Ovarian cancer

Ovarian cancer (or carcinoma) is the name that doctors give to malignant tumors of the ovaries.

A woman’s ovaries consist of various tissue and cell types from which cancer cells can develop. That means that there are different types of ovarian cancer: 

• About 90 to 100 malignant tumors of the ovaries develop from the outer epithelium and are called epithelial tumors.  
  Borderline tumors also belong to this group. Such tumors cannot be clearly classified as either benign or malignant. 
• On rarer occasions, sex cord stromal tumors can develop from the supporting tissue or germ-cell tumors can directly develop from egg cells. 

Ovarian cancer often goes undetected for a long time: the tumor has lots of room to grow in the pelvis and abdominal cavity and often only triggers symptoms once it is larger. 

The following symptoms can indicate ovarian cancer: 

• feeling of fullness 
• bloating 
• unexplained abdominal pain or indigestion 
• abdominal swelling or unexplained weight loss 
• more frequent urination than usual 

Symptoms such as indigestion or frequent urination do not only occur with ovarian cancer, but often also with benign conditions. If these symptoms occur repeatedly or persistently, a doctor should be consulted. This particularly applies to women over the age of 50. General practitioners or gynecologists can quickly narrow down the causes of the symptoms and initiate further diagnostic steps if necessary. 

The risk of ovarian cancer increases with age. Obesity also plays a role and hormonal factors influence the risk: for example, childlessness or infertility can increase the risk of ovarian cancer. The same applies to hormone therapy for the treatment of menopause symptoms in women after their final period. 

According to recent studies, hereditary factors play a role in one in every four or five cases of ovarian cancer. Often, close relatives have also suffered from breast or ovarian cancer. The most common mutations are in the genes BRCA1 and BRCA2. The term BRCA is made up of the first two letters of the words “breast” and “cancer”. 

There is currently no legal scheme for ovarian cancer screening. To date, it has not been possible to show that screening reduces ovarian cancer mortality: this applies to both ultrasound examinations of the ovaries through the vagina (transvaginal ultrasounds) and the determination of specific tumor markers.  

Specialists do not even recommend ovarian cancer screening for women with a hereditary risk.

Various complementary diagnostic procedures are available to doctors who suspect that a patient may have ovarian cancer: 

• Asking the patient about previous conditions (medical history), symptoms and possible risk factors. 
• Physical examination: the doctor palpates the abdominal wall externally and examines the internal reproductive organs through the vagina.  
• Mirror examination: this makes it possible to see the internal reproductive organs. 
• Ultrasound examination of the ovaries through the vagina (transvaginal ultrasound). 
• Imaging procedures such as computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET): these enable doctors to see how extensive a tumor is. 

Surgery is generally required for the final diagnosis: the tumor is removed and histologically examined. This shows if the tumor is benign or malignant and what type of tumor it is. 

Do you want to know how examinations for the diagnosis of ovarian cancer are conducted as well as what they can and cannot determine? Information about the diagnosis of ovarian cancer can be obtained from the Cancer Information Service of the German Cancer Research Center (in German). 

When selecting the appropriate therapy, doctors consider three main factors:

• The stage of the disease: how advanced is the ovarian cancer?
• The type of tumor: what is the histological subtype?
• The patient’s general health: do any other conditions need to be taken into account when planning the treatment?

The primary treatment for patients with ovarian cancer is surgery followed by chemotherapy. If ovarian cancer is detected at an early stage, it will often not yet have affected the ovary’s capsule and the cancer cells will not yet have significantly changed. In such cases, surgery alone may suffice as treatment.

Surgery

Surgery should remove as much of the tumor as possible. What happens next depends on whether the disease is localized or has already spread.

Localized means that one or both ovaries are affected and the tumor is confined to the reproductive organs in the pelvis. Doctors closely examine this during the surgery. In medical terms, this is referred to as “staging surgery”.

Hidden metastases are found in almost one in three patients whose ovarian cancer is initially diagnosed as localized. This means that the cancer is no longer localized, but more advanced and must be treated differently.

In about three-quarters of patients with ovarian cancer, the tumor is at an advanced stage. That means that it also affects other organs in the pelvis or abdominal cavity or has spread to organs elsewhere in the body.

