Ovarian cancer, also known as ovarian carcinoma, is the second most common cancer of the female reproductive organs and is unfortunately one of the most aggressive types of tumor. In Germany, around 8,000 women are diagnosed with ovarian cancer every year. The average age of diagnosis is 68. Around one in 75 women will be affected by ovarian cancer during their lifetime.

In ovarian cancer, the cells of one or both ovaries, the female reproductive organs responsible for the production of eggs and hormones, become malignant and grow uncontrollably. Various cell types can be affected, but most commonly it is tumors that arise from the uppermost cell layers, known as epithelial tumors.

One challenge with this type of cancer is that it often causes no symptoms for a long time and therefore provides no indication of an existing disease. Due to their anatomical location, ovarian tumors have plenty of room to grow unnoticed before causing symptoms. Therefore, the earlier it is detected, the better the chances of recovery.

The exact cause of ovarian cancer is often unclear, but certain risk factors such as older age, family history of cancer, late pregnancies, and hormone therapies can increase the risk.

Some known risk factors are:

• Family history: Women whose close relatives (mother, sister, or daughter) have had ovarian cancer are at higher risk of developing this type of cancer themselves. A family history of breast cancer can also increase the risk, as certain gene mutations increase the risk of both breast and ovarian cancer.
  
  
• Genetic mutations: Certain genetic mutations, particularly BRCA1 and BRCA2 mutations, are associated with an increased risk of ovarian cancer. Women who carry these mutations have a significantly increased risk of ovarian cancer.
  
  
• Age: The risk of ovarian cancer increases with age. Women over the age of 50 are at higher risk.
  
  
• Fertility: Women who have never been pregnant or who became pregnant late in life have a slightly increased risk of ovarian cancer.
  
  
• Hormone replacement therapy (HRT): Long-term use of hormone replacement therapy after menopause may slightly increase the risk of ovarian cancer.

However, the presence of one or more of these risk factors does not necessarily mean that a woman will develop ovarian cancer. Many women with these risk factors never develop ovarian cancer, while some women without any apparent risk factors may develop the disease.

Nevertheless, women who are concerned about their personal risk of ovarian cancer should discuss this with their doctor. Early detection and regular screening can help minimize the risk and detect the disease at an early stage.

Ovarian cancer does not cause any symptoms for a long time. Symptoms usually only appear at an advanced stage and are often very unspecific. However, there are signs that women should always pay attention to and which warrant a visit to a gynecologist. This is especially true if the symptoms have only recently appeared, are more intense than normal menstrual cramps, and if several symptoms occur at the same time.

Symptoms that should be taken seriously include:

• Unclear pain or discomfort in the abdomen
• Non-specific digestive problems, bloating, and flatulence
• Increase in abdominal girth without weight gain
• More frequent urination than usual
• Bleeding outside of the menstrual cycle or after menopause
• Persistent fatigue and reduced performance

Of course, all of these symptoms can also be harmless and have completely different causes. In any case, however, cancer should be ruled out if the symptoms do not disappear on their own within a short period of time. 

Early detection of cancer offers good treatment options and prospects for recovery, especially in the case of ovarian cancer. If ovarian cancer is suspected, a comprehensive diagnosis is made, often consisting of a combination of imaging, blood tests, and tissue sampling. Often, the exact stage and spread of the tumor can only be assessed during surgery.

Surgery

Surgery is almost always the basis of treatment for ovarian cancer. The procedure is usually a major operation in the abdominal cavity, performed under general anesthesia. What is special about this operation is that it serves both as treatment and further diagnosis, helping to determine the stage of the tumor, known as staging. Often, doctors can only assess during the operation whether the disease is localized or has already spread further.

Ovarian cancer is classified according to the spread of the tumor:

• A localized tumor (stage I–II) grows only in one ovary or both ovaries or is confined to the reproductive organs in the pelvis.
• An advanced tumor (stage III–IV) has spread to other organs in the pelvis or abdominal cavity or has metastasized to more distant organs in the body.

In all cases, the goal of surgery is to remove the tumor as completely as possible. The removed tissue is then examined histologically. This also involves analyzing how much the cancer cells differ from normal tissue. The so-called grading indicates how much the cancer cells differ from normal tissue: the less differentiated a tumor is, the more it differs from normal tissue and the more malignant it is.

In patients with early ovarian cancer, the ovary affected by the tumor and the associated fallopian tube are removed. If the ovarian cancer is advanced, the surgery is more extensive and it may also be necessary to remove affected surrounding organs or parts of organs, such as parts of the intestine. Advanced ovarian cancer often forms distant metastases in the brain, lungs, liver, spleen, lymph nodes, and bones.

Chemotherapy

In addition, patients with advanced tumors usually receive chemotherapy after surgery. This is intended to inhibit the growth of the cancer and kill metastases in the body. However, most patients with early ovarian cancer also receive chemotherapy. Many women are afraid of the side effects of chemotherapy, such as hair loss, fatigue, or severe nausea. However, many of these side effects can now be treated effectively and significantly alleviated by supportive measures.

Radiation therapy is used relatively rarely for ovarian cancer.

The treatment of ovarian cancer has made some progress in recent years, and new approaches to therapy have been explored.

Here are some of them:

Immunotherapy is a promising approach in cancer treatment that is also being investigated for ovarian cancer. This involves activating the patient’s immune system to fight the cancer cells. Monoclonal antibodies such as pembrolizumab and avelumab are examples of immunotherapies that are being considered for certain forms of ovarian cancer.

• PARP inhibitors are drugs used in women with BRCA mutations and ovarian cancer. These drugs, which include olaparib, rucaparib, and niraparib, block a repair protein in cancer cells and can inhibit their growth.
• Targeted therapy targets specific molecules or signaling pathways involved in the growth of cancer cells. Bevacizumab is an example of a targeted drug used in the treatment of ovarian cancer that inhibits blood supply to tumors.
• Advances in minimally invasive surgery and robotics have expanded the possibilities for surgical procedures for ovarian cancer. This can lead to shorter recovery times and fewer post-operative complications.
• The combination of different therapeutic approaches such as chemotherapy, targeted therapies, and immunotherapy is being intensively researched to increase the effectiveness of treatment.
• Work is underway to develop biomarkers and imaging technologies, but there is currently no “true” early detection of ovarian cancer. Nevertheless, women, especially those of advanced age, should continue to have the recommended annual pelvic exam.

The treatment of ovarian cancer depends heavily on individual factors, including the stage of the disease, the type of tumor, and the patient’s genetic characteristics. The decision on the appropriate therapy should therefore be made in close consultation between the patient and her medical team. It is also important that women at increased risk for ovarian cancer undergo regular screening to detect the disease at an early stage.