the 1970s, talcum powder was sometimes contaminated with asbestos, a mineral known to cause cancer. Women who used talcum powder on their genital area may have had an increased risk of ovarian cancer. Since the 1970s, talcum powder has been required to be free of asbestos. No evidence currently exists to suggest that the asbestos-free powder is linked to ovarian cancer.
Non-controllable risk factors
Age
Ovarian cancer risk increases with age. The disease is rare in women under age 40, and most cases develop after menopause.
Family history of ovarian cancer
Women who have relatives with ovarian cancer — especially mother, sister or daughter — have a higher risk.
Family history of other cancers
A family history of other cancer types — including colon, rectal, pancreatic or breast cancer — may raise the risk due to an inherited gene mutation.
Inherited BRCA1 or BRCA2 gene mutations
Both of these genes make proteins that help stop potential malignant tumors from forming. If a woman has a BRCA1 gene mutation, her risk of developing ovarian cancer ranges from 35% to 70%. The risk for a BRCA2 gene mutation is 10% to 30%. These gene mutations also are linked to a higher risk of breast cancer.
Family history and genetic counseling
If you or a family member has a higher than average risk of ovarian cancer due to a personal or family history of cancer, genetic testing can help identify gene mutations. Scripps genetic counselors can assist with referrals for genetic testing, and provide information, counseling and recommendations.
Our genetic counselors are health care professionals with specialized graduate training in medical genetics and counseling. Find out more about genetic testing for ovarian cancer at Scripps.
Ovarian cancer prevention, screenings and early detection
An estimated 1 in 5 cases of ovarian cancer is detected early, usually because a woman has symptoms or an abnormal pelvic exam. No ovarian cancer screening exams are currently used for women whose risk is average. If you have an increased risk due to a family history or other factors, talk with your doctor about ways to monitor your risk.
Ovarian cancer can be prevented only by removing the ovaries, but you can help protect your health with these steps:
- Maintain a healthy weight
- Eat a low-fat diet
- Discuss hormone replacement therapy with your doctor
In addition, the following preventive factors may help lower your risk of ovarian cancer:
Reproductive history
Women who have carried a baby to term before age 26 have a lower risk of ovarian cancer than women who have not, and the risk decreases with each full-term pregnancy.
Birth control
Women who have used oral contraceptives for at least three months may have a lower risk. The longer a woman takes the pills, the lower her risk. Even after she stops using the pills, the risk remains lower for many years. The lower risk also has been seen in women who use injectable forms or birth control.
Gynecologic surgery
Tubal ligation surgery (having your tubes tied) may reduce the risk of developing ovarian cancer by up to two-thirds. A hysterectomy (removing the uterus without removing the ovaries) seems to reduce the risk by about one-third.
Taking proactive steps for ovarian cancer prevention can make a difference. Be sure to see your physician if you’re experiencing any possible symptoms, or if you’re at higher risk for developing ovarian cancer and have noticed sudden changes in your health.
Ovarian cancer symptoms, diagnosis and stages
Ovarian cancer symptoms are unusual in the early stages of the disease, but some women do have symptoms. When ovarian cancer is detected before it has spread, treatment is more likely to be successful. Diagnostic testing and staging can help physicians determine the most effective ovarian cancer treatment. Learn more about symptoms, imaging and diagnostic testing, and cancer stages below.
Ovarian cancer symptoms
Signs and symptoms of ovarian cancer may include:
- Abdominal discomfort or pain
- Bloating (gas, indigestion, cramps)
- Feeling full, even after a light meal, or having difficulty eating
- Frequent urination or frequently feeling an urge to urinate
According to the American Cancer Society, women who have the above symptoms more than 12 times a month should see their physician.
Other symptoms of ovarian cancer may include:
- Abdominal discomfort (gas, indigestion, cramps)
- Abdominal swelling with weight loss
- Unusual vaginal bleeding
- Back pain
- Pain during sex
- Menstrual changes
Many women have these symptoms and do not have ovarian cancer. Other conditions, such as vaginal infections or hormonal changes, cause similar symptoms. But let your physician know if your symptoms persist or get worse, so that you can find the cause and any potential problems.
