Cancer that develops in the ovaries (the egg-producing reproductive organs) is referred to as ovarian cancer. There are three types of ovarian cancer. Each type has differences in how they will respond to treatment.

The most common type of ovarian cancer is epithelial ovarian carcinoma. The other two types are germ cell tumors and stromal tumors.

Detecting the differences among the types can help healthcare providers accurately diagnose ovarian cancer and find the most appropriate treatment. Knowing what type of ovarian cancer they have can give people a clearer understanding of their condition and possible outcomes.

1. Epithelial Ovarian Carcinoma

Epithelial ovarian carcinoma is the most common type of ovarian cancer. About 90% of all ovarian cancers being epithelial. It starts in the epithelial cells that cover the outer surface of the ovaries. The different subtypes of epithelial ovarian cancer are:

• Serous
• Mucinous 
• Endometrioid
• Clear cell

Epithelial ovarian cancer is also classified by grade. The grade signifies the abnormal appearance of these cancer cells compared to normal cells, as follows:

• Low-grade (grade 1) cancers look more like normal cells and tend to grow slowly.
• High-grade (grade 3) cancers look very different from normal cells and grow faster.

Understanding the subtype and grade helps providers decide on the best treatment plan.

Serous is the most common subtype and is classified into one of the two grades. Mucinous, endometrioid, and clear cell cancers are less common and have unique characteristics and treatments.

2. Germ Cell Tumors

Germ cell tumors are a less common type of ovarian cancer. They are most often found in teenagers and young adults. These tumors start in the cells of the ovaries that develop into eggs.

Types of germ cell tumors in order of most to least common are:

• Dysgerminoma
• Yolk sac tumor
• Malignant teratoma
• Mixed germ cell tumor
• Embryonal carcinoma
• Choriocarcinoma

As with other ovarian cancers, germ cell tumors are graded based on how they look under a microscope. Low-grade tumors grow more slowly and may not spread as quickly. High-grade tumors grow faster and may spread to other parts of the body. This information can help determine the best treatment.

3. Stromal Tumors

Stromal tumors are a rare type of ovarian cancer that starts in the connective tissue cells that hold the ovary together and produce sex hormones, namely estrogen. These cancers tend to be slow-growing and are most often diagnosed at an earlier stage.

Although these tumors can happen at any age, they are more common people over 50. Since stromal tumors often make sex hormones like estrogen or testosterone, they can cause unusual symptoms, such as abnormal bleeding or changes in hair growth.

Subtypes of malignant (cancerous) stromal tumors are:

• Granulosa cell tumors
• Sertoli cell tumors
• Sertoli-Leydig cell tumors

Granulosa cell tumors usually grow slowly and can often be treated with surgery alone. Sertoli-Leydig cell tumors are rare and can sometimes produce androgen hormones (such as testosterone), leading to symptoms like a deeper voice or extra facial hair.

Symptoms of Ovarian Cancer (Regardless of Type)

Ovarian cancer is often difficult to detect in its early stages because its symptoms are often mild or mistaken for other common health issues. Many people do not realize something is wrong until the cancer has grown or spread.

Paying attention to your body, recognizing unusual or persistent symptoms, and reporting them to a healthcare provider can help with early detection and treatment. Ovarian cancer symptoms can include:

• Persistent bloating or abdominal swelling
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Frequent or urgent urination
• Unexplained weight loss
• Fatigue
• Changes in bowel habits, such as constipation or diarrhea
• Irregular menstrual cycles or postmenopausal bleeding
• Back pain or pressure in the lower abdomen
• Pain during intercourse

Diagnosis and Testing

A variety of tests can be used to diagnose ovarian cancer. If a person has symptoms or a family history of ovarian cancer, the provider may start with a physical exam and ask about their health history.

Pelvic Exam

One of the first tests is a pelvic exam, during which the provider manually checks the ovaries and other nearby organs, such as the uterus, for lumps or swelling. 

Imaging Studies

An ultrasound is commonly used to evaluate the ovaries. Ultrasound uses sound waves to create images of the ovaries. This can help determine if there is any abnormal growth. Ultrasounds can be performed on the abdomen, through the vagina (transvaginal ultrasound), or both. 

Additional imaging studies can include a computed tomography (CT) scan, magnetic resonance imaging (MRI), and positron-emission tomography (PET). These imaging studies provide a more detailed picture of the cancer and can determine if the cancer has spread to other areas of the body. 

Blood Tests

A blood test called the CA-125 test may be ordered. This test looks for a protein that can be elevated in people with ovarian cancer. However, other health conditions can also raise CA-125 levels, so this alone isn’t enough to diagnose ovarian cancer. 

