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Advanced Ovarian Cancer: What You Need To Know

Posted on March 02, 2021
Medically reviewed by
Howard Goodman, M.D.
Article written by
Maureen McNulty

  • When ovarian cancer is classified as “advanced,” that means it has spread to other areas of the body beyond the ovaries.
  • Treatments like surgery, chemotherapy, and targeted therapies can help treat advanced ovarian cancer.
  • Getting emotional, mental, and practical support is important when you have advanced cancer.

Not all ovarian cancer is the same. Ovarian cancer is a type of gynecologic cancer (cancer of the female reproductive system). Cancers that fall under this umbrella include tumors that grow in the ovaries, fallopian tubes, and peritoneum (tissue that lines the inside of your abdomen).

Some cancers are caught early, when the tumor is still small. Others are more advanced — they involve bigger tumors that have begun to grow into other organs or spread throughout the body. Advanced ovarian cancer is usually harder to treat and comes with a worse outlook.

What Is Advanced Ovarian Cancer?

If you are diagnosed with ovarian cancer, your doctor will perform tests to find out your cancer’s stage. In many cases, the stage of the cancer cannot be absolutely determined until surgery is completed. Your stage tells you where the cancer is located in your body and whether it has spread.

There is more than one way to stage ovarian cancer. In one method, your cancer is assigned a Roman numeral between I and IV. Stage I (stage 1) ovarian cancer is considered to be early-stage cancer. Cancers at this stage are only located in the ovary or fallopian tube. Stage IV (stage 4) cancer is the most advanced. In this case, cancer cells have spread to other organs, such as the liver, spleen, or lungs. When a tumor has spread outside of the ovaries (stage 2, 3, or 4 cancer), it is considered to be advanced-stage cancer.

You may already have advanced ovarian cancer by the time you are diagnosed. In other cases, you may have earlier-stage cancer that later progressed to late-stage disease or cancer that went into remission but returned.

How Many People Get Advanced Ovarian Cancer?

Experts estimate that about 21,410 people in the United States will be diagnosed with ovarian cancer in 2021, and about 13,770 people will die from the disease. About 80 percent of people with ovarian cancer have advanced cancer by the time they are diagnosed.

Advanced Ovarian Cancer Symptoms

Ovarian cancer can cause symptoms at any stage, but most people won’t have any symptoms until the cancer has grown to advanced-stage disease. Common symptoms include:

  • Abdominal or back pain
  • Constipation
  • Bloating or ascites (buildup of fluid in the abdomen)
  • Feeling full quickly when eating
  • Nausea
  • Persistent need to urinate
  • Fatigue
  • Pain while having sex
  • Heavy or irregular periods

Read more about managing advanced ovarian cancer symptoms.

Diagnosing Advanced Ovarian Cancer

Getting regular checkups and talking to your doctor about any new symptoms you experience can help with early detection of ovarian cancer. Some women may be at high risk for developing this disease because of a family history of ovarian or breast cancer, or they may have mutations in the BRCA1 and BRCA2 genes or other related genes. If you have these risk factors, your doctor may want you to have regular screening tests to look for signs of cancer.

If your doctor wants to screen you for ovarian cancer, or if they suspect you may have this disease, they may want you to undergo blood tests or imaging tests. Blood tests can look for proteins, such as cancer antigen 125 (CA-125), that are made by cancer cells. Imaging tests, including ultrasounds or CT and MRI scans, can help your doctor see what your ovaries look like.

Read more about ovarian cancer diagnosis.

Outcomes for Advanced Ovarian Cancer

Your outcome largely depends on what type of ovarian cancer you have:

  • About 48 percent of people with epithelial ovarian cancer live for at least five years after being diagnosed.
  • Approximately 88 percent of people with stromal tumors live for at least five years after diagnosis.
  • Nearly 93 percent of people with germ cell tumors live for at least five years after diagnosis.

These survival rates include early and advanced stage cancer. They are general estimates based on large numbers of people, and don’t necessarily predict what will happen to you. Other factors can affect your outcome. Having more advanced cancer, being older, or having other health problems may lead to a worse outcome. Talk to your doctor for a better idea of what you should expect from ovarian cancer.

Treatment Options for Advanced Ovarian Cancer

Treatment for advanced ovarian cancer may have several goals. These goals may include curing the cancer and removing all traces of cancer cells from the body, decreasing the size of your tumor, delaying cancer from growing for as long as possible, or treating your cancer symptoms. What treatment you choose may depend on factors like:

  • Other health conditions you may have
  • How big the cancer is
  • How far the cancer has spread
  • How past treatments have worked
  • Your own preferences

Surgery

Surgery is often used to treat advanced ovarian cancer. During surgery, a doctor will try to remove as much of the cancer as possible. You will probably have your ovaries, fallopian tubes, and uterus removed. If your cancer is very advanced, you may not be able to have surgery.

