The most effective tool physicians have in treating ovarian cancer is early detection. But this is not always easy, explains Yale Medicine's Elena Ratner, MD, because ovarian cancer is known as "the cancer that whispers."

"When women get diagnosed, what they usually want to know is how long have they had this cancer," says Dr. Ratner, co-chief of Gynecologic Oncology at Yale Cancer Center. "Frequently, women will not have any symptoms until they get diagnosed and their cancer is at more advanced stages."

Catching ovarian cancer early greatly improves the odds a woman will make a full recovery. At Yale Medicine, our approach to ovarian and other gynecological cancers is rooted in a program called Discovery to Cure, which combines cutting-edge laboratory research with a team approach to patient care using the latest early-detection methods.

Ovarian cancer is the fifth most common type of cancer among women in the United States. There are three main types of ovarian cancer, and they differ based on the location of the cancer cells.

With the most common type, called epithelial carcinoma, the cancer cells start growing in the outer layer of cells in the ovaries. The second type is germ cell cancer typically appears in girls and teenagers.

Germ cell cancer develops in egg cells inside the ovaries and can usually be treated without harming fertility. The third and most rare type, stromal cell cancer, starts in the connective tissue that holds the ovaries together.

• Age: Women over the age of 55 are more likely than  younger women to develop ovarian cancer.
• Weight: Women who are obese are at a higher risk.
• History with fertility drugs or estrogen replacement therapy: These treatments have been linked to a higher incidence of ovarian cancer.
• Endometriosis: Recent studies indicate that endometriosis, particularly endometriosis that develops on the ovary, can increase a woman's risk of ovarian cancer by 43 percent.
• Family history: A woman whose female relatives have had ovarian cancer is at a higher risk.
• Gene mutations: Women with mutations in certain genes, called BRCA1 or BRCA2, are at a higher risk.

Ovarian cancer has no single hallmark symptom. Particularly in the early stages of the disease, symptoms tend to be subtle, but could include pain in the back or pelvis, shortness of breath, vaginal bleeding (though it is rare) or irregular periods.

Gastrointestinal symptoms can also be a sign of ovarian cancer, including abdominal bloating or swelling, loss of appetite, indigestion, nausea, gas, diarrhea, constipation, frequent urination or fullness, even after eating small meals.

The presence of these symptoms does not mean a woman has ovarian cancer; they could be early indicators of any number of issues. 

Regular checkups are key in the early detection of ovarian cancer. During an exam, the doctor will ask about family medical history and conduct a pelvic exam, checking for an enlarged ovary or other abnormal lumps.

If any masses are found, the doctor will order blood tests and imaging tests. Imaging tests may include an ultrasound, a computed tomography (CT) scan, and/or a magnetic resonance imaging (MRI) scan.

If any of those tests suggest ovarian cancer, a biopsy is usually necessary to confirm the diagnosis. Ovarian and abdominal tissues may be biopsied using a needle or during a minimally invasive surgical procedure called laparoscopy. 

In most cases, however, biopsies are collected via surgery. In this procedure, a surgeon will make an incision in the abdomen, assess the ovaries and other tissues for abnormalities, and collect biopsies from several sites including the ovary, nearby lymph nodes, and other organs. 

During the surgery, a pathologist examines the tissue samples under a microscope to check for the presence of cancer cells. If cancer is detected, the surgeon will remove the cancer. This may involve removal of the ovaries, fallopian tubes, and uterus.

This initial surgical procedure allows doctors to make a diagnosis, remove as much of the cancer as possible, and determine whether the cancer has spread to nearby tissues and organs. If cancer is diagnosed, the doctor may order additional imaging tests such as a positron emission tomography (PET) scan or a chest X-ray to check whether the cancer has spread to other parts of the body.

Treatments vary depending on a patient’s age, overall health, and the size of the tumor once it is detected, and whether the cancer has spread to other parts of the body. In general, a combination of two or more treatments may be called for, typically including surgery and/or chemotherapy.

A new kind of treatment called targeted therapy, which employs a class of drugs that go after cancer cells while minimizing damage to healthy cells, may also be considered. In addition, patients with a specific type of ovarian cancer called stromal cell cancer, which occurs in just 1 percent of cases, may benefit from hormone therapy.

While it was often used in the past, today radiation therapy is rarely used to treat ovarian cancer.

For overweight and obese women, losing weight will decrease the risk of cancer. In addition, using birth control pills for an extended period of time may decrease risk in some women. For women with cancer that runs in the family, genetic counseling with a physician can help mitigate concerns and establish the right screening protocols.

Many women at high risk choose resection, which involves surgically removing all or part of the ovaries as a precaution; this step is generally appropriate only for women who are highly likely to develop ovarian cancer.

Women with a family history of breast, colon, uterine or ovarian cancer should consider discussing options with a geneticist.

At Yale Medicine, we are dedicated to catching ovarian cancer early and treating it with the latest therapies. Some patients elect to participate in clinical trials; these trials are designed to test the safety and effectiveness of new, promising drugs and therapies.

Our patients who participate in clinical trials—after an exhaustive consult with their caregivers and families—might receive a promising drug or treatment that has not been approved by the Food and Drug Administration and therefore is not yet available to the general public.

For the past 25 years, our Discovery to Cure has helped doctors and researchers understand which screening tests work best to spot cancer early on, how often patients should be tested and how much variation exists from patient to patient.