Ovarian Cancer: Symptoms, Diagnosis, Treatment, and Care at Apollo Hospitals

Ovarian cancer is a group of cancers that begin in or near the ovaries. Because the ovaries sit deep in the pelvis and early symptoms can be subtle, the disease is sometimes diagnosed after it has spread within the abdomen. Even so, outcomes continue to improve with modern surgery, platinum-based chemotherapy, targeted maintenance therapies, and coordinated multidisciplinary care. This article explains what ovarian cancer is, how it’s diagnosed and staged, today’s treatment options, recovery and follow-up, prevention and risk reduction, international patient support, and answers to common questions.

Note: This guide is for education only and does not replace medical advice. Personal decisions should be made with a qualified gynecologic oncology team.

What Is Ovarian Cancer and Why Early Detection Matters

Ovarian cancer often actually begins in the fallopian tube and then spreads to the ovary. Most “”ovarian”” cancers actually arise from the fimbrial end of the fallopian tube and then spread to the ovary and peritoneal surfaces. Because early disease may cause vague gastrointestinal or urinary symptoms, it can be overlooked. Recognizing persistent symptoms and seeking evaluation can lead to earlier diagnosis and less extensive treatment.

Why early detection matters:

• Earlier disease is more likely to be completely removed with surgery.
• Smaller tumor burden responds better to chemotherapy and targeted therapies.
• Timely treatment improves control, recovery, and long-term quality of life.

How common is it?

• Ovarian cancer is less common than breast or cervical cancer but remains a leading cause of gynecologic cancer death due to later-stage diagnosis.
• Risk increases with age; most diagnoses occur after menopause, though it can occur at any adult age.

Types of Ovarian Cancer

There are different types of ovarian cancer depending on where they start—most are from the surface of the ovary or fallopian tube, while some rare ones start in younger women or in hormone-producing cells.

• Epithelial ovarian cancer (most common)
  – High-grade serous carcinoma (HGSC): Accounts for the majority; often linked to BRCA mutations and defects in DNA repair (homologous recombination deficiency, HRD).
  – Endometrioid, clear cell, mucinous, and low-grade serous carcinomas: Less common; each has distinct biology and treatment implications.
• Germ cell tumors (less common, often in younger patients)
  – Examples: Dysgerminoma, yolk sac tumor, immature teratoma.
  – Typically very chemosensitive and often curable, with careful fertility-preserving approaches where safe.
• Sex cord–stromal tumors (rare)
  – Examples: Granulosa cell tumor, Sertoli–Leydig tumor.
  – Often hormonally active; surgical management is central, with tailored systemic therapies as needed.
• Primary peritoneal carcinoma and fallopian tube carcinoma
  – Biologically and clinically similar to high-grade serous ovarian cancer; treated in the same way.

Causes: Known or Suspected Contributors

Most women with ovarian cancer did nothing to cause it. Sometimes it’s linked to inherited genes, age, or conditions like endometriosis, but often no clear reason is found. Contributing factors include:

• Genetic changes in DNA repair pathways (e.g., BRCA1/2, RAD51C/D, BRIP1).
• Age-related DNA damage and reduced repair fidelity.
• Chronic inflammation and repeated ovulatory cycles.
• Endometriosis (associated with some clear cell and endometrioid subtypes).
• Rare hereditary syndromes (e.g., Lynch syndrome for non-serous histologies).

Importantly, many people with ovarian cancer have no identifiable risk factor and did nothing to cause the disease.

Risk Factors: Lifestyle, Genetic, Environmental, and Medical

• Genetic and family history
  – BRCA1/2 and other hereditary mutations significantly raise lifetime risk.
  – Multiple relatives with breast/ovarian/tubal/peritoneal cancer warrant genetic counseling.
• Reproductive and hormonal factors
  – Increasing age and postmenopausal status.
  – Fewer or no pregnancies (more lifetime ovulatory cycles).
  – Endometriosis (certain histologies).
• Medical and lifestyle factors
  – Obesity and sedentary lifestyle (affect outcomes).
  – Smoking (especially for mucinous histology).
  – Prior pelvic radiation (rare).
  – Hormonal therapy effects vary; discuss individualized risk/benefit with a clinician.

