Archives: Cancer Types

Gallbladder Cancer Treatment (PDQ®)–Health Professional Version

Gallbladder Cancer Treatment (PDQ®)–Health Professional Version

General Information About Gallbladder Cancer

Go to Patient Version

Incidence and Mortality

Estimated new cases and deaths from gallbladder (and other biliary) cancer in the United States in 2025:[1]

  • New cases: 12,610.
  • Deaths: 4,400.

Cancer that arises in the gallbladder is uncommon.

Clinical Features

The most common symptoms caused by gallbladder cancer are jaundice, pain, and fever.

Histopathology and Diagnostics

In patients whose superficial cancer (T1 or confined to the mucosa) is discovered on pathological examination of tissue after gallbladder removal for other reasons, the disease is often cured without further therapy. In patients who present with symptoms, the tumor is rarely diagnosed preoperatively.[2] In such cases, the tumor often cannot be removed completely by surgery and the disease cannot be cured, although palliative measures may be beneficial. For patients with T2 or greater disease, extended resection with partial hepatectomy and portal lymph node dissection may be an option.[3,4]

Other Prognostic Factors

Cholelithiasis is an associated finding in most cases, but less than 1% of patients with cholelithiasis develop this cancer.

References
  1. American Cancer Society: Cancer Facts and Figures 2025. American Cancer Society, 2025. Available online. Last accessed January 16, 2025.
  2. Chao TC, Greager JA: Primary carcinoma of the gallbladder. J Surg Oncol 46 (4): 215-21, 1991. [PUBMED Abstract]
  3. Shoup M, Fong Y: Surgical indications and extent of resection in gallbladder cancer. Surg Oncol Clin N Am 11 (4): 985-94, 2002. [PUBMED Abstract]
  4. Sasson AR, Hoffman JP, Ross E, et al.: Trimodality therapy for advanced gallbladder cancer. Am Surg 67 (3): 277-83; discussion 284, 2001. [PUBMED Abstract]

Cellular Classification of Gallbladder Cancer

Some histological types of gallbladder cancer have a better prognosis than others. Papillary carcinomas have the best prognosis. The histological types of gallbladder cancer include:[1]

  • Carcinoma in situ.
  • Biliary intraepithelial neoplasia, high grade.
  • Intracystic papillary neoplasm with high-grade intraepithelial neoplasia.
  • Mucinous cystic neoplasm with high-grade intraepithelial neoplasia.
  • Adenocarcinoma.
  • Adenocarcinoma, biliary type.
  • Adenocarcinoma, intestinal type.
  • Adenocarcinoma, gastric foveolar type.
  • Mucinous adenocarcinoma.
  • Clear cell adenocarcinoma.
  • Signet-ring cell carcinoma.
  • Squamous cell carcinoma.
  • Adenosquamous carcinoma.
  • Undifferentiated carcinoma.
  • High-grade neuroendocrine carcinoma.
  • Small cell neuroendocrine carcinoma.
  • Mixed adenoneuroendocrine carcinoma.
  • Intraductal papillary neoplasm with an associated invasive carcinoma.
  • Mucinous cystic neoplasm with an associated invasive carcinoma.
References
  1. Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 303–9.

Stage Information for Gallbladder Cancer

AJCC Stage Groupings and TNM Definitions

The American Joint Committee on Cancer (AJCC) has designated staging by the TNM classification to define gallbladder cancer.[1]

Table 1. Definitions of TNM Stage 0a
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
0 Tis, N0, M0 Tis = Carcinoma in situ.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 2. Definitions of TNM Stage Ia
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
I T1, N0, M0 T1 = Tumor invades the lamina propria or muscular layer.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 3. Definitions of TNM Stage IIAa
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
IIA T2a, N0, M0 T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 4. Definitions of TNM Stage IIBa
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
IIB T2b, N0, M0 T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 5. Definitions of TNM Stage IIIAa
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
IIIA T3, N0, M0 T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.
N0 = No regional lymph node metastasis.
M0 = No distant metastasis.
Table 6. Definitions of TNM Stage IIIBa
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
IIIB T1–3, N1, M0 T1 = Tumor invades the lamina propria or muscular layer.
–T1a = Tumor invades the lamina propria.
–T1b = Tumor invades the muscular layer.
T2 = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum). Or, tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
–T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).
–T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.
N1 = Metastases to one to three regional lymph nodes.
M0 = No distant metastasis.
Table 7. Definitions of TNM Stage IVAa
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
IVA T4, N0–1, M0 T4 = Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures.
N0 = No regional lymph node metastasis.
N1 = Metastases to one to three regional lymph nodes.
M0 = No distant metastasis.
Table 8. Definitions of TNM Stage IVBa
Stage TNM Description
T = primary tumor; N = regional lymph node; M = distant metastasis.
aReprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp 303–9.
IVB Any T, N2, M0 TX = Primary tumor cannot be assessed.
T0 = No evidence of primary tumor.
Tis = Carcinoma in situ.
T1 = Tumor invades the lamina propria or muscular layer.
–T1a = Tumor invades the lamina propria.
–T1b = Tumor invades the muscular layer.
T2 = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum). Or, tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
–T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).
–T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.
T4 = Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures.
N2 = Metastases to four or more regional lymph nodes.
M0 = No distant metastasis.
Any T, Any N, M1 TX = Primary tumor cannot be assessed.
T0 = No evidence of primary tumor.
Tis = Carcinoma in situ.
T1 = Tumor invades the lamina propria or muscular layer.
–T1a = Tumor invades the lamina propria.
–T1b = Tumor invades the muscular layer.
T2 = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum). Or, tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
–T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).
–T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.
T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.
T4 = Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures.
NX = Regional lymph nodes cannot be assessed.
N0 = No regional lymph node metastasis.
N1 = Metastases to one to three regional lymph nodes.
N2 = Metastases to four or more regional lymph nodes.
M1 = Distant metastases.

Localized and Locally Advanced

Patients with stage I disease have cancer confined to the gallbladder wall that can be completely resected. Patients with stage I tumors that are discovered incidentally and resected during routine cholecystectomy have 5-year survival rates of nearly 100%.[2]

Patients with stage II or III disease have tumors with direct extension into the muscular layer, serosa, or adjacent organs, with or without involvement of locoregional lymph nodes.

Unresectable

Patients with disease that has spread beyond the locoregional lymph nodes or to distant organs have unresectable tumors, and standard therapy is directed at palliation. Patients with earlier-stage disease with poor performance status and/or significant comorbidities may be deemed poor surgical candidates.

References
  1. Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 303–9.
  2. Shirai Y, Yoshida K, Tsukada K, et al.: Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215 (4): 326-31, 1992. [PUBMED Abstract]

Treatment of Localized and Locally Advanced Gallbladder Cancer

Treatment Options for Localized and Locally Advanced Gallbladder Cancer

Previously unsuspected gallbladder cancer that is incidentally discovered in the mucosa of the gallbladder during pathological examination is curable in more than 80% of patients. However, symptomatic gallbladder cancer that is suspected prior to surgery often penetrates the muscularis and serosa. This type of gallbladder cancer is curable in less than 5% of patients.

One study reported the patterns of lymph node spread from gallbladder cancer and outcomes of patients with metastases to lymph nodes in 111 consecutive surgical patients in a single institution from 1981 to 1995.[1][Level of evidence C1] The standard surgical procedure was removal of the gallbladder, a wedge resection of the liver, resection of the extrahepatic bile duct, and resection of the regional (N1 and N2) lymph nodes. Kaplan-Meier estimates of the 5-year survival rates were 42.5% ± 6.5% for patients with node-negative tumors pathologically staged as T2 to T4 and 31% ± 6.2% for patients with similar node-positive tumors.

Treatment options for localized and locally advanced gallbladder cancer include:

  1. Surgery.
  2. External-beam radiation therapy (EBRT).
  3. Clinical trials exploring the use of radiation therapy and radiosensitizer drugs to improve local control.

Surgery

In patients with previously unsuspected gallbladder cancer that is discovered in the surgical specimen after a routine gallbladder operation and confined to mucosa (T1), most disease is cured.[2,3] During laparoscopic removal of an unsuspected cancer, implantation of carcinoma at all port sites (including the camera site) is possible.[4] All port sites are typically excised completely, even for stage I cancers.

The need for reexploration for more extended resection in incidentally discovered T1b disease is controversial. A multicenter retrospective review identified lymph node metastases in 12% of patients who underwent re-resection after cholecystectomy, but there are no prospective data regarding relative outcome with a second surgery in these patients.[5][Level of evidence C2]

Patients with T2 or T3 disease have higher rates of unsuspected invasive disease at the time of diagnosis. A multicenter retrospective review was performed in patients who underwent re-resection after carcinoma was discovered incidentally. Residual disease was present in 57% of patients with T2 disease (including 31% with lymph node involvement and 10% with liver involvement) and in 77% of patients with T3 disease (including 46% with lymph node metastases and 36% with liver involvement).[5] On the basis of these observations, eligible patients may undergo reexploration to resect liver tissue near the gallbladder bed, portal lymph nodes, and lymphatic tissue in the hepatoduodenal ligament. Retrospective analyses suggest that extended re-resection can delay recurrences and potentially improve survival.[6–8][Level of evidence C2]

For patients with locoregional lymph node involvement (at the cystic duct, common bile duct, hepatic artery, and portal vein), long-term disease-free survival can occasionally be achieved with radical resection. In patients with jaundice (stage III or stage IV), preoperative percutaneous transhepatic biliary drainage for relief of biliary obstruction should be considered.

Surgery with curative intent is not considered possible in patients with metastatic spread beyond the locoregional lymph nodes or to distant organs.

EBRT

The use of EBRT with or without chemotherapy as a primary treatment has been reported to produce short-term disease control in small groups of patients. Similar benefits have been reported for radiation therapy, with or without chemotherapy, administered after resection.[9,10]

There are no phase III studies to support the use of adjuvant radiation therapy, even for patients with high-risk localized disease.

Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Tsukada K, Kurosaki I, Uchida K, et al.: Lymph node spread from carcinoma of the gallbladder. Cancer 80 (4): 661-7, 1997. [PUBMED Abstract]
  2. Fong Y, Brennan MF, Turnbull A, et al.: Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination. Arch Surg 128 (9): 1054-6, 1993. [PUBMED Abstract]
  3. Chijiiwa K, Tanaka M: Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 115 (6): 751-6, 1994. [PUBMED Abstract]
  4. Wibbenmeyer LA, Wade TP, Chen RC, et al.: Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder. J Am Coll Surg 181 (6): 504-10, 1995. [PUBMED Abstract]
  5. Pawlik TM, Gleisner AL, Vigano L, et al.: Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg 11 (11): 1478-86; discussion 1486-7, 2007. [PUBMED Abstract]
  6. Shirai Y, Yoshida K, Tsukada K, et al.: Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215 (4): 326-31, 1992. [PUBMED Abstract]
  7. Yamaguchi K, Chijiiwa K, Saiki S, et al.: Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 84 (2): 200-4, 1997. [PUBMED Abstract]
  8. Downing SR, Cadogan KA, Ortega G, et al.: Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection. Arch Surg 146 (6): 734-8, 2011. [PUBMED Abstract]
  9. Smoron GL: Radiation therapy of carcinoma of gallbladder and biliary tract. Cancer 40 (4): 1422-4, 1977. [PUBMED Abstract]
  10. Hejna M, Pruckmayer M, Raderer M: The role of chemotherapy and radiation in the management of biliary cancer: a review of the literature. Eur J Cancer 34 (7): 977-86, 1998. [PUBMED Abstract]

Treatment of Unresectable, Metastatic, or Recurrent Gallbladder Cancer

Treatment Options for Unresectable, Metastatic, or Recurrent Gallbladder Cancer

Unresectable, metastatic, and recurrent gallbladder cancers are not curable. Symptoms can be significantly improved with relief of biliary obstruction. A few patients have very slow-growing tumors and may live several years. Patients with unresectable, metastatic, or recurrent gallbladder cancer should consider enrolling in clinical trials whenever possible. Information about ongoing clinical trials is available from the NCI website.

