Ovarian Epithelial Cancer Treatment (PDQ®)

As a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, a core part of our mission is to educate patients and the community about cancer. The following summary is trusted information from the NCI.

General Information About Ovarian Epithelial Cancer

Ovarian epithelial cancer is a disease in which malignant (cancer) cells form in the tissue covering the ovary.

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones (chemicals that control the way certain cells or organs work). Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Ovarian epithelial cancer is one type of cancer that affects the ovary. See the following PDQ treatment summaries for information about other types of ovarian tumors:

Women who have a family history of ovarian cancer are at an increased risk of ovarian cancer.

Anything that increases your risk of getting a disease is called a risk factor. Women who have one first-degree relative (mother, daughter, or sister) with ovarian cancer are at an increased risk of ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with ovarian cancer.

Some ovarian cancers are caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person's parents. Hereditary ovarian cancer makes up about 5% to 10% of all cases of ovarian cancer. Three hereditary patterns have been identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers.

There are tests that can detect mutated genes. These genetic tests are sometimes done for members of families with a high risk of cancer. See the following PDQ summaries for more information:

Women with an increased risk of ovarian cancer may consider surgery to prevent it.

Some women who have an increased risk of ovarian cancer may choose to have a prophylactic oophorectomy (the removal of healthy ovaries so that cancer cannot grow in them). In high-risk women, this procedure has been shown to greatly decrease the risk of ovarian cancer. (See the PDQ summary on Ovarian Cancer Prevention for more information.)

Possible signs of ovarian cancer include pain or swelling in the abdomen.

Early ovarian cancer may not cause any symptoms. When symptoms do appear, ovarian cancer is often advanced. Symptoms of ovarian cancer may include the following:

These symptoms also may be caused by other conditions and not by ovarian cancer. If the symptoms get worse or do not go away on their own, check with your doctor so that any problem can be diagnosed and treated as early as possible. When found in its early stages, ovarian epithelial cancer can often be cured.

Women with any stage of ovarian cancer should think about taking part in a clinical trial. Information about ongoing clinical trials is available from the NCI Web site.

Tests that examine the ovaries and pelvic area are used to detect (find) and diagnose ovarian cancer.

The following tests and procedures may be used:

Certain factors affect treatment options and prognosis (chance of recovery).

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer.
  • The type and size of the tumor.
  • Whether all of the tumor can be removed by surgery.
  • The patient's age and general health.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Ovarian Epithelial Cancer

After ovarian cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body.

The process used to find out whether cancer has spread within the ovaries or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose ovarian cancer are often also used to stage the disease. (See the General Information section.)

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if ovarian epithelial cancer spreads to the lung, the cancer cells in the lung are actually ovarian epithelial cancer cells. The disease is metastatic ovarian epithelial cancer, not lung cancer.

The following stages are used for ovarian epithelial cancer:

Stage I

Ovarian cancer stage IA, IB, and IC. In stage IA, cancer is found inside a single ovary. In stage IB, cancer is found inside both ovaries. In stage IC, cancer is found in one or both ovaries and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage I, cancer is found in one or both ovaries. Stage I is divided into stage IA, stage IB, and stage IC.

Stage II

Ovarian cancer stage IIA, IIB, and IIC. In stage IIA, cancer is found inside one or both ovaries and has spread to the uterus and/or the fallopian tubes. In stage IIB, cancer is found inside one or both ovaries and has spread to other tissues within the pelvis. In stage IIC, cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis, and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage II, cancer is found in one or both ovaries and has spread into other areas of the pelvis. Stage II is divided into stage IIA, stage IIB, and stage IIC.

Pea, peanut, walnut, and lime show tumor sizes.

Stage III

In stage III, cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

Cancer that has spread to the surface of the liver is also considered stage III ovarian cancer.

Stage IV

Stage IV ovarian cancer. Cancer is found in one or both ovaries and may spread to other parts of the body, such as the lymph nodes, lung, liver, and bone. Cancer cells may also be found in an area between the lungs and the chest wall that has filled with fluid.

In stage IV, cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver.

Cancer cells in the fluid around the lungs is also considered stage IV ovarian cancer.

Recurrent or Persistent Ovarian Epithelial Cancer

Recurrent ovarian epithelial cancer is cancer that has recurred (come back) after it has been treated. Persistent cancer is cancer that does not go away with treatment.

Treatment Option Overview

There are different types of treatment for patients with ovarian epithelial cancer.

Different types of treatment are available for patients with ovarian epithelial cancer. Some treatments are standard, and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the treatment currently used as standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three kinds of standard treatment are used. These include the following:

Surgery

Most patients have surgery to remove as much of the tumor as possible. Different types of surgery may include:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Some women receive a treatment called intraperitoneal radiation therapy, in which radioactive liquid is put directly in the abdomen through a catheter.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody being studied in treating ovarian epithelial cancer.

PARP inhibitors are targeted therapy drugs that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied in treating ovarian epithelial cancer that remains after chemotherapy.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

Stage I and II Ovarian Epithelial Cancer

Treatment of stage I and stage II ovarian epithelial cancer may include the following:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I ovarian epithelial cancer and stage II ovarian epithelial cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Stage III and IV Ovarian Epithelial Cancer

Treatment of stage III and stage IV ovarian epithelial cancer may be surgery to remove the tumor, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. After surgery, treatment depends on how much tumor remains.

When the tumor that remains is 1 centimeter or smaller, treatment is usually combination chemotherapy, including intraperitoneal (IP) chemotherapy.

When the tumor that remains is larger than 1 centimeter, treatment may include the following:

  • Combination chemotherapy, including intraperitoneal (IP) chemotherapy.
  • A clinical trial of combination chemotherapy, including IP chemotherapy, before and after second-look surgery (surgery performed after the initial surgery to determine whether tumor cells remain).
  • A clinical trial of biologic therapy or targeted therapy following combination chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III ovarian epithelial cancer and stage IV ovarian epithelial cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent or Persistent Ovarian Epithelial Cancer

Treatment of recurrent ovarian epithelial cancer may include the following:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent ovarian epithelial cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

To Learn More About Ovarian Epithelial Cancer

For more information from the National Cancer Institute about ovarian epithelial cancer, see the following:

For general cancer information and other resources from the National Cancer Institute, see the following: