Ovarian Cancer from Detection to Treatment
What Is Ovarian Cancer?
Ovarian cancer begins in the ovaries, the female reproductive organs that produce eggs and hormones.
It is often called a “silent disease” because early stages usually have no noticeable symptoms.
Most ovarian cancers are epithelial tumors, starting in the outer lining of the ovary.
Other types include germ cell tumors and stromal tumors.
Ovarian cancer begins in the ovaries, the female reproductive organs that produce eggs and hormones.
It is often called a “silent disease” because early stages usually have no noticeable symptoms.
Most ovarian cancers are epithelial tumors, starting in the outer lining of the ovary.
Other types include germ cell tumors and stromal tumors.
1. Initial Evaluation
Medical History and Physical Exam
Common symptoms:
• Abdominal bloating or swelling
• Pelvic or lower abdominal pain
• Early satiety or loss of appetite
• Frequent urination or bowel habit changes
• Fatigue or unexplained weight loss
Doctors assess risk factors such as:
• Family history of ovarian/breast cancer
• BRCA1/BRCA2 gene mutations
• Endometriosis or infertility history
• Hormonal/reproductive history
Medical History and Physical Exam
Common symptoms:
• Abdominal bloating or swelling
• Pelvic or lower abdominal pain
• Early satiety or loss of appetite
• Frequent urination or bowel habit changes
• Fatigue or unexplained weight loss
Doctors assess risk factors such as:
• Family history of ovarian/breast cancer
• BRCA1/BRCA2 gene mutations
• Endometriosis or infertility history
• Hormonal/reproductive history
2. Physical and Pelvic Examination
• Doctor palpates abdomen for masses, fluid buildup | ascites, or tenderness.
• Bimanual pelvic exam checks ovaries, uterus, and surrounding tissues.
• If a mass is suspected ➧ proceed to imaging and lab tests.
• Doctor palpates abdomen for masses, fluid buildup | ascites, or tenderness.
• Bimanual pelvic exam checks ovaries, uterus, and surrounding tissues.
• If a mass is suspected ➧ proceed to imaging and lab tests.
3. Laboratory & Tumor Marker Tests
CA-125 Blood Test
Measures a protein often elevated in ovarian cancer.
Not diagnostic alone.
Used to monitor response to treatment and detect recurrence.
Other Tumor Markers
Human Epididymis Protein 4
AFP, hCG, LDH
Inhibin A/B, Estradiol
CA-125 Blood Test
Measures a protein often elevated in ovarian cancer.
Not diagnostic alone.
Used to monitor response to treatment and detect recurrence.
Other Tumor Markers
Human Epididymis Protein 4
AFP, hCG, LDH
Inhibin A/B, Estradiol
4. Imaging and Scanning Tests
Pelvic & Transvaginal Ultrasound
First-line imaging.
Detects ovarian masses, cysts, and fluid in the abdomen.
Evaluates whether mass is solid, cystic, or mixed.
CT Scan
Determines spread to lymph nodes, liver, intestines, etc.
Helps plan surgery.
MRI
Gives detailed soft-tissue images; useful if CT results unclear.
PET-CT Scan
Detects metabolically active cancer cells; helps in staging and recurrence detection.
Chest X-ray / CT Chest
Detects pleural effusion or lung metastasis.
Paracentesis
Fluid from abdomen is aspirated and tested for cancer cells | cytology.
Pelvic & Transvaginal Ultrasound
First-line imaging.
Detects ovarian masses, cysts, and fluid in the abdomen.
Evaluates whether mass is solid, cystic, or mixed.
CT Scan
Determines spread to lymph nodes, liver, intestines, etc.
Helps plan surgery.
MRI
Gives detailed soft-tissue images; useful if CT results unclear.
PET-CT Scan
Detects metabolically active cancer cells; helps in staging and recurrence detection.
Chest X-ray / CT Chest
Detects pleural effusion or lung metastasis.
Paracentesis
Fluid from abdomen is aspirated and tested for cancer cells | cytology.
5. Confirmatory Diagnosis
Biopsy or Surgical Tissue Sampling
Often performed during exploratory laparotomy or laparoscopy.
Pathologist examines tissue under a microscope to confirm:
• Type | epithelial, germ cell, stromal
• Grade | how aggressive the tumor is
Note: In many cases, definitive diagnosis and staging are done during primary surgery, not before.
Biopsy or Surgical Tissue Sampling
Often performed during exploratory laparotomy or laparoscopy.
Pathologist examines tissue under a microscope to confirm:
• Type | epithelial, germ cell, stromal
• Grade | how aggressive the tumor is
Note: In many cases, definitive diagnosis and staging are done during primary surgery, not before.
6. Staging | FIGO System
I - Cancer limited to one/both ovaries.
II - Spread to pelvic tissues | uterus, fallopian tubes.
III - Spread to abdominal lining or lymph nodes.
IV - Distant metastasis | liver, lungs, pleural fluid.
I - Cancer limited to one/both ovaries.
II - Spread to pelvic tissues | uterus, fallopian tubes.