Treatment options for unresectable, metastatic, or recurrent gallbladder cancer include:

  1. Percutaneous transhepatic drainage or endoscopically placed stents, or surgical bypass.
  2. Systemic therapy.

Percutaneous transhepatic drainage or endoscopically placed stents, or surgical bypass

Relief of biliary obstruction is warranted when symptoms such as pruritus and hepatic dysfunction outweigh other symptoms of the cancer. The preferred approach is percutaneous transhepatic drainage or endoscopically placed stents.[1] Surgical bypass may be appropriate when these approaches are infeasible.

Palliative radiation therapy after biliary drainage may be beneficial. Patients may be candidates for inclusion in clinical trials that explore ways to improve the effects of radiation therapy with various radiosensitizers, such as hyperthermia, radiosensitizer drugs, or cytotoxic chemotherapeutic agents.

Systemic therapy

Systemic therapy is appropriate for selected patients with adequate performance status and intact organ function. Fluoropyrimidines, gemcitabine, platinum agents, and docetaxel have produced transient partial remissions in a few patients. The incidence of gallbladder cancer is low, and clinical trials often enroll patients with all subsites of biliary tract cancers. Therefore, data must be interpreted with caution when applied specifically to patients with gallbladder cancer. In clinical practice, treatment algorithms in advanced disease often follow those with biliary tract cancer, relying on extrapolation from other trials. In this section, only current landmark studies, or those that specifically enrolled patients with gallbladder cancer, have been explicitly summarized. For more information, see Bile Duct Cancer (Cholangiocarcinoma) Treatment.

Capecitabine and fluorouracil dosing

The DPYD gene encodes an enzyme that catabolizes pyrimidines and fluoropyrimidines, like capecitabine and fluorouracil. An estimated 1% to 2% of the population has germline pathogenic variants in DPYD, which lead to reduced DPD protein function and an accumulation of pyrimidines and fluoropyrimidines in the body.[2,3] Patients with the DPYD*2A variant who receive fluoropyrimidines may experience severe, life-threatening toxicities that are sometimes fatal. Many other DPYD variants have been identified, with a range of clinical effects.[2–4] Fluoropyrimidine avoidance or a dose reduction of 50% may be recommended based on the patient’s DPYD genotype and number of functioning DPYD alleles.[5–7] DPYD genetic testing costs less than $200, but insurance coverage varies due to a lack of national guidelines.[8] In addition, testing may delay therapy by 2 weeks, which would not be advisable in urgent situations. This controversial issue requires further evaluation.[9]

Evidence (systemic therapy):

