Ovarian Cancer

What Is Ovarian Cancer?

Ovarian cancer begins in the ovaries, the two small organs that produce eggs and hormones such as estrogen and progesterone. It can also start in nearby structures such as the fallopian tubes or the lining of the abdomen, and it is often grouped together with ovarian cancer because the diseases behave similarly.

These cancers are treated similarly because they behave in the same way and often spread in a similar pattern. This is an important reason why they are commonly grouped together under ovarian cancer care. Ovarian cancer is sometimes called a “silent” cancer or a “silent killer” because it is often diagnosed in advanced stages. This does not mean it has no symptoms. Many people notice digestive discomfort, bloating, pelvic pressure, or abdominal fullness long before diagnosis, but these signs are often mistaken for common stomach issues and ignored.

Unlike breast cancer or cervical cancer, ovarian cancer does not have a routine screening test for early detection. This makes symptom awareness extremely important. Early detection of ovarian cancer is largely based on recognising persistent symptoms rather than screening.
If symptoms continue and are ignored, diagnosis may happen only after the disease has spread, making treatment more complex.

Types of Ovarian Cancer

Ovarian cancer includes several different types.

• Epithelial ovarian cancer: The most common form, starting in the outer surface of the ovary.

• Germ cell tumours: Develop from the cells that produce eggs and are more common in younger women.

• Stromal tumours: Begin in the hormone-producing cells of the ovary.

• Fallopian tube cancer: Closely related and often treated like ovarian cancer.

• Primary peritoneal cancer: Starts in the lining of the abdomen but behaves like ovarian cancer.

Signs and Symptoms of Ovarian Cancer

The symptoms may seem ordinary at first, which is why they are sometimes overlooked. Watch for:

• Persistent bloating

• Feeling full quickly while eating

• Pelvic or abdominal pain

• Changes in bowel habits

• Increased urination

• Loss of appetite

• Unexplained weight loss

• Fatigue

• Back pain

• Abdominal swelling

If any of these symptoms happen often, especially almost daily for several weeks, they should not be ignored and should be evaluated by a physician, preferably an oncologist.

Why Does Ovarian Cancer Develop?

The exact cause is not always known. In many cases, ovarian cancer begins when cells in the ovary or nearby tissue acquire DNA changes and start growing uncontrollably.

Risk factors may include:

• Increasing age

• Family history of ovarian, breast, or colorectal cancer

• Inherited gene mutations such as BRCA1 or BRCA2

• Endometriosis

• Never having been pregnant

• Starting menstruation early or menopause late

• Hormone replacement therapy in some cases

• Obesity 

• Physical inactivity 

Having risk factors does not mean cancer will definitely occur, but it may increase the chance.

Diagnosis of Ovarian Cancer

Because symptoms are often vague, diagnosis may involve several tests.

• Pelvic examination: A doctor checks for masses or tenderness.

• Ultrasound: Helps identify ovarian masses and their appearance.

• CT or MRI scan: Gives a more detailed view of the pelvis and abdomen.

• Blood tests: Including CA-125 in some cases, though this test alone cannot confirm cancer.

• Biopsy or surgery: Biopsy in early-stage ovarian cancer is usually avoided because rupture of the tumour can cause spillage of cancer cells into the abdominal cavity. In advanced ovarian cancer (commonly Stage III), when chemotherapy is planned before surgery, a biopsy may be performed to confirm the diagnosis before starting treatment.

• Genetic testing: All ovarian cancer patients should be counselled for genetic testing, especially to check for inherited mutations such as BRCA1 and BRCA2.

A single test is usually not enough. Doctors combine symptoms, scans, blood work, and tissue results to make a diagnosis.

Treatment Options for Ovarian Cancer

Treatment depends on the type and stage of the cancer, and whether the person wants future fertility preservation. Surgery is the most important part of ovarian cancer treatment

Surgery may be done as:

• Primary surgery (before chemotherapy) 

• Interval surgery (after chemotherapy) 

This surgery is called:

Cytoreduction Surgery

Cytoreduction surgery aims to remove all visible cancer from the body and may involve:

• Removal of the uterus 

• One or both ovaries 

• Pelvic lymph nodes 

• Para-aortic lymph nodes 

• Omentum 

• Peritoneum 

In some advanced cases, it may also involve the removal of parts of other organs, such as:

• Bowel (including rectum) 

• Any nearby organ involved by cancer spread 

This is why ovarian cancer surgery is often extensive and highly specialised.

Fertility-Sparing Surgery

Fertility-sparing surgery may be offered to younger women only when:

• The cancer is confined to one ovary 

• There is no spread to other abdominal structures 

• Future pregnancy is planned 

• This helps preserve fertility while still treating the cancer safely.

Chemotherapy

Chemotherapy is an integral part of ovarian cancer treatment.

• When chemotherapy is given before surgery, it is called Neoadjuvant Chemotherapy 

• When chemotherapy is given after surgery, it is called Adjuvant Chemotherapy 

Chemotherapy may be used before surgery, after surgery, or both depending on the stage and spread of the disease.

Targeted therapy, hormone therapy, and immunotherapy may also be used in selected cases depending on tumour biology and molecular testing.

HIPEC Treatment (Hyperthermic Intraperitoneal Chemotherapy)

HIPEC is an advanced treatment used especially in epithelial ovarian cancers.

After completing cytoreduction surgery, heated chemotherapy is delivered directly into the abdominal cavity using a specialised machine.

This helps:

• Destroy microscopic cancer cells 

• Reduce the risk of recurrence 

• Improve disease control in selected advanced cases 

Because the chemotherapy is heated and delivered directly into the abdomen, it can be more effective in treating residual disease.

HIPEC is considered an advanced treatment option and is offered in specialised centres.

PIPAC / PIPEC Treatment (For Very Advanced Disease)

PIPAC (Pressurised Intraperitoneal Aerosol Chemotherapy), also referred to as PIPEC in some settings, is used in very advanced ovarian cancer where curative surgery may not be possible.

It helps in disease control and symptom management when standard surgery cannot be performed. In early disease, treatment may be more limited. In advanced cases, a combination approach is often needed.

Recovery and Follow-Up

Recovery varies depending on the extent of surgery and whether chemotherapy is needed. Some people recover quickly, while others need a longer period to regain strength.

Follow-up care may include:

• Regular scans or blood tests

• Monitoring for recurrence

• Managing fatigue, nausea, or bowel changes

• Emotional support

• Fertility or menopause counselling when needed

When to Seek Medical Help

See a doctor if you have:

• Ongoing bloating

• Pelvic pain that does not go away

• Feeling full after small meals

• Frequent urination without another clear reason

• Unexplained abdominal swelling

• Symptoms that last for more than a few weeks