# Ovarian cancer
What is it
Ovarian cancer is a malignant tumor that develops in the tissue of the ovaries. The ovaries are two small glands where an egg is released each month and where hormones are produced.
There are different types of ovarian cancer. The most common form is serous carcinoma, especially the high-grade type. This is a more aggressive form that grows and spreads faster. Other types are less frequent, but may progress differently.
Cancer develops when cells in the ovary begin to divide uncontrollably. This can happen in the surface cells of the ovary itself, or possibly also in other parts of the pelvis. In many cases, ovarian cancer is only detected when it has already spread to other parts of the body.
Causes
The cause of ovarian cancer is usually unclear. It is not something you can prevent yourself or something you are responsible for. However, there are some known factors that can increase the risk:
**Heredity**: In about one in ten women with ovarian cancer, heredity plays a role. Mutations in certain genes (especially BRCA1 and BRCA2) can significantly increase the risk. This risk also applies to breast and colorectal cancer in the family.
**Age**: Ovarian cancer is more common as you get older. Most cases occur in middle age or later.
**Female hormones**: Longer use of hormone therapy around menopause can slightly increase the risk.
**Medical history**: Certain conditions can slightly increase the risk.
It is important to know that having one or more of these risk factors does not mean you will definitely get ovarian cancer. Many women with risk factors never get cancer, and many women without clear risk factors do.
How the disease progresses
Ovarian cancer develops slowly. Often there are no clear symptoms at first, which is why the disease is sometimes only noticed when it has already progressed.
The disease is divided into different stages:
**Stage I**: The cancer is limited to one or both ovaries.
**Stage II**: The cancer has also grown into other organs in the pelvis, such as the uterus or intestine.
**Stage III**: The cancer has grown into the abdominal cavity and possibly into nearby lymph nodes.
**Stage IV**: The cancer has spread to other parts of the body, for example the lung, liver or distant lymph nodes.
After treatment, ovarian cancer can return (recurrence). This can happen months or years after the initial treatment. Return can be local (in the same place) or elsewhere in the body.
Symptoms by phase
**Early stages**:
At first there are often no symptoms, or these are very vague. Some women notice nothing and the cancer is discovered by chance during an examination for something else.
**Advanced stages**:
- Swollen abdomen or abdominal pain
- Feeling of fullness shortly after eating
- Increased urge to urinate more frequently
- Changes in menstruation or irregular bleeding
- Fatigue
- Weight loss without clear reason
- Constipation or diarrhea
- Back or side pain
These symptoms can also be caused by many other conditions. It is important that you discuss this with your doctor, especially if symptoms persist.
**Upon recurrence**:
The symptoms are often similar to those of advanced disease: abdominal pain, swelling, fatigue and changes in your bowel habits.
What it means for daily life
The diagnosis and treatment of ovarian cancer bring major changes.
**Emotional**: A cancer diagnosis is disruptive. Fear, sadness, anger and uncertainty are normal. Many hospitals offer support through psychologists, social workers or support groups.
**Physical**: The treatment can be quite exhausting. Surgery means recovery at home. Chemotherapy can last weeks and brings side effects — nausea, hair loss, increased susceptibility to infections and fatigue. This can have a major impact on work, hobbies and relationships.
**Work and finances**: Many women have to interrupt or adjust their work. This has financial consequences. Talk to your employer and explore what support is available.
**Intimacy and sexuality**: Surgery, treatment and emotional burden can affect your sexual well-being. This is difficult to talk about, but your doctor and your partner can support you.
**Family**: If ovarian cancer is hereditary, family members may worry or want to have screening themselves.
**Follow-up appointments**: After treatment, regular follow-up appointments will be needed. This can last a long time and bring considerable anxiety, especially around the time of check-ups.
Outlook
The outlook for ovarian cancer depends on many factors: the stage at diagnosis, the type of cancer, your overall health and how well the cancer responds to treatment.
Because ovarian cancer is often detected late, the outlook is generally poorer than for many other types of cancer. In the Netherlands, approximately 45% of women with diagnosed ovarian cancer survive at least five years, but this figure says nothing about your personal situation.
**With early detection** (stage I-II) the outlook is significantly better than with advanced disease.
**With advanced disease** (stage III-IV) treatment is less often successful, but even then women can live well for months or years after treatment.
**Recurrence**: Ovarian cancer can return after treatment. Doctors call this 'platinum-sensitive' or 'platinum-resistant' depending on how much time has passed since the previous treatment with certain chemotherapy. This determines which treatments are possible afterwards.
In recent years, more and more treatment options are becoming available. Research focuses on better ways to detect cancer and on new medicines that are better suited to your personal cancer type.
It is crucial to understand that survival rates are based on groups of patients and say nothing about one person. Your doctor can better assess what your personal situation means.
Frequently asked questions
**Q: Can I prevent ovarian cancer?**
A: There is no way to completely prevent ovarian cancer. If you have hereditary risk factors (especially BRCA mutations), your doctor can discuss with you what your options are, such as more intensive screening or in exceptional cases preventive surgery. However, many women with risk factors never develop cancer.
**Q: What is the treatment?**
A: The main treatments are surgery (usually to remove as much cancer tissue as possible) and chemotherapy. Other options are hereditary and molecular targeted therapies (such as PARP inhibitors) and sometimes radiation. Your doctor determines which combination best suits your situation.
**Q: Does ovarian cancer always mean death?**
A: No. Many women live well for months or years after diagnosis and treatment. Some are cured. Others will have to continue living with recurrent disease. The course depends heavily on the individual situation.
**Q: What happens after treatment?**
A: You will have regular follow-up appointments with your hospital doctor, initially fairly frequent and later further apart. These check-ups are aimed at detecting any recurrence early. Support with side effects, emotional well-being and return to normal life are also part of post-treatment care.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._