Risk reduction strategies exist (see Screening and Prevention).

What Are the Symptoms of Ovarian Cancer?

Ovarian cancer symptoms may seem like ordinary stomach or bladder problems. Watch out for:

Common early signs:

• Persistent bloating or swelling of the abdomen.
• Pelvic or abdominal pain or pressure.
• Feeling full quickly while eating or loss of appetite.
• Needing to pass urine more often or increased urinary urgency.
• Changes in bowel habits (usually constipation, less commonly diarrhea).
• Unexplained fatigue.

Progressive symptoms:

• Increasing abdominal girth from fluid (ascites).
• Unintentional weight loss or loss of muscle.
• Shortness of breath (large ascites or pleural effusion).
• Pelvic mass found on examination or imaging.

If these symptoms keep coming back for more than 2–3 weeks, see a gynecologist.

How Is Ovarian Cancer Diagnosed?

Scans and blood tests can suggest ovarian cancer, but surgery or biopsy is needed to confirm it.

• Medical history and pelvic examination
  – Review of symptoms, menstrual/menopausal status, and family history.
  – Bimanual exam to assess masses or tenderness.
• Imaging
  – Transvaginal and transabdominal ultrasound: First-line to characterize adnexal masses (solid, cystic, septations, papillary projections, blood flow).
  – Contrast-enhanced CT scan of abdomen/pelvis (and chest): Maps disease, guides surgical planning.
  – MRI pelvis: Clarifies complex masses and local anatomy when needed.
  – PET-CT: Selectively used for staging dilemmas or suspected recurrence.
• Tumor markers and labs
  – CA-125 (often elevated in epithelial ovarian cancer, especially HGSC); not specific, but useful for monitoring.
  – HE4 may complement CA-125 in selected cases.
  – For germ cell tumors: AFP, beta-hCG, LDH.
  – Complete blood count, kidney/liver function, nutritional markers.
• Surgical assessment (gold standard)
  – Either primary debulking surgery (PDS) or diagnostic laparoscopy to assess resectability.
  – Tissue sampling confirms histology and obtains material for tumor genomic testing.
• Genetic testing
  – Germline testing for BRCA1/2 and related genes is recommended for all epithelial tubo-ovarian cancers.
  – Somatic (tumor) testing for HRD, BRCA, and other alterations may inform targeted maintenance therapy.

A multidisciplinary tumor board coordinates the diagnostic and treatment plan.

Staging and Grading: What They Mean

The stage shows how far the cancer has spread, from Stage I (early, limited to ovary) to Stage IV (spread to distant organs). The more cancer removed at surgery, the better the outlook.

• Staging (FIGO)
  – Stage I: Confined to one or both ovaries/fallopian tubes.
  – Stage II: Spread to pelvic tissues (uterus, bladder, sigmoid/rectum).
  – Stage III: Spread to abdominal peritoneum and/or retroperitoneal lymph nodes.
  – Stage IV: Distant metastasis (e.g., liver parenchyma, lungs).
• Grading and histology
  – High-grade vs low-grade indicates how abnormal and fast-growing the tumor cells appear.
  – Histology (serous, endometrioid, clear cell, mucinous) influences treatment choices and prognosis.
• Surgical outcome
  – Completeness of cytoreduction (no visible residual disease vs residual implants) is one of the strongest prognostic factors.

Why it matters:

• Stage, grade, histology, and surgical debulking status guide the need for chemotherapy, targeted maintenance, or other therapies.
• Molecular features (BRCA/HRD) inform eligibility for PARP inhibitors.

Treatment Options for Ovarian Cancer

Most women need surgery and chemotherapy. Newer treatments like targeted medicines (PARP inhibitors, bevacizumab) and sometimes immunotherapy can help control the cancer for longer. Care is personalized by stage, histology, tumor biology, surgical fitness, and goals. Most epithelial ovarian cancers are treated with a combination of surgery and systemic therapy.

Surgery

Goals:

• Comprehensive staging and maximal cytoreduction (debulking) to no visible residual disease, where feasible.

