Ovarian cancer

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

Last reviewed: 9 Apr 2025

Last updated: 12 Mar 2025

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.

Biopsy and fine-needle aspiration of an ovarian mass are not routinely recommended. These procedures can disseminate tumor cells into the peritoneal cavity, and are prone to sampling error and potential bleeding complications.

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 cancer, breast cancer, colorectal cancer, and/or endometrial cancer
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
PET, PET-CT, or PET/MRI
MRI
CT scan
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

Authors

Sareena Singh, MD

Gynecologic Oncologist

Aultman Medical Group

Northeast Ohio Medical University

Canton

Disclosures

SS declares that she has no competing interests.

Acknowledgements

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

Disclosures

JCC and AEA declare that they have no competing interests.

Peer reviewers

Michael P. Hopkins, MD, MEd

Chairman

Obstetrics and Gynecology

Northeast Ohio Universities of Medicine (NEOMED)

Rootstown

Disclosures

MPH declares that he has no competing interests.

Ritu Salani, MD

Gynecologic Oncology Fellow

Johns Hopkins Medical Institutions

Baltimore

Disclosures

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

Disclosures

SAD declares that she has no competing interests.

Khadra Galaal, MBChB, MPH, MRCOG

Consultant Gynaecological Oncologist

Northern Gynaecological Oncology Centre

Queen Elizabeth Hospital

Gateshead

Disclosures

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

Disclosures

JT declares that she has no competing interests.

References

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.

Key articles

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

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.Full text Abstract

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.Full text Abstract

Berek JS, Renz M, Kehoe S, et al. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):61-85.Full text Abstract

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.Full text Abstract

Reference articles

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

Differentials
- Irritable bowel syndrome (IBS)
- Metastases to the ovary
- Endometriosis
More Differentials
Guidelines
- Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: ASCO guideline update
- Ovarian epithelial, fallopian tube, and primary peritoneal cancer treatment
More Guidelines
Patient information
Ovarian cancer: what is it?
Ovarian cancer: what treatments work?
More Patient information
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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

Authors

Sareena Singh, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Michael P. Hopkins, MD, MEd

Disclosures

Ritu Salani, MD

Disclosures

Susan A. Davidson, MD

Disclosures

Khadra Galaal, MBChB, MPH, MRCOG

Disclosures

Jill Tseng, MD

Disclosures

References

Key articles

Reference articles

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

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice