• 2 peaks of presentation - 10-30 age and 6th and 7th decade
  • More than half of patients present in stage 3 and above


Risk factors

  • Nulliparity
  • Obesity
  • Smoking
  • Genetic factors - BRCA gene - 20 - 40% chances



Non specific


  • Bloating
  • Pelvic / abdominal pain
  • Early satiety
  • Urinary symptoms
  • Menstrual disturbances

Present for >12 days a month


What are the tests ?

  • USG abdomen
  • CT scan/MRI
  • Blood markers -
    • CA 125
    • B- HCG
    • Alpha fetoprotein
    • LDH


Types of ovarian cancer



Epithelial ovarian carcinomas


  • Most common
  • Usually Occurs in post menopausal age
  • Serous, mucinous, endometroid and clear cell


Germ cell tumors


  • 10- 30 age group
  • Dysgerminomas, teratomas, embryonal tumors and yolksac tumors
  • Candidates for fertility sparing surgery


Sex cord stromal tumors


  • 15-30 age group
  • Granulosa cell tumors, Sertoli Leydig tumors
  • Symptoms of hormonal production – hirsutism, virilization, precocious puberty or menstrual changes
  • Candidates for fertility sparing surgery


What are the stages ?

In what way ca ovary is different from others ?

  • Usual spread is through blood / lymphatics
  • Ca ovary – spreads as single cell/ spheroids in peritoneum and omentum
  • Detailed examination and removal is very essential part of surgery.
  • Fluid collection in abdomen (ascites )is common in advanced stages


Treatment of ovarian cancer?

  • Surgery is the main modality in planning for cure
  • Surgery should ensure complete removal of all the disease. (R0 resection)
  • To be done by a qualified cancer surgeon as there is no alternative for good surgery.
  • Chemotherapy is given based on stage of the disease


What is the surgery done?

Cancer in young


  • Fertility sparing surgery.
  • Possible in stage 1 epithelial tumors, germ cell and sex cord stromal tumors
  • Tumor with ovary is removed with surgical staging
  • Uterus and normal ovary is left


Cancer in elderly


  • Removal of uterus with ovaries
  • Omentum
  • Pelvic and paraaortic nodes
  • Peritoneal sampling/removal
  • Bowel and any other viscera if involved


What is CRS+HIPEC? 

  • Done in advanced cases as upfront surgery or after giving chemotherapy
  • Also an option in recurrent cases
  • Has better chances of cure than traditional surgery and chemotherapy
  • Involves surgery to remove all cancer from the abdominal cavity
  • Chemotherapy is circulated inside the abdominal cavity at higher temperature 41 c for around 90 min
  • This takes care of cancer cells which are not visible to naked eye.


What is ca 125 ?

  • It’s a tumor marker used in management of ca ovary
  • It’s a supportive test and not confirmatory
  • Once the treatment is finished, follow up is done with ca125 levels.
  • Rising levels suggests a recurrence.


What to do if cancer comes back ?

  • The chance of cancer coming back is determined by tumor biology and stage of cancer
  • Cure is still possible if surgery can be done to remove all of recurrent cancer
  • If not, chemotherapy is given to control the disease.


Is there any way to detect or prevent the ovarian cancer ?

  • No screening method is approved for routine use
  • No effective measures to prevent the cancer
  • In patients with genetic predisposition - BRCA gene


Take home message

Proper treatment with team of oncologists is the corner stone for chance of cure

No alternative for complete surgery