Additional tumor markers are:

• Alpha fetoprotein (AFP)
• Human chorionic gonadotropin (HCG)
• Lactate dehydrogenase (LDH)
• Carcinoembryogenic antigen (CEA)

Biopsy

Ultimately, a biopsy is needed to confirm a diagnosis of ovarian cancer definitively. During a biopsy, a sample of tissue is evaluated in the lab for the presence of cancer cells. With ovarian cancer, the tumor sample is usually obtained when the tumor is surgically removed.

The sample may be genetically tested to identify specific characteristics of the cancer. After the biopsy results are known, a final treatment plan can be determined. 

Early diagnosis is important because ovarian cancer is easier to treat when found early. If you have symptoms or a high risk of ovarian cancer, talk to a healthcare provider about testing options.

Treatment Options for Different Types

Treatment for ovarian cancer depends on the type, grade, and stage of the disease. Here are the common treatments for each type.

Epithelial Ovarian Cancer

Ovarian cancer is often treated with surgery. A surgeon removes the cancer and any affected organs, such as the ovaries, fallopian tubes, uterus, or other nearby tissue.

After surgery, chemotherapy is often used. This treatment uses strong medicines to kill actively dividing cells (like cancer cells) and help keep the cancer from coming back.

Some people may also get targeted therapy, which uses special medicines, like poly (ADP-ribose) polymerase (PARP) inhibitors, to attack specific changes in cancer cells. This is especially helpful for people with breast cancer gene (BRCA) mutations.

Another treatment is immunotherapy, which helps the body’s immune system fight the cancer more effectively.

Germ Cell Tumors

The main treatment for germ cell tumors is surgery, with a focus on preserving fertility, if possible, as this disease is often found in younger people. Following surgery, further treatment depends on the exact subtype of cancer and its characteristics. Postoperative treatment can include chemotherapy or surveillance.

Chemotherapy frequently is given after surgery. BEP (bleomycin, etoposide, cisplatin) is the most common chemotherapy regimen.

Stromal Tumors

Surgery is often the primary treatment, particularly for slow-growing tumors. By removing the tumor, healthcare providers aim to eliminate as much of the cancer as possible. In some cases, additional treatments may be necessary to prevent recurrence or to manage any remaining cancer cells.

Hormone therapy is another option, especially for stromal tumors that produce excess hormones. Certain medications can help block these hormones, slowing the cancer’s growth. Chemotherapy may also be prescribed, particularly if the cancer is advanced or has spread to other parts of the body.

Each patient’s treatment plan is tailored to their specific condition, taking into account their overall health and the type of cancer they have. Some individuals may also participate in clinical trials, accessing new and potentially effective treatments.

Prevention and Risk Reduction

Although ovarian cancer cannot always be prevented, there may be ways to help lower the risk, such as:

• Taking birth control pills for five or more years may also reduce the risk of ovarian cancer. However, these pills are not appropriate for everyone, so it’s important to talk to a provider to determine if it’s safe for you.
• Pregnancy and breastfeeding may help lower the risk.
• Healthy lifestyle choices, such as eating a balanced diet, staying active, and maintaining a healthy weight, may help reduce risk. Avoiding smoking and limiting alcohol can improve overall health and reduce cancer risk.
• Regular checkups with a healthcare provider are also important. Going for routine exams and reporting any unusual symptoms early may lead to earlier detection and better treatment outcomes.
• Genetic testing and counseling is important if ovarian cancer runs in your family. Genetic testing can check for gene mutations like BRCA1 and BRCA2. Talking to a genetic counselor can help you understand your risk and possible ways to lower it.
• Surgery to remove the ovaries and fallopian tubes (called prophylactic oophorectomy) can lower the chance of developing ovarian cancer in people with a high genetic risk.

When to See a Provider

If symptoms do not go away or it they worsen over time, it is important to see a healthcare provider. Bloating, stomach pain, trouble eating, or changes in bathroom habits lasting more than a few weeks should not be ignored. Even if the symptoms seem mild, getting checked early can help find problems sooner.

You should also see a provider if you have a family history of ovarian cancer or other related cancers. If genetic tests show that you have a higher risk, your provider can talk to you about ways to lower it. Regular checkups and talking to a healthcare provider about any changes in your body are good steps to staying healthy.

Summary

Ovarian cancer starts in the ovaries and has different types, with epithelial ovarian cancer being the most common. Symptoms can be mild or mistaken for other issues, making early detection difficult.

Healthcare providers use exams, imaging tests, and biopsies to diagnose ovarian cancer. Treatment often includes surgery, chemotherapy, and sometimes targeted therapy or immunotherapy.

While ovarian cancer cannot always be prevented, genetic testing, birth control pills, pregnancy, and a healthy lifestyle may help lower the risk. Regular checkups and paying attention to unusual symptoms can provide early detection and improve treatment outcomes.