Ovarian cancer

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 17 Feb 2026

Topic last updated: 20 Feb 2026

Epithelial ovarian cancer is the most common histologic subtype of ovarian cancer, and is the primary focus of this topic.

Patients often present with vague, nonspecific symptoms such as abdominal bloating, early satiety, and dyspepsia (suggestive of upper abdominal disease). Other symptoms are more suggestive of pelvic disease, such as pelvic pain, abdominal or pelvic pressure, low back pain, and urinary urgency.

Women with a suspicious pelvic mass should be referred to a gynecologic oncologist for further evaluation.

Definitive diagnosis typically entails pathologic analysis of a surgical specimen. Fine-needle aspiration (FNA) is not routinely recommended for definitive diagnosis as this procedure can disseminate tumor cells into the peritoneal cavity.

Surgery is typically required for definitive diagnosis, staging, and tumor debulking.

Adjuvant chemotherapy may be required to eradicate residual disease following debulking surgery. Bevacizumab and/or a poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitor may be considered for maintenance therapy following initial treatment.

Definition

The primary focus of this topic is epithelial ovarian cancer, the most common histologic subtype of ovarian cancer (accounting for approximately 90% of cases).[1]

Epithelial ovarian cancer develops when there is malignant transformation of the epithelium covering the ovarian capsule and distal fallopian tube.[2][3][4] The epithelium covering the ovary and fallopian tubes consists of the same epithelial cells that line the peritoneal cavity. Thus, epithelial ovarian cancer and primary peritoneal cancer occur via the same pathophysiology and are treated with the same basic principles.

For the purpose of this topic, ovarian cancer also refers to fallopian tube cancer and primary peritoneal cancer.

Nonepithelial ovarian cancers (e.g., germ cell tumors and sex cord stromal tumors) are not specifically addressed in this topic.

History and exam

Key diagnostic factors

pelvic mass
ascites
pleural effusion

Full details

Other diagnostic factors

gastrointestinal symptoms
urinary urgency or frequency
symptom duration >3 months
abdominal distention
pelvic/abdominal pain or pressure

Full details

Risk factors

genetic mutations associated with hereditary ovarian cancer
increasing age
family history of ovarian, breast, and/or other cancers
never used combined oral contraceptives
nulliparity
obesity
hormone therapy
endometriosis

Full details

Diagnostic tests

1st tests to order

pelvic ultrasound
CA-125
histopathology

Full details

Tests to consider

genetic testing
MRI
CT scan
fluorodeoxyglucose (FDG) PET-CT or FDG PET-MRI
biomarker tests

Full details

Treatment algorithm

ACUTE

surgical candidate, intraoperative histology confirmed disease

poor surgical candidate, biopsy confirmed disease

ONGOING

platinum-sensitive recurrent disease

platinum-resistant recurrent or refractory disease

Contributors

作者

Sareena Singh, MD

Gynecologic Oncologist

Aultman Medical Group

Northeast Ohio Medical University

Canton

利益声明

SS declares that she has no competing interests.

鸣谢

Dr Sareena Singh would like to gratefully acknowledge Dr Justin C. Chura and Dr Allison E. Axtell, previous contributors to this topic.

利益声明

JCC and AEA declare that they have no competing interests.

同行评议者

Michael P. Hopkins, MD, MEd

Chairman

Obstetrics and Gynecology

Northeast Ohio Universities of Medicine (NEOMED)

Rootstown

利益声明

MPH declares that he has no competing interests.

Ritu Salani, MD

Gynecologic Oncology Fellow

Johns Hopkins Medical Institutions

Baltimore

利益声明

RS declares that she has no competing interests.

Susan A. Davidson, MD

Associate Professor

Chief, Gynecologic Oncology

Department of Obstetrics & Gynecology (UCD)

University of Colorado Cancer Center

Aurora

利益声明

SAD declares that she has no competing interests.

Khadra Galaal, MBChB, MPH, MRCOG

Consultant Gynaecological Oncologist

Northern Gynaecological Oncology Centre

Queen Elizabeth Hospital

Gateshead

利益声明

KG is co-author of a systematic review of follow-up strategies after primary treatment in ovarian cancer. This is not referenced in this topic.

Jill Tseng, MD

Assistant Clinical Professor of Gynecologic Oncology

University of California, Irvine

Orange

利益声明

JT declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: ovarian cancer including fallopian tube cancer and primary peritoneal cancer [internet publication].全文

González-Martín A, Harter P, Leary A, et al. Newly diagnosed and relapsed epithelial ovarian cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023 Oct;34(10):833-48.全文摘要

Gaillard S, Lacchetti C, Armstrong DK, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: ASCO guideline update. J Clin Oncol. 2025 Mar;43(7):868-91.全文摘要

Renz M, Friedlander M, Berek JS. Cancer of the ovary, fallopian tube, and peritoneum: 2025 update. Int J Gynaecol Obstet. 2025 Sep;171(suppl 1):6-35.全文摘要

Tew WP, Lacchetti C, Kohn EC, et al. Poly(ADP-Ribose) polymerase inhibitors in the management of ovarian cancer: ASCO guideline rapid recommendation update. J Clin Oncol. 2022 Nov 20;40(33):3878-81.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Irritable bowel syndrome (IBS)
- Metastases to the ovary
- Endometriosis
更多鉴别诊断
指南
- ACR appropriateness criteria: staging and follow-up of ovarian cancer
- Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: ASCO guideline update
更多指南
患者教育信息
Ovarian cancer: what is it?
Ovarian cancer: what are the treatment options?
更多患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明

Ovarian cancer

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

surgical candidate, intraoperative histology confirmed disease

poor surgical candidate, biopsy confirmed disease

platinum-sensitive recurrent disease

platinum-resistant recurrent or refractory disease

Contributors

作者

Sareena Singh, MD

利益声明

鸣谢

利益声明

同行评议者

Michael P. Hopkins, MD, MEd

利益声明

Ritu Salani, MD

利益声明

Susan A. Davidson, MD

利益声明

Khadra Galaal, MBChB, MPH, MRCOG

利益声明

Jill Tseng, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录后可浏览 BMJ Best Practice 临床实践完整内容