This article has been fact-checked by Dr Timothy Lim Yong Kuei, gynecologist at Timothy Lim Clinic for Women & Cancer Surgery, Mount Alvernia Hospital, Singapore.
About the Doctor
Ovarian cancer is one of the most challenging gynaecological cancers because it often develops silently and is diagnosed at an advanced stage. Unlike cervical cancer, there is no widely recommended screening test for women at average risk, making early detection difficult.
However, significant advances in surgery, chemotherapy, targeted therapies, and personalised medicine have improved survival and quality of life for many patients. Modern treatment strategies are increasingly tailored to the individual characteristics of each patient and their tumour.
What Is Ovarian Cancer?
Ovarian cancer begins in the ovaries, fallopian tubes, or the lining of the abdominal cavity (peritoneum). The most common type is epithelial ovarian cancer, which accounts for approximately 90% of cases. Less common types include germ cell tumours and sex cord-stromal tumors, which typically affect younger women.
Several factors increase the risk of ovarian cancer, including:
- Increasing age, particularly after menopause
- A family history of ovarian or breast cancer
- Inherited genetic mutations, especially BRCA1 and BRCA2
- Homologous recombination deficiency (HRD), which affects the body’s ability to repair damaged DNA
- Never having been pregnant and certain reproductive factors
Identifying inherited genetic mutations has become an essential part of ovarian cancer management because it influences both treatment options and family counselling.
What are the Warning Symptoms?
Ovarian cancer symptoms are often subtle and may resemble common digestive or urinary conditions. Women should seek medical evaluation if these symptoms are persistent, frequent, or worsen over several weeks.
Common warning signs include:
- Persistent abdominal bloating
- Feeling full quickly (early satiety)
- Pelvic or lower abdominal pain
- Increased urinary frequency or urgency
- Unexplained weight loss
- Changes in bowel habits
- Fatigue
Recognizing these symptoms early may lead to earlier diagnosis and better treatment outcomes.
How Is Ovarian Cancer Diagnosed?
Diagnosis begins with a thorough medical history and physical examination, including a pelvic examination.
Several investigations help confirm the diagnosis:
- Pelvic ultrasound: Usually the first imaging test used to evaluate ovarian masses.
- Tumor markers: Blood tests such as CA-125 can support the diagnosis, although they are not specific for ovarian cancer.
- CT or MRI scans: These determine the extent of disease and assist in treatment planning.
- Surgical staging: Surgery confirms the diagnosis, determines the stage of cancer, and evaluates disease spread.
- Histopathological examination (HPE): Microscopic examination of tissue provides the definitive diagnosis and identifies the cancer subtype.
Accurate staging is essential because treatment depends heavily on the extent of disease.
What Are the Latest Advances in Treatment?
Treatment has evolved considerably over the past decade, offering more personalized and effective options.
Precision Surgery
Surgery remains the cornerstone of treatment for most women with ovarian cancer. The primary goal is complete removal of all visible disease, known as cytoreductive surgery or debulking surgery. Achieving no visible residual disease is associated with significantly better survival.
For patients with extensive disease who are not suitable for immediate surgery, chemotherapy may be given first, followed by interval debulking surgery to improve surgical outcomes.
Chemotherapy
Platinum-based chemotherapy, usually combining carboplatin with paclitaxel, remains the standard first-line treatment. Most patients receive chemotherapy after surgery, although some begin treatment before surgery depending on disease stage and overall health.
HIPEC
Hyperthermic intraperitoneal chemotherapy (HIPEC) is an emerging treatment for selected patients undergoing interval debulking surgery. Heated chemotherapy is delivered directly into the abdominal cavity during surgery, allowing high drug concentrations to reach microscopic cancer cells while limiting systemic exposure.
Targeted Therapy
Targeted therapies have transformed ovarian cancer treatment.
Bevacizumab (Avastin) blocks the formation of new blood vessels that tumours need to grow. It may be combined with chemotherapy and continued as maintenance therapy in selected patients.
PARP inhibitors have also become an important treatment, particularly for patients with BRCA mutations or HRD-positive tumours, and they help delay disease recurrence after chemotherapy.
Personalised Medicine
Modern ovarian cancer care increasingly relies on molecular profiling. Testing for BRCA mutations and HRD status helps identify patients who are most likely to benefit from targeted therapies, allowing treatment to be tailored to the biology of each individual’s cancer.
Key Takeaways
Ovarian cancer remains a challenging disease because symptoms are often vague and diagnosis frequently occurs at an advanced stage. However, advances in precision surgery, platinum-based chemotherapy, HIPEC, targeted therapies, and personalised medicine have significantly improved patient outcomes.
References
- Tavares, Valéria, et al. “Paradigm shift: a comprehensive review of ovarian cancer management in an era of advancements.” International journal of molecular sciences 25.3 (2024): 1845.
- Coleman, Robert L., et al. “Latest research and treatment of advanced-stage epithelial ovarian cancer.” Nature reviews Clinical oncology 10.4 (2013): 211-224.
- Cortez, Alexander J., et al. “Advances in ovarian cancer therapy.” Cancer chemotherapy and pharmacology 81.1 (2018): 17-38.
- Papageorgiou, Dimitrios, et al. “Management of advanced ovarian cancer: current clinical practice and future perspectives.” Biomedicines 13.7 (2025): 1525.
- Aletti, Giovanni D., et al. “Current management strategies for ovarian cancer.” Mayo Clinic Proceedings. Vol. 82. No. 6. Elsevier, 2007.