III - Spread to abdominal lining or lymph nodes.
IV - Distant metastasis | liver, lungs, pleural fluid.
7. Multidisciplinary Treatment Planning
Team includes:
• Gynecologic Oncologist
• Medical Oncologist
• Radiologist
• Pathologist
• Genetic Counselor | for BRCA testing
• Nutritionist & Psychologist
Treatment decisions depend on:
Stage | tumor type | patient’s age | fertility goals | and overall health.
Team includes:
• Gynecologic Oncologist
• Medical Oncologist
• Radiologist
• Pathologist
• Genetic Counselor | for BRCA testing
• Nutritionist & Psychologist
Treatment decisions depend on:
Stage | tumor type | patient’s age | fertility goals | and overall health.
8. Treatment Options
➛ Surgery
Goal:
Remove as much visible tumor as possible | debulking.
Early Stage | I - IIA
Total Hysterectomy:
Removes uterus.
Bilateral Salpingo-Oophorectomy:
Removes both ovaries & fallopian tubes.
Omentectomy:
Removes fatty tissue covering intestines.
Lymph Node Sampling:
Checks for spread.
Peritoneal Washings:
Detects microscopic cancer cells.
For fertility preservation:
If confined to one ovary, unilateral salpingo-oophorectomy may be done.
Advanced Stage | IIB–IV
Cytoreductive surgery:
Removes all visible tumor deposits.
Sometimes followed or preceded by chemotherapy.
➛ Chemotherapy
First-Line Chemotherapy
Usually Carboplatin + Paclitaxel | Taxol | every 3 weeks for 6 cycles.
Given intravenously or intraperitoneally | directly into abdomen.
Neoadjuvant Chemotherapy
For patients not fit for immediate surgery.
Given before surgery to shrink the tumor.
Adjuvant Chemotherapy
Given after surgery to destroy remaining cancer cells.
➛ Targeted Therapy
Bevacizumab | Avastin:
Blocks blood vessel growth feeding the tumor.
PARP Inhibitors | Olaparib, Niraparib, Rucaparib:
For BRCA-mutated or HRD-positive cancers - helps prevent recurrence.
➛ Immunotherapy
For advanced or recurrent cases:
Pembrolizumab if tumor has specific genetic features | MSI-H or PD-L1 positive.
➛ Radiation Therapy
Not primary treatment, but may be used:
For symptom control | pain, bleeding, bone metastases.
➛ Surgery
Goal:
Remove as much visible tumor as possible | debulking.
Early Stage | I - IIA
Total Hysterectomy:
Removes uterus.
Bilateral Salpingo-Oophorectomy:
Removes both ovaries & fallopian tubes.
Omentectomy:
Removes fatty tissue covering intestines.
Lymph Node Sampling:
Checks for spread.
Peritoneal Washings:
Detects microscopic cancer cells.
For fertility preservation:
If confined to one ovary, unilateral salpingo-oophorectomy may be done.
Advanced Stage | IIB–IV
Cytoreductive surgery:
Removes all visible tumor deposits.
Sometimes followed or preceded by chemotherapy.
➛ Chemotherapy
First-Line Chemotherapy
Usually Carboplatin + Paclitaxel | Taxol | every 3 weeks for 6 cycles.
Given intravenously or intraperitoneally | directly into abdomen.
Neoadjuvant Chemotherapy
For patients not fit for immediate surgery.
Given before surgery to shrink the tumor.
Adjuvant Chemotherapy
Given after surgery to destroy remaining cancer cells.
➛ Targeted Therapy
Bevacizumab | Avastin:
Blocks blood vessel growth feeding the tumor.
PARP Inhibitors | Olaparib, Niraparib, Rucaparib:
For BRCA-mutated or HRD-positive cancers - helps prevent recurrence.
➛ Immunotherapy
For advanced or recurrent cases:
Pembrolizumab if tumor has specific genetic features | MSI-H or PD-L1 positive.
➛ Radiation Therapy
Not primary treatment, but may be used:
For symptom control | pain, bleeding, bone metastases.
9. Supportive & Rehabilitative Care
➛ Pain management and anti-nausea medication.
➛ Nutritional support during chemotherapy.
➛ Fertility counseling and options before treatment | egg/embryo freezing.
➛ Emotional and psychological support for coping with diagnosis and treatment.
➛ Physical therapy for recovery and preventing muscle weakness.
➛ Pain management and anti-nausea medication.
➛ Nutritional support during chemotherapy.
➛ Fertility counseling and options before treatment | egg/embryo freezing.
➛ Emotional and psychological support for coping with diagnosis and treatment.
➛ Physical therapy for recovery and preventing muscle weakness.
10. Follow-up and Monitoring
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Physical & pelvic exams
CA-125 blood test monitoring
Imaging | CT/MRI | if recurrence suspected
Symptom assessment and management of side effects
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Physical & pelvic exams
CA-125 blood test monitoring
Imaging | CT/MRI | if recurrence suspected
Symptom assessment and management of side effects
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