Diagnostic testing
Scripps cancer specialists diagnose ovarian cancer using advanced imaging technology and laboratory tests. In addition to a physical exam and family medical history, tests to diagnose and stage ovarian cancer may include:
Pelvic exam
During this physical exam, the doctor inserts a gloved finger into the vagina while pressing on the lower abdomen with the other hand to feel for masses that may be a sign of ovarian cancer.
CA-125 blood test
This blood test measures your CA-125 level, which is a protein made by ovarian cancer cells. High levels may indicate cancer, but this test alone cannot confirm cancer.
Biopsy
A small sample of tissue is removed from the tumor and examined under a microscope to determine if it’s cancer.
Transvaginal ultrasound
A wand-shaped probe inserted into the vagina uses ultrasound to show abnormal changes on the ovaries.
Computed tomography (CT) scan
A CT scan captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.
Magnetic resonance imaging (MRI)
MRI uses a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.
Positron emission tomography (PET) scan
A PET scan uses a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.
Ovarian cancer stages
Ovarian cancer staging determines how far the cancer may have spread beyond its original starting point. Staging for ovarian cancer is done during surgery. In addition to removing cancerous organs, the surgeon may remove lymph nodes and surrounding tissue to check for the presence of cancer cells. This helps your cancer team decide the best type of treatment.
Stage I
Stage I ovarian cancer is limited to the ovary or ovaries and has three substages:
- Stage IA: Cancer is in one ovary.
- Stage IB: Cancer is in both ovaries.
- Stage IC: Cancer is in one or both ovaries, and is also is on the surface of the ovary or in abdominal fluid, or a fluid-filled capsule has burst.
Stage II
In stage II ovarian cancer, cancer is in one or both ovaries and has spread to other parts of the pelvis. Stage II includes:
- Stage IIA: The tumor has spread to the uterus, fallopian tubes or both.
- Stage IIB: The tumor has spread to the bladder, rectum or colon.
- Stage IIC: The tumor has spread to any of the above, and is also on the surface of the ovary, a fluid-filled capsule has burst or cancer cells are in abdominal fluid.
Stage III
Stage III ovarian cancer is in one or both ovaries and has spread to nearby lymph nodes or other abdominal organs, not including the liver.
- Stage IIIA: The cancer has spread to the lining of the abdomen, but not the lymph nodes, and cannot be seen.
- Stage IIIB: The cancer has spread into the abdomen, but not the lymph nodes, and is visible but is less than 2 cm.
- Stage IIIC: The cancer has spread into the abdomen and the lymph nodes, and is larger than 2 cm.
Stage IV
Stage IV ovarian cancer has spread to the lung, liver or other distant organs.
Understanding your diagnosis
A cancer diagnosis can bring up many emotions: anxiety, confusion, fear and more. We’ve found that the more gynecologic oncology patients understand about their diagnosis and next steps, the more confident they feel about their care decisions.
Questions and considerations
You’ll have questions throughout your journey. Here are some you might want to bring up with your cancer care team or health insurance provider:
- Should I get a second opinion?
- How do I find a specialist?
- What is my treatment plan?
- Will I have to miss work/school?
- What are the side effects of ovarian cancer treatment?
- How successful is my treatment likely to be?
- What costs will be covered by insurance?
- Which costs will I be responsible for?
Your Scripps team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community cancer resources that provide education, information and helpful resources — often at no cost.
Treatment and clinical trials
Scripps expert cancer care teams treat our ovarian cancer patients with the most advanced treatments and technologies, including minimally invasive robotic surgery and precise radiation therapies.
Our approach to treating ovarian cancer
At Scripps, you’ll have a multidisciplinary team of professionals caring for you, including physicians, surgeons, radiation oncologists and oncology nurses who specialize in cancer care. For complex cases, you’ll be partnered with a nurse navigator, who will help coordinate your care and ensure you get the support you need throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.
