Ovarian cancer

Ovarian cancer is a disease in which abnormal cells in or around the ovaries begin to grow and multiply in a way the body cannot control. The ovaries are two small organs, roughly the size of an almond, that sit on either side of the womb (uterus). They release eggs and produce the hormones oestrogen and progesterone.

Although we say "ovarian" cancer, doctors now understand that many of these cancers actually begin in the fallopian tubes (the thin tubes that carry eggs from the ovaries to the womb) or in the peritoneum (the thin lining of the inside of the abdomen). Because cancers that start in the ovary, fallopian tube, or peritoneum behave in a very similar way and are treated the same way, they are usually grouped together.

Ovarian cancer mostly affects women over the age of 50, and it can affect anyone who has ovaries. It is uncommon in younger women. The reason it has a reputation for being serious is that it often causes only vague symptoms at first, so it can be found at a later stage than some other cancers. That said, treatment has improved a great deal, and when the disease is found early it is often very treatable. The death rate from ovarian cancer has fallen substantially over recent decades thanks to better surgery and better drugs.

Ovarian cancer is not a single disease. Doctors classify it by the kind of cell the cancer started in, because this affects how it behaves and how it is treated. Knowing your exact type helps your medical team choose the right plan.

• Epithelial ovarian cancer. This is by far the most common type. It begins in the layer of cells that cover the outer surface of the ovary or the lining of the fallopian tube or abdomen. Within this group there are further subtypes (such as high-grade serous, low-grade serous, endometrioid, clear cell, and mucinous), which a pathologist (a doctor who examines tissue under a microscope) identifies.
• Germ cell tumours. These start in the cells that would normally develop into eggs. They are rare and tend to occur in younger women and teenagers. Many germ cell cancers respond very well to treatment.
• Stromal tumours. These begin in the supporting tissue of the ovary that produces hormones. They are also uncommon and are sometimes found earlier because they can cause hormone-related symptoms.
• Borderline tumours. These are abnormal growths that are not fully cancerous. They grow slowly, rarely spread, and usually have a good outlook, though they still need treatment and follow-up.

Fallopian tube cancer and primary peritoneal cancer are closely related to epithelial ovarian cancer and are managed in the same way.

In most cases, no one can say exactly why a particular person develops ovarian cancer, and the precise cause is not fully understood. Having one or more risk factors does not mean you will get the disease, and many people with ovarian cancer have no obvious risk factors at all. It is also important to know that ovarian cancer is not infectious and is not something you caused.

Factors that can increase risk include:

• Getting older. Risk rises with age, and the disease is most common after the menopause. About half of women diagnosed are 63 or older.
• Inherited gene changes. Faults in the BRCA1 or BRCA2 genes raise risk noticeably. So can Lynch syndrome (an inherited condition that also raises the risk of bowel and womb cancer) and some less common gene changes such as RAD51C, RAD51D, BRIP1, and PALB2.
• Family history. Having a close relative (mother, sister, or daughter) who had ovarian or breast cancer can increase your risk, even without a known gene fault.
• Endometriosis, a condition where tissue similar to the womb lining grows elsewhere.
• Hormone therapy after the menopause, never having been pregnant, having children later in life, being overweight, and being tall have each been linked with a modest increase in risk.

Some things are linked with a lower risk, including having taken the combined contraceptive pill for several years, pregnancy, breastfeeding, and having had your tubes tied (tubal ligation). You should never start or stop a medicine for cancer-prevention reasons without talking to your doctor.

The tricky thing about ovarian cancer is that its symptoms are common, vague, and often caused by far less serious problems such as digestive upset. This is exactly why it can be missed. The symptoms to be aware of include:

• Persistent bloating, or a swollen tummy
• Feeling full quickly when eating, or loss of appetite
• Pain or discomfort in the lower tummy or pelvis (the area between your hips)
• Needing to pee more often or more urgently than usual
• Changes in bowel habits, such as constipation
• Feeling very tired, unexplained weight loss, or, less commonly, abnormal vaginal bleeding

The key signal is when these symptoms are new for you, happen frequently (roughly more than 12 times a month), and do not go away. Bloating that comes and goes with your meals or your period is rarely a sign of cancer.

See a doctor if you have these persistent symptoms, especially if you are over 50 or have a family history of ovarian or breast cancer. Most people with these symptoms will not have cancer, but getting checked early matters, because finding ovarian cancer at an earlier stage usually makes it more treatable. Asking for a check is sensible, not an over-reaction.

This is an honest and important point: there is no reliable screening test for ovarian cancer for women at average risk, and no country runs a national screening programme for it the way many do for breast or cervical cancer.

Two tests have been studied closely: a blood test called CA-125 (a protein that can be raised in ovarian cancer) and a transvaginal ultrasound (a scan using a small probe). A very large UK trial (UKCTOCS) found that, although these tests could sometimes detect cancer earlier, screening did not save lives in the general population, and both tests produce many false alarms. CA-125 can be raised by harmless conditions such as endometriosis, fibroids, infection, or even menstruation, and a normal result does not rule cancer out.

The situation is different for women at high risk because of an inherited gene fault or strong family history. They should be referred to a genetics service. Depending on their situation, options may include regular CA-125 monitoring (sometimes every few months) and, more importantly, risk-reducing surgery to remove the ovaries and tubes once a woman has finished having children. Because screening is limited, the best "early detection" tool for everyone else is simply knowing the symptoms and getting persistent ones checked promptly.

If your doctor suspects ovarian cancer, they will usually start with simple steps and move on to more detailed tests. Reaching a clear diagnosis can take a little time, and it is normal to feel anxious during this period.

• Examination and history. Your doctor will ask about your symptoms and may perform an internal (pelvic) examination to feel for any lumps or swelling.
• Blood tests. A CA-125 blood test may be done. Younger women may have additional blood markers checked, as some rarer tumour types produce different proteins.
• Ultrasound scan. Often a transvaginal ultrasound, to look closely at the ovaries.
• CT, MRI, or PET scans. These detailed pictures help show whether and where the cancer has spread, which guides surgical planning.
• Biopsy or surgery. A firm diagnosis requires looking at the cells themselves under a microscope. Sometimes this is done by taking a tissue or fluid sample; often the diagnosis is confirmed during the operation to treat the cancer.

If cancer is confirmed, doctors work out its stage (how far it has spread) and grade (how abnormal the cells look). Staging runs from Stage I (confined to the ovary or tube) through Stage II (spread within the pelvis), Stage III (spread to the abdominal lining or nearby lymph nodes), to Stage IV (spread to distant organs such as the lungs or liver). Stage and grade together shape the treatment plan and what to expect.

Treatment is planned by a multidisciplinary team, a group of specialists who meet to agree on the best approach for you. This typically includes a gynaecological oncologist (a surgeon specialising in cancers of the female reproductive organs), a medical oncologist (a cancer-drug specialist), a pathologist, a radiologist, and specialist nurses. The two main treatments for most ovarian cancers are surgery and chemotherapy, usually used together.

Surgery

Surgery aims to remove as much cancer as possible, an approach called debulking or cytoreduction. Depending on the stage, this may mean removing both ovaries and tubes, the womb, and the fatty apron of tissue in the abdomen (the omentum), along with any other affected tissue. Removing as much disease as possible improves how well later treatments work. In selected younger women with very early disease who wish to preserve fertility, more limited surgery is sometimes possible. Your surgeon will explain what is realistic in your case.

Chemotherapy

Chemotherapy uses medicines that kill cancer cells. It is often given after surgery to treat any remaining cells, and sometimes before surgery (called neoadjuvant chemotherapy) to shrink the cancer first. Common drugs include carboplatin and paclitaxel, usually given through a drip over several cycles.

Targeted and other therapies

Newer medicines target specific features of cancer cells. These include PARP inhibitors such as olaparib and niraparib (tablets that can help keep certain cancers, especially BRCA-related ones, under control after chemotherapy) and bevacizumab (a drug that limits a tumour's blood supply). Hormone therapy is used for some types, and radiotherapy is used only occasionally, mainly to ease symptoms. Supportive (palliative) care, which focuses on comfort, symptom relief, and quality of life, is valuable at any stage, not only late on.

It is natural to want to know "what does this mean for me?" The honest answer is that outlook depends on many things, including the type of cancer, its stage and grade when found, how much can be removed by surgery, your gene status, and your general health. No statistic can predict what will happen for any single person, and the figures below are population averages, not a prediction for you.

To give a sense of scale, the American Cancer Society reports 5-year relative survival figures for invasive epithelial ovarian cancer based on how far the cancer had spread when it was found: around 92% when the cancer is still localised to the ovary, around 71% when it has spread regionally, and around 32% when it has spread to distant parts of the body, with about 51% across all stages combined. "Relative survival" compares people with the cancer to people without it.