Chemotherapy

Chemotherapy is often used to treat advanced ovarian cancer both before and after surgery. These medications can kill cancer cells located throughout the body. Other drugs called targeted therapies are also often given along with chemotherapy to treat advanced cancer. Targeted therapies can specifically recognize and destroy cancer cells. If surgery and chemotherapy successfully remove most of the cancer cells, you may continue to be given targeted therapy drugs to keep the cancer away for as long as possible.

Clinical Trials

Clinical trials may be an option for people with advanced ovarian cancer. If you participate in a trial, you may be able to receive new treatments that aren’t yet a part of standard cancer care. Talk to your doctor to learn more about being a part of new cancer research.

Other Treatments

Other treatments are not as common for advanced ovarian cancer. Radiation therapy using X-rays may be used to treat cancer within the abdomen or in other areas of the body. Additionally, advanced stromal tumors may be treated with hormone therapy drugs like Lupron (leuprolide), Zoladex (goserelin), or Nolvadex (tamoxifen).

Read more about treatments for ovarian cancer.

Planning for the Future

A diagnosis of advanced ovarian cancer can be overwhelming. You may have to make a lot of decisions, rethink future plans, and change up daily routines. However, you don’t have to figure it all out alone. There are many resources that can help.

Palliative Care

Advanced cancer often comes with many symptoms and side effects. Palliative care aims to reduce symptoms, ease pain, and help you feel more comfortable. You can use palliative care while also receiving other treatments that aim to cure your cancer. A palliative care team can help you better understand your treatment options and provide emotional support. Talk to your doctor if you are interested in learning more about palliative care.

Deciding Not To Treat

Sometimes, the right treatment option is none at all. This may be a temporary decision — if you have advanced cancer but don’t have any symptoms, your doctor may recommend putting off treatment until you start feeling worse. This can help you avoid treatment side effects.

You may also decide to permanently stop all cancer treatments because you feel the risks outweigh the benefits. In some cases, treatment may not be expected to be very helpful. Most treatments also come with side effects that can impact your physical and mental health. It’s important to have ongoing conversations with your doctor about what is realistic to expect from every treatment option.

Hospice Care

If you decide that you no longer want to continue going through cancer treatments, you can choose to receive hospice care. Hospice is an option for end-of-life care. It connects you with a care team that helps manage your physical, mental, emotional, and spiritual needs. If you choose to use hospice care, you can still receive medical care to reduce pain and improve your quality of life, but you will no longer use treatments like chemotherapy. You can receive hospice care in a hospital or nursing home or in your own home.

Advance Care Planning

If you have advanced cancer, you may reach a point where you become too sick to make your own medical decisions related to things like CPR or using a ventilator. Advance care planning helps you think about and make these decisions ahead of time.

You can start by talking to your doctor about what types of choices you may face in the future related to your cancer care. Usually, these decisions are then written up in a legal document called an advance directive. In the United States, the two most common types of advance directives are a living will and durable power of attorney for health care. You may use a lawyer for this process, but it’s not necessary. Your doctor can help you understand exactly how the process works in your area.

Your hospital or care center may have social workers or other professionals on staff who can help you think through these decisions and have conversations with loved ones.

Getting Your Affairs in Order

Just as you may need to make plans for your future medical care, you may also need to plan for certain practical considerations. Many people with cancer have financial difficulties when paying for cancer treatments. A social worker can help direct you towards local services and organizations designed to provide support for people with cancer.

Another thing you may want to consider is a will. This document outlines what happens to your assets and belongings once you die. Lawyers can help you write up this document, or your care team may know of local services that can help.

Finding Support

Making these decisions can be incredibly difficult. Relying on your friends and family can help, but it may also be a good idea to work through treatment decisions with a professional, such as someone on your cancer care team or a mental health professional or a clergy member.

Connecting with others who’ve faced ovarian cancer can also offer invaluable support. The members at MyOvarianCancerTeam have likely dealt with many of the same issues you’re facing, and have asked the same questions you have. If you have advanced ovarian, fallopian tube, or primary peritoneal cancer, comment below or start a conversation at MyOvarianCancerTeam. Getting emotional support is an important part of dealing with a cancer diagnosis.

All updates must be accompanied by text or a picture.
Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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