Ovarian cancer treatment options at Scripps
If you have ovarian cancer, your cancer care team will consider several factors when personalizing your treatment, including:
- Your cancer type and stage
- Your plans to have children
- Your age and overall health
Your ovarian cancer treatment plan may include one or more of the following: surgery, chemotherapy, radiation therapy, hormonal therapy and targeted therapy.
Ovarian cancer surgery
Usually the first treatment for ovarian cancer, surgery is performed to remove as much of the tumor as possible (known as debulking), and also to determine how far the cancer may have spread.
Scripps gynecologic surgeons frequently perform surgeries that once required large incisions and extensive recovery time, now through minimally invasive techniques. Scripps is one of the country's only cancer treatment centers offering minimally invasive ovarian cancer surgery. Minimally invasive techniques use smaller incisions, which can result in a shorter hospital stay, faster healing and less scarring.
Depending on how far cancer has spread, surgical treatments may include the following:
- Oophorectomy is when surgeons remove the fallopian tubes and both ovaries, often using minimally invasive techniques.
- Hysterectomy is the removal of the uterus. Whenever appropriate, Scripps surgeons perform the hysterectomy using single-site robotic surgery, which requires just one small incision. If this is not appropriate, our surgeons can perform the hysterectomy through an abdominal incision, through the vagina or through minimally invasive procedures, such as laparoscopic surgery or robotic-assisted surgery.
- Bilateral salpingo-oophorectomy is when surgeons remove the fallopian tubes and both ovaries, often using minimally invasive laparoscopic techniques.
Chemotherapy
Chemotherapy may be given after surgery to kill cancer cells that remain in the body. Intraperitoneal chemotherapy (IP therapy) is a type of chemotherapy that delivers cancer-fighting drugs directly into the abdominal cavity through a port in the patient’s abdomen, where ovarian cancer is most likely to spread. The drugs also get into the bloodstream and travel throughout the body.
Radiation therapy
Radiation therapy is rarely part of ovarian cancer treatment, but it may be used if ovarian cancer has spread to other parts of the body.
Targeted therapy
Targeted therapy drugs attack ovarian cancer cells by interfering with proteins or receptors they need for growth, or by blocking the blood vessels that supply the cancer cells. Scripps medical oncologists may use targeted therapy drugs in combination with chemotherapy.
Ovarian cancer clinical trials
Some ovarian cancer treatment plans involve clinical trials. Talk with your physician about whether a clinical trial is right for you.
See our list of clinical trials that are currently enrolling patients.
Your custom cancer treatment plan
Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.
Your ovarian cancer treatment plan generally includes:
- Family and medical history
- A summary of your cancer diagnosis and staging information
- Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
- Plans for surgery, radiation, chemotherapy and/or other treatments
- Potential side effects of treatments
- Contact information for your cancer care team members
Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.
Your cancer care team
Your ovarian cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need.
Your team may include:
- Gynecologists
- Gynecologic surgeons
- Gastroenterologists
- Surgeons and surgical oncologists
- Radiation oncologists
- Medical oncologists
- Registered nurses
- Nurse navigators
- Dietitians
- Oncology social workers
Visit your cancer care team for more on Scripps' multidisciplinary approach to treatment.
Ovarian cancer treatment locations
Scripps diagnoses and treats ovarian cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of Southern California cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
Visit cancer care locations for details of each cancer hospital, clinic and specialty center.
Support groups, services and resources
Scripps offers a comprehensive lineup of support groups, support services and resources to help you along every step of your cancer journey.
Ovarian cancer support groups, workshops and events
In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics such as:
- Nutrition
- Expressive writing
- Yoga
- Meditation
Gynecological support group
The following support group in La Jolla is for gynecological cancer patients only.
Scripps Campus Point Complex
1st and 3rd Thursdays, 10 – 11:30 am
4275 Campus Point Court
2nd Floor PMO Conference Room
Facilitator: Janine Rodriguez
Contact info: 858-626-7950
For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps Cancer Center offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
Patient education is an integral part of understanding and coping with your cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:
- Bookmark the Scripps glossary of cancer terms for easy referencing.
- Download the appointment form and list of medications form on our resources page.
- Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site.
Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.