Ovarian cancer: symptoms, tests and treatment
In brief
Ovarian cancer (a malignant tumour of the ovary, fallopian tube or peritoneum) causes subtle but persistent symptoms: bloating, a growing abdomen, pelvic pain, feeling full quickly or needing to pass urine often. If these last for several weeks, see a doctor for a pelvic ultrasound and a CA 125 blood test. Treatment usually combines complete surgery, performed in a specialist centre, and chemotherapy, decided by a multidisciplinary team meeting.
What is ovarian cancer?
Ovarian cancer is one of the gynaecological cancers described on our Gynaecological cancer care page. The term "ovarian cancer" covers malignant tumours arising from the ovary, the fallopian tube or the peritoneum (the membrane lining the abdomen). These three sites behave in a similar way and are treated in the same way. The most common form is high-grade serous carcinoma, which usually starts at the end of the fallopian tube.
Other, less common types exist: endometrioid, clear cell, mucinous and low-grade serous carcinomas, and non-epithelial tumours (germ cell or sex cord tumours), which are more frequent in young women. Borderline tumours must also be distinguished, as their outlook is very good.
Most ovarian masses found on ultrasound are benign, especially before the menopause (see benign ovarian cysts).
What are the symptoms of ovarian cancer?
Ovarian cancer often causes no symptoms for a long time. Symptoms are usually commonplace, but the warning sign is that they are new, frequent and persistent (several times a week, for several weeks):
- abdominal bloating, a swollen tummy, an increasing waist size;
- pain in the lower abdomen or pelvis;
- feeling full very quickly, loss of appetite;
- needing to pass urine more often or more urgently;
- recent change in bowel habit, tiredness, unexplained weight loss;
- more rarely, abnormal bleeding.
These signs usually have another cause, digestive or urinary. But if they persist, especially after the age of 50, you should have a gynaecological examination and a pelvic ultrasound.
Who is most at risk of ovarian cancer?
- Age: the disease mainly occurs after the menopause.
- A genetic predisposition: a mutation in the BRCA1 or BRCA2 genes, Lynch syndrome, or other rarer genes. It is suspected when there is a family history of breast or ovarian cancer.
- Endometriosis, linked to certain types (endometrioid, clear cell), although the absolute risk remains low.
Conversely, long-term use of the combined pill, pregnancies and breastfeeding are associated with a lower risk.
Is there a screening test?
No. The large UK trial UKCTOCS, which followed more than 200,000 postmenopausal women for 16 years, showed that screening with CA 125 or annual ultrasound did not reduce deaths. Screening is therefore not recommended for the general population. Women who carry a BRCA mutation are offered specific care in a cancer genetics clinic, including preventive removal of the fallopian tubes and ovaries at an age discussed with them.
Which tests are used to diagnose and stage ovarian cancer?
| Test | What it is for |
|---|---|
| Clinical examination | Feeling the abdomen, internal (vaginal) examination, checking for ascites (fluid in the abdomen) or enlarged lymph nodes. |
| Transvaginal and abdominal pelvic ultrasound | The key test: it describes the mass (size, walls, growths, blood supply) and grades its risk using standardised systems (IOTA, O-RADS). |
| CA 125 blood test (sometimes HE4 and other markers) | Helps guide the diagnosis and provides a baseline for follow-up. A raised CA 125 is not specific: it also rises with endometriosis, periods or infection. |
| Pelvic MRI | Clarifies the nature of a mass when ultrasound is inconclusive. |
| CT scan of the chest, abdomen and pelvis | Assesses spread within the abdomen (peritoneum, lymph nodes, liver) and to the chest. |
| Biopsy or exploratory laparoscopy | Confirms the diagnosis and the tumour type, and assesses whether complete surgery is possible. |
A definite diagnosis always relies on histology: a sample of the tumour is examined under the microscope. Genetic changes (BRCA, homologous recombination deficiency) are also looked for in the tumour and in the blood, because they guide treatment.
How is ovarian cancer treated?
Every case is discussed at a multidisciplinary team meeting (MDT), bringing together surgeons, oncologists, radiologists and pathologists. The FIGO stage (I to IV) and the tumour type guide the strategy.