  1. In a phase III study, 410 patients with unresectable metastatic, or recurrent biliary tract cancer were randomly assigned to receive up to 6 months of gemcitabine with or without cisplatin.[10]
    • With a median follow-up of 8.2 months, the median overall survival (OS) was superior for patients who received combination chemotherapy (11.7 months vs. 8.1 months; hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.52–0.80; P < .001).[10][Level of evidence A1]
    • A similar median OS benefit was demonstrated in all subgroups, including 149 patients with gallbladder cancer.
    • Grade 3 and 4 toxicities occurred with similar frequency in both study arms, except for increased hematologic toxic effects in patients who received gemcitabine plus cisplatin and increased hepatotoxicity in patients who received single-agent gemcitabine.
  2. An international, multicenter, phase III study (TOPAZ-1 [NCT03875235]) included 685 patients with previously untreated and unresectable locally advanced, recurrent, or metastatic biliary tract cancer. Patients were randomly assigned to receive either durvalumab or placebo with cisplatin plus gemcitabine for up to eight cycles, followed by durvalumab or placebo maintenance until disease progression or unacceptable toxicity. After a median follow-up of 23.4 months for patients in the durvalumab group, the following was observed:[11,12]
    • The primary end point of median OS was 12.9 months in the durvalumab group and 11.3 months in the placebo group (HR, 0.76; 95% CI, 0.64–0.91). In the durvalumab group, the 18-month OS rate was 35.1%, and the 24-month OS was 24.9%. In the placebo group, the 18-month OS rate was 25.5%, and the 24-month OS rate was 10.4%.[11,12][Level of evidence A1]
    • There was no significant difference between groups in the number of grade 3 or 4 treatment-related adverse events or the number of events leading to discontinuation of a study medication.
  3. An international, multicenter, phase III study (KEYNOTE-966 [NCT04003636]) enrolled 1,069 patients with previously untreated unresectable, locally advanced or metastatic biliary tract cancer. Patients were randomly assigned to receive either pembrolizumab or placebo for up to 35 cycles. This was combined with gemcitabine (with no maximum duration) and cisplatin for up to 8 cycles. After a median follow-up of 25.6 months, the following results were observed:[13][Level of evidence A1]
    • The median OS was 12.7 months in the pembrolizumab group and 10.9 months in the placebo group (HR, 0.83; 95% CI, 0.72–0.95; one-sided P = .0034).
    • There was no difference in the total frequency of treatment-related adverse events between treatment groups, including grade 3 or grade 4 events. Death due to treatment-related adverse events was seen in a total of eight patients (2%) in the pembrolizumab arm and three patients (1%) in the placebo arm.
  4. A three-arm randomized phase III study of patients with unresectable gallbladder cancer compared best supportive care (n = 27), fluorouracil plus folinic acid (FUFA) weekly for 30 weeks (n = 28), and modified gemcitabine plus oxaliplatin (mGEMOX) for up to six 21-day cycles.[14][Level of evidence A1]
    • With a median follow-up of 9 months, the OS was 4.5 months for patients who received best supportive care (95% CI, 0.2−8.8), 4.6 months for patients who received FUFA (95% CI, 3−6.2), and 9.5 months for patients who received mGEMOX (95% CI, 5−14; P = .039).
    • The only significant difference in grade 3 or 4 toxicities between the chemotherapy arms was transaminitis, which was more prevalent in the mGEMOX arm (P = .04).
  5. A phase III noninferiority study (NCT01470443) enrolled 114 patients with metastatic biliary tract cancers, including 30 (26%) with primary gallbladder cancer. Patients were randomly assigned to receive either capecitabine plus oxaliplatin (XELOX) or gemcitabine plus oxaliplatin (GEMOX).[15][Level of evidence B1]
    • OS was not significantly different, at 10.4 months (95% CI, 8.0−12.6) for patients in the GEMOX group and 10.6 months (95% CI, 7.3−15.5) for patients in the XELOX group (P = .131).
    • The primary end point of 6-month progression-free survival (PFS) rates were 44.6% for the GEMOX group and 46.7% for the XELOX group (95% CI of difference in 6-month PFS rate, -12% to 16%, meeting criteria for noninferiority).
    • A predefined subgroup analysis based on the primary site of disease was performed. The analysis did not reveal a difference in objective response rate between the two arms in patients with gallbladder cancer (P = .598).

Pending additional clinical trials, cisplatin plus gemcitabine is considered the reference standard chemotherapy backbone for patients with unresectable, metastatic, or recurrent gallbladder cancer. Extrapolating from the results of the TOPAZ-1 and KEYNOTE-966 trials for biliary tract cancer, addition of a checkpoint inhibitor (durvalumab or pembrolizumab) to first-line therapy has become the standard of care. Potential alternative regimens include gemcitabine plus capecitabine, GEMOX, and XELOX. All patients should consider clinical trials.

All patients with unresectable, metastatic, or recurrent disease who have not already received checkpoint inhibitors should undergo molecular testing for deficient mismatch repair (dMMR) or microsatellite instability (MSI-H). Extrapolating from a subgroup of patients with gastrointestinal and hepatopancreatobiliary tumors in the I-PREDICT (NCT02534675) and KEYNOTE-158 (NCT02628067) studies, patients with either dMMR or MSI-H tumors can be considered for treatment with pembrolizumab.[16,17][Level of evidence C3]

Additional testing for IDH1 variants, FGFR2 gene fusions, and HER2 expression may provide potential targets in clinical trials. In clinical practice, targeted treatments that have been approved by the U.S. Food and Drug Administration as second-line treatments for patients with cholangiocarcinoma could likely be used to treat appropriate patients with gallbladder cancer. Compelling treatment options for these patients are scarce. For more information, see the Targeted therapy section in Bile Duct Cancer (Cholangiocarcinoma) Treatment.

Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References
  1. Baron TH: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344 (22): 1681-7, 2001. [PUBMED Abstract]
  2. Sharma BB, Rai K, Blunt H, et al.: Pathogenic DPYD Variants and Treatment-Related Mortality in Patients Receiving Fluoropyrimidine Chemotherapy: A Systematic Review and Meta-Analysis. Oncologist 26 (12): 1008-1016, 2021. [PUBMED Abstract]
  3. Lam SW, Guchelaar HJ, Boven E: The role of pharmacogenetics in capecitabine efficacy and toxicity. Cancer Treat Rev 50: 9-22, 2016. [PUBMED Abstract]
  4. Shakeel F, Fang F, Kwon JW, et al.: Patients carrying DPYD variant alleles have increased risk of severe toxicity and related treatment modifications during fluoropyrimidine chemotherapy. Pharmacogenomics 22 (3): 145-155, 2021. [PUBMED Abstract]
  5. Amstutz U, Henricks LM, Offer SM, et al.: Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update. Clin Pharmacol Ther 103 (2): 210-216, 2018. [PUBMED Abstract]
  6. Henricks LM, Lunenburg CATC, de Man FM, et al.: DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol 19 (11): 1459-1467, 2018. [PUBMED Abstract]
  7. Lau-Min KS, Varughese LA, Nelson MN, et al.: Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies: a qualitative study of barriers to implementation. BMC Cancer 22 (1): 47, 2022. [PUBMED Abstract]
  8. Brooks GA, Tapp S, Daly AT, et al.: Cost-effectiveness of DPYD Genotyping Prior to Fluoropyrimidine-based Adjuvant Chemotherapy for Colon Cancer. Clin Colorectal Cancer 21 (3): e189-e195, 2022. [PUBMED Abstract]
  9. Baker SD, Bates SE, Brooks GA, et al.: DPYD Testing: Time to Put Patient Safety First. J Clin Oncol 41 (15): 2701-2705, 2023. [PUBMED Abstract]
  10. Valle J, Wasan H, Palmer DH, et al.: Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362 (14): 1273-81, 2010. [PUBMED Abstract]
  11. Oh DY, He AR, Qin S, et al.: Updated overall survival (OS) from the phase III TOPAZ-1 study of durvalumab (D) or placebo (PBO) plus gemcitabine and cisplatin (+ GC) in patients (pts) with advanced biliary tract cancer (BTC). Ann Oncol 33 (Suppl 7): S565-S566, 2022.
  12. Oh DY, He AR, Bouattour M, et al.: Durvalumab or placebo plus gemcitabine and cisplatin in participants with advanced biliary tract cancer (TOPAZ-1): updated overall survival from a randomised phase 3 study. Lancet Gastroenterol Hepatol 9 (8): 694-704, 2024. [PUBMED Abstract]
  13. Kelley RK, Ueno M, Yoo C, et al.: Pembrolizumab in combination with gemcitabine and cisplatin compared with gemcitabine and cisplatin alone for patients with advanced biliary tract cancer (KEYNOTE-966): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 401 (10391): 1853-1865, 2023. [PUBMED Abstract]
  14. Sharma A, Dwary AD, Mohanti BK, et al.: Best supportive care compared with chemotherapy for unresectable gall bladder cancer: a randomized controlled study. J Clin Oncol 28 (30): 4581-6, 2010. [PUBMED Abstract]
  15. Kim ST, Kang JH, Lee J, et al.: Capecitabine plus oxaliplatin versus gemcitabine plus oxaliplatin as first-line therapy for advanced biliary tract cancers: a multicenter, open-label, randomized, phase III, noninferiority trial. Ann Oncol 30 (5): 788-795, 2019. [PUBMED Abstract]
  16. Sicklick JK, Kato S, Okamura R, et al.: Molecular profiling of cancer patients enables personalized combination therapy: the I-PREDICT study. Nat Med 25 (5): 744-750, 2019. [PUBMED Abstract]
  17. Marabelle A, Le DT, Ascierto PA, et al.: Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair-Deficient Cancer: Results From the Phase II KEYNOTE-158 Study. J Clin Oncol 38 (1): 1-10, 2020. [PUBMED Abstract]

Latest Updates to This Summary (02/12/2025)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information About Gallbladder Cancer

Updated statistics with estimated new cases and deaths for 2025 (cited American Cancer Society as reference 1).