In such cases, experts recommend that the tumor should ideally be removed to such an extent that it is no longer visible to the naked eye. Where possible, surgeons will also remove affected organs or organ parts. This can mean parts of the intestine, for example.

Chemotherapy and other treatment types

Most patients with ovarian cancer receive chemotherapy after their surgery. This involves the use of cytostatic drugs to slow down cell growth or inhibit cell division.

Other types of treatment used by doctors to treat ovarian cancer include the following:

• Targeted therapies: drugs specifically interfere with the biological processes of tumor cells that are key to cancer development or spread. These are used at advanced tumor stages.
• Supportive treatments: these include all treatments for alleviating symptoms and improving quality of life.

Radiotherapy is rarely used to treat ovarian cancer.

Do you want to find out more about chemotherapy and other treatments? Key information about the impact, side effects and course of the treatments listed above can be obtained from the website for the Cancer Information Service of the German Cancer Research Center (in German).

Medical rehabilitation (rehab) following cancer treatment aims to help patients regain their strength. It can also help them optimally deal with the consequences of the disease and treatment. Rehab programs are therefore based on patients’ personal medical history and physical limitations. 

Rehabilitation following ovarian cancer treatment can involve: 

• exercises to improve physical strength 
• help with digestive disorders and nutrition 
• dealing with the consequences of chemotherapy, such as fatigue or neuralgic pain 
• psychosocial counseling to help the patient cope with the disease 

Both the treatment and the disease itself can affect patients physically and psychologically. There is also a risk of recurrence. Ovarian cancer aftercare is intended to detect any recurrence at an early stage as well as any delayed effects of the treatment.

Patients are examined at regular intervals after the therapy has ended. The intervals between these check-ups are determined on a case-by-case basis. Doctors ask about symptoms and examine the body. The checks include a gynecological mirror and palpation examination as well as a rectal examination and a vaginal ultrasound.

If the cancer cannot be cured, regular follow-up checks will help to detect adverse symptoms at an early stage. Supportive treatment for the symptoms should help patients maintain a good quality of life for as long as possible.

The surgical removal of ovarian cancer requires major abdominal surgery under general anesthesia. It often takes patients a long time to recover from this.  

Ovarian cancer surgery leaves a large scar. Scars known as adhesions can also form within the abdomen. These can go unnoticed or cause abdominal pain or digestive problems. An abdominal wall hernia can occur as a delayed effect, which causes pain or other issues. 

Due to the removal of both ovaries, women who still had their period prior to surgery suddenly enter premature menopause and may experience the associated symptoms. If patients suffer greatly from such symptoms, they can discuss hormone therapy with their doctor. 

Physical changes and mental stress can affect patients’ sex life. It can help them to talk about this – both with their partner and their doctors. 

Many ovarian cancer patients want to do something to assist with their recovery. There are a number of ways they can do this. What can help them to cope better with the disease and the consequences of treatment depends on the individual situation: 

• Exercise can help overcome fatigue and weakness. This should be adapted to the patient’s physical ability. 
• A healthy balanced diet, or nutritional therapy, can prevent or treat malnourishment.  
• Psycho-oncological counseling can help when worries and fears become overwhelming. 

If it is no longer possible to cure the cancer and it is becoming more advanced, good medical and nursing care are very important. Adverse symptoms such as water retention in the abdomen (ascites), pain or digestive problems can be alleviated. Psychosocial support can also help patients maintain a good quality of life for as long as possible.  

Are you looking for a registered psycho-oncologist, a self-help group or a cancer advisory service? Contact details can be found on the website of the Cancer Information Service of the German Cancer Research Center (in German). 

Doctors from a variety of disciplines work together to treat ovarian cancer. Hospitals with a great deal of experience in treating patients with ovarian cancer can demonstrate this through certification. The German Cancer Society (DKG) regularly checks compliance with specific professional requirements and certifies such hospitals as gynecological centers.  

The addresses of the certified gynecological centers can be found on the OncoMAP website.

Do you have further questions about dealing with the condition in everyday life and additional support options? The website of the Cancer Information Service of the German Cancer Research Center provides a wide range of information (in German). 

You can also contact the Cancer Information Service directly on freephone 0800 420 30 40 or by e-mail at krebsinformationsdienst@dkfz.