Two things are worth holding onto. First, these numbers come from people diagnosed years ago and may not reflect today's improved treatments, so the real outlook for someone diagnosed now may be better. Second, these are group averages, and your specialist, who knows your specific situation, is the right person to discuss your individual outlook with you. Treatments continue to improve, and the overall death rate from ovarian cancer has fallen significantly over the past few decades.

Life during and after ovarian cancer treatment involves more than the medical side. Many people find the emotional impact as significant as the physical one, and support is available and worth asking for.

After treatment, you will have regular follow-up appointments. These usually involve a chat about how you feel, an examination, and sometimes CA-125 blood tests or scans. The purpose is to check your recovery and to spot any sign that the cancer has come back. If ovarian cancer does return, it can often still be treated, frequently with further chemotherapy or targeted drugs, so the goal becomes controlling the disease and maintaining quality of life.

Practical things that can help include eating well, gentle activity as your energy allows, managing fatigue by pacing yourself, and leaning on family, friends, or a support group. If your surgery brought on an early menopause, your team can discuss ways to manage symptoms. Many hospitals have specialist nurses and counsellors, and patient charities offer information and someone to talk to. Asking questions and writing them down before appointments helps you stay in control of your care.

If you are considering treatment in another country, it helps to understand what shapes the overall cost so you can plan and compare fairly. We do not list prices here because every case is genuinely different; instead, we arrange a personalised estimate after reviewing your situation.

The main factors that affect the cost and scope of ovarian cancer care include:

• The stage and type of cancer, which determine how extensive surgery needs to be
• The type of operation (for example, the complexity of debulking surgery) and whether it is open or keyhole
• The number of chemotherapy cycles and which drugs are used
• Whether targeted therapies such as PARP inhibitors are part of the plan, and for how long
• The diagnostic tests needed (scans, blood tests, pathology, and any genetic testing)
• Length of hospital stay and any need for intensive care
• Accommodation, translation, and travel for you and a companion

To prepare, gather your medical records into one folder: previous scan images and reports, biopsy or pathology results, blood test results including any CA-125 values, a list of your current medicines, and a written summary from your current doctor. Clear, complete records let an overseas team review your case accurately and give a realistic plan and estimate before you travel. A free consultation is the simplest way to begin this review.

Turkiye has become a well-established destination for international patients seeking cancer care, with large hospitals that treat patients from many countries, experienced surgical and oncology teams, and services designed to support people travelling from abroad. As with anywhere, the most important thing is to choose carefully and verify the details rather than rely on reputation alone.

When evaluating a centre, it is reasonable to check the following:

• Accreditation. Look for recognised quality accreditation, such as Joint Commission International (JCI), which assesses hospitals against international safety and quality standards.
• A genuine multidisciplinary team. Ovarian cancer is best managed by a team that includes a gynaecological oncology surgeon, medical oncologist, pathologist, and radiologist who discuss cases together.
• Specialist experience. Ask whether the surgeon specialises in gynaecological cancers and how regularly the centre treats ovarian cancer.
• Clear plans and second opinions. A good centre will explain your diagnosis, give a written treatment plan, and welcome a second opinion.
• Continuity of care. Ask how follow-up and communication with your doctors back home will work after you return.

Verifying these points helps you make a confident, well-informed choice. We are happy to help you ask the right questions and review proposed plans.

Ovarian cancer cannot be reliably prevented, but a few things are linked with lower risk and may be worth discussing with your doctor: several years of combined oral contraceptive use, pregnancy and breastfeeding, and, for those at high inherited risk, risk-reducing surgery to remove the ovaries and tubes after childbearing. If you have a strong family history of ovarian or breast cancer, ask about a referral for genetic counselling and testing, which can guide both your care and your relatives'.

If you or a family member is diagnosed, two further options are worth knowing about. Clinical trials study new treatments and may offer access to therapies not yet widely available; your oncologist or trusted cancer organisations can tell you whether a suitable trial exists. A second opinion is a normal and accepted part of cancer care, not a sign of distrust. Reviewing your diagnosis and plan with another specialist can confirm the approach or reveal additional options, and most doctors fully support patients seeking one.

Above all, work with a qualified specialist, ask questions, and take the time you need to understand your choices. Being informed is one of the most powerful things you can do.