Common procedures:

• Total hysterectomy and bilateral salpingo-oophorectomy (uterus, both tubes and ovaries).
• Omentectomy (removal of the fatty apron within the abdomen).
• Peritoneal washings and biopsies.
• Pelvic and para-aortic lymph node assessment (selective, based on current guidelines).
• Resection of peritoneal implants and, when necessary, segmental bowel, diaphragm, spleen, or liver surface to achieve optimal debulking.

Approach:

• Primary debulking surgery (PDS) if complete cytoreduction appears achievable and patient fitness permits.
• Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) if disease is extensive, complete cytoreduction is unlikely upfront, or medical conditions favor downstaging first.

Recovery:

• Hospital stay varies with surgical extent; enhanced recovery protocols (early feeding, mobilization, optimized pain control) shorten recovery and decrease complications.

Medical Treatment

• Chemotherapy (backbone for most epithelial tumors)
  – Platinum-based combinations (e.g., carboplatin + paclitaxel) given every 3 weeks.
  – Used after PDS, or before and after IDS (3–4 cycles pre-op, then 3–4 cycles post-op).
  – Side effects: fatigue, hair loss, nausea, neuropathy, low blood counts; modern supportive care reduces risks.
• Targeted therapy
  – PARP inhibitors (e.g., as maintenance after response to platinum therapy), especially effective for BRCA-mutated or HRD-positive tumors; can significantly extend remission.
  – Anti-angiogenic therapy (e.g., bevacizumab) may be added to chemotherapy and continued as maintenance in selected patients.
  – Other targeted agents may be considered for specific molecular subtypes or within clinical trials.
• Immunotherapy
  – Checkpoint inhibitors benefit biomarker-selected populations (e.g., MSI-high) and are being explored in combinations for recurrent disease.
  – Side effects involve immune-related inflammation; timely management is key.
• Hormonal therapy
  – Has a role in low-grade serous carcinoma and certain recurrent settings.
• Germ cell and sex cord–stromal tumors
  – Often curable with fertility-sparing surgery (if safe) and platinum-based chemotherapy (for germ cell tumors).
  – Sex cord–stromal tumors may require hormonal therapies or chemotherapy depending on stage and behavior.
• Intraperitoneal therapy and HIPEC (select centers)
  – Intraperitoneal chemotherapy or hyperthermic intraperitoneal chemotherapy at surgery may be considered in highly selected cases; evidence and protocols vary.

Radiation Therapy

• Not a routine first-line treatment for epithelial ovarian cancer.
• Used selectively for symptom control (e.g., painful localized recurrences, brain or bone metastases) or for consolidation in rare situations.
• Modern techniques (IMRT/IGRT/SBRT) focus dose to minimize bowel, bladder, and marrow exposure.

Proton Therapy

• Generally not required for primary management.
• May be considered for re-irradiation or unique anatomical challenges, primarily for palliative control near sensitive organs.

Prognosis: Survival, Outcomes, and What Affects Them

Many patients achieve durable remissions with optimal surgery, platinum-based chemotherapy, and appropriate maintenance therapy. Key factors include:

• Stage at diagnosis and total tumor burden.
• Completeness of cytoreduction (no visible residual disease is best).
• Histology and tumor biology (BRCA/HRD status).
• Response to first-line platinum therapy.
• Use of maintenance therapies (PARP inhibitors, bevacizumab) when indicated.
• Nutritional status, fitness, and care at specialized centers.

In recurrence, disease can often be controlled for many months or years with tailored combinations of chemotherapy, targeted agents, hormonal therapy, surgery for isolated disease, and symptom-directed radiation.

Screening and Prevention: How to Lower Risk and Catch Problems Early

There is no reliable screening test for ovarian cancer. If you have a strong family history or BRCA mutation, your doctor may advise genetic testing and preventive surgery.