Surgery
The aim is to remove all visible disease. This is one of the most important factors for the outcome. The operation usually involves removing the uterus, ovaries and fallopian tubes, the omentum (a fatty fold in the abdomen) and all peritoneal deposits, sometimes with part of the bowel. For advanced disease, French guidelines first assess by laparoscopy whether complete surgery is possible; this major surgery is carried out in specialist centres.
For early-stage cancer in a young woman who wants to become pregnant, surgery preserving the uterus and one ovary may be considered in some cases.
Chemotherapy
It usually combines a platinum drug (carboplatin) and paclitaxel. It is given after surgery, or before it ("neoadjuvant" chemotherapy) when complete surgery is not possible straight away, followed by so-called "interval" surgery.
Maintenance treatment
After chemotherapy, some patients receive maintenance treatment: PARP inhibitors (particularly with a BRCA mutation or homologous recombination deficiency) and/or bevacizumab, an anti-angiogenic drug. The choice depends on the molecular profile of the tumour.
Why is genetic testing offered for ovarian cancer?
Guidelines advise offering BRCA1/BRCA2 genetic testing to patients with non-mucinous epithelial ovarian cancer, even without a family history. The result matters in two ways:
- for you: it guides the choice of maintenance treatment;
- for your family: your relatives can be tested for the mutation and then offered surveillance or preventive surgery.
The test is carried out with your written consent, during a cancer genetics consultation.
What follow-up is needed after ovarian cancer treatment?
Follow-up combines a clinical examination, often a CA 125 blood test, and imaging if there are symptoms or abnormal findings. Visits are more frequent in the first few years. Follow-up also covers the effects of treatment-induced menopause, fatigue, digestive problems, sexual health and psychological impact. The exact schedule is set by the team that treated you.
When should you seek help urgently?
- Severe abdominal pain, a very swollen and hard abdomen, vomiting, no wind or stools: possible signs of bowel obstruction. In France, call 15 (or 112), or your local emergency number.
- Sudden breathlessness, pain in a calf: in France, call 15, or your local emergency number.
- Fever during chemotherapy: contact the oncology team immediately.
Frequently asked questions
Can an ovarian cyst turn into cancer?
Functional cysts and most benign cysts do not become cancerous. What matters is how the cyst looks on ultrasound: a suspicious-looking cyst is investigated with MRI and often removed for analysis.
Does a high CA 125 mean cancer?
No. CA 125 also rises with endometriosis, fibroids, periods, pregnancy or inflammation of the peritoneum. It is always interpreted together with ultrasound and a clinical examination.
Does a smear test detect ovarian cancer?
No. The smear test and the HPV test only detect changes in the cervix. There is no effective screening test for ovarian cancer in the general population.
Can you have a baby after ovarian cancer?
It is sometimes possible for certain early-stage, borderline or non-epithelial tumours, thanks to fertility-sparing surgery. A fertility preservation consultation should be offered before any treatment when the question arises.
Is ovarian cancer painful?
Not always, and often not at first: the disease is silent for a long time. Pain in the lower tummy or pelvis is one possible sign, along with bloating and feeling full quickly. What should alert you is that these symptoms are new and persist for several weeks.
References
- Lavoue V, et al. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Short text of the French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Eur J Obstet Gynecol Reprod Biol, 2019. doi:10.1016/j.ejogrb.2019.03.010 — PMID 30905627
- Ledermann JA, et al. ESGO-ESMO-ESP consensus conference recommendations on ovarian cancer: pathology and molecular biology and early, advanced and recurrent disease. Ann Oncol, 2024. doi:10.1016/j.annonc.2023.11.015 — PMID 38307807
- Menon U, et al. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet, 2021. doi:10.1016/S0140-6736(21)00731-5 — PMID 33991479
Dr Olivier KadochObstetrician-gynaecologist and gynaecological surgeon in Paris (16th and 5th arrondissements). Former chef de clinique-assistant (senior registrar) at the Paris public hospitals (AP-HP); individually accredited by the French National Authority for Health (HAS). RPPS 10003957809. Background and practice locations
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