• Screening
  – No proven population screening exists for average-risk individuals. CA-125 and ultrasound have not reduced mortality when used broadly.
• Risk-reducing strategies
  – Genetic counseling and testing for those with relevant family histories or early-onset cases.
  – Risk-reducing salpingo-oophorectomy (removing tubes and ovaries) after childbearing reduces risk and improves survival in BRCA mutation carriers (timing individualized, often between ages 35–45).
  – Opportunistic salpingectomy (removing fallopian tubes) during other benign gynecologic surgeries may reduce risk while preserving ovarian function.
  – Oral contraceptives are associated with reduced lifetime risk; discuss benefits and risks with a clinician.
• Lifestyle and vigilance
  – Maintain a healthy weight, exercise regularly, and avoid smoking.
  – Report persistent bloating, pelvic pain/pressure, early satiety, or urinary changes—especially after menopause.

Recovery, Side Effects, and Follow-Up: What to Expect

• After surgery
  – Expect some abdominal soreness, bloating, and fatigue for days to weeks, depending on surgical extent.
  – Early mobilization, breathing exercises, and nutrition support speed recovery.
  – Bowel function typically normalizes within a few days; your team provides guidance on diet, activity, and wound care.
• During chemotherapy
  – Side effects include fatigue, hair loss, nausea, altered taste, neuropathy (tingling/numbness), and lowered blood counts.
  – Antiemetics, growth factors, dose adjustments, and supportive therapies help maintain comfort and treatment intensity.
  – Many patients can continue light activities and modified work schedules.
• Maintenance therapy
  – PARP inhibitors and/or bevacizumab may continue for months after chemotherapy to help keep cancer controlled.
  – Regular labs and clinic visits monitor side effects (blood counts, blood pressure, kidney function).
• Long-term wellness
  – Pelvic floor physiotherapy, sexual health counseling, and management of menopausal symptoms (if ovaries removed) support quality of life.
  – Nutrition and exercise programs help prevent deconditioning and maintain bone and heart health.
• Follow-up schedule
  – Typically every 3 months for the first 2 years, then every 4–6 months for years 3–5, and annually thereafter, including focused history, exam, and tumor markers/imaging as indicated.
  – Prompt evaluation for new or concerning symptoms between visits.

For International Patients: Seamless Access and Support at Apollo

Apollo Hospitals supports patients with a full team approach—from diagnosis to treatment, recovery, and long-term follow-up. International patients also get help with travel, stay, and follow-up care.

Apollo Hospitals offers end-to-end coordination to help international patients start care quickly and confidently:

• Pre-arrival medical review and preliminary opinion to aid planning and budgeting.
• Priority scheduling with gynecologic oncology, surgical oncology, medical oncology, radiation oncology, genetics, nutrition, physiotherapy, and psychosocial support.
• Assistance with medical visa invitations, airport pickup on request, nearby accommodation guidance, and local transport.
• Interpreter services, written care plans, patient navigators, and culturally sensitive support.
• Transparent estimates, insurance coordination, and assistance with international payments.
• Detailed discharge summaries, treatment records, survivorship plans, and teleconsultations for follow-up with home-country clinicians.

Next Steps

• Seek gynecologic oncology evaluation for persistent bloating, pelvic pain/pressure, early satiety, or urinary changes—especially after menopause or with a strong family history.
• Bring prior imaging, tumor markers, pathology reports, operative notes, medication lists, and family history details to the consultation.
• Ask about the surgical plan (primary vs interval debulking), platinum-based chemotherapy options, eligibility for maintenance therapy (BRCA/HRD status), expected recovery, nutrition and exercise guidance, and an individualized follow-up schedule.
• Discuss genetic testing for self and implications for relatives; consider preventive strategies where appropriate.

With modern treatment, many women live long and active lives after ovarian cancer. Early recognition, expert surgery, and tailored therapy make the biggest difference.

About Apollo Proton Cancer Centre

Apollo Proton Cancer Centre (APCC) is the first proton therapy centre in India. APCC has a fully integrated treatment suite that offers the most advanced treatment in surgical, radiation and medical oncology procedures. True to the Apollo Pillars of Expertise and Excellence, the Centre brings together a powerful team of clinicians renowned globally for cancer care.

At Apollo Proton Cancer Centre (APCC), we combine advanced technology with globally renowned clinical expertise to deliver superior outcomes and improved quality of life to our patients.