Treatment of Unresectable, Metastatic, or Recurrent Gallbladder Cancer

Revised text about the results of the TOPAZ-1 study which included 685 patients with locally advanced, recurrent, or metastatic biliary tract cancer that was unresectable and previously untreated and randomly assigned them to receive either durvalumab or placebo with cisplatin plus gemcitabine followed by durvalumab or placebo maintenance (cited Oh et al. as reference 12).

This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® Cancer Information for Health Professionals pages.

About This PDQ Summary

Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of gallbladder cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.

Reviewers and Updates

This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).

Board members review recently published articles each month to determine whether an article should:

  • be discussed at a meeting,
  • be cited with text, or
  • replace or update an existing article that is already cited.

Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.

The lead reviewers for Gallbladder Cancer Treatment are:

  • Amit Chowdhry, MD, PhD (University of Rochester Medical Center)
  • Leon Pappas, MD, PhD (Massachusetts General Hospital)
  • Ari Seifter, MD (Advocate Health Care)

Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website’s Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Levels of Evidence

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

Permission to Use This Summary

PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”

The preferred citation for this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Gallbladder Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/gallbladder/hp/gallbladder-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389371]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.

Disclaimer

Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s Email Us.

Gallbladder Cancer—Health Professional Version

Gallbladder Cancer—Health Professional Version

Treatment

PDQ Treatment Information for Health Professionals

More information

Causes & Prevention

NCI does not have PDQ evidence-based information about prevention of gallbladder cancer.

More information

Screening

NCI does not have PDQ evidence-based information about screening for gallbladder cancer.

More information

Supportive & Palliative Care

We offer evidence-based supportive and palliative care information for health professionals on the assessment and management of cancer-related symptoms and conditions.

Cancer Pain Nausea and Vomiting Nutrition in Cancer Care Transition to End-of-Life Care Last Days of Life View all Supportive and Palliative Care Summaries

Gallbladder Cancer—Patient Version

Gallbladder Cancer—Patient Version

Overview

Gallbladder cancer is a rare cancer that is usually diagnosed late due a to lack of early signs and symptoms. It is sometimes found when the gallbladder is checked for gallstones or removed. Explore the links on this page to learn more about gallbladder cancer treatment and clinical trials.

Treatment

PDQ Treatment Information for Patients

More information

Causes & Prevention

NCI does not have PDQ evidence-based information about prevention of gallbladder cancer.

More information

Screening

NCI does not have PDQ evidence-based information about screening for gallbladder cancer.

More information

Coping with Cancer

The information in this section is meant to help you cope with the many issues and concerns that occur when you have cancer.

Emotions and Cancer Adjusting to Cancer Support for Caregivers Survivorship Advanced Cancer Managing Cancer Care

Ovarian Germ Cell Tumors Treatment (PDQ®)–Patient Version

Ovarian Germ Cell Tumors Treatment (PDQ®)–Patient Version

General Information About Ovarian Germ Cell Tumors

Go to Health Professional Version

Key Points

  • Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary.
  • Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause.
  • Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to diagnose ovarian germ cell tumor.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Ovarian germ cell tumor is a disease in which malignant (cancer) cells form in the germ (egg) cells of the ovary.

Germ cell tumors begin in the reproductive cells (egg or sperm) of the body. Ovarian germ cell tumors usually occur in teenage girls or young women and most often affect just one ovary.

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones.

EnlargeAnatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina.
Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Ovarian germ cell tumor is a general name that is used to describe several different types of cancer. The most common ovarian germ cell tumor is called dysgerminoma. See the following PDQ summaries for information about other types of ovarian tumors:

Signs of ovarian germ cell tumor are swelling of the abdomen or vaginal bleeding after menopause.

Ovarian germ cell tumors can be hard to diagnose (find) early. Often there are no symptoms in the early stages, but tumors may be found during regular gynecologic exams (checkups). Check with your doctor if you have:

  • Swollen abdomen without weight gain in other parts of the body.
  • Bleeding from the vagina after menopause (when you are no longer having menstrual periods).

Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used to diagnose ovarian germ cell tumor.

In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
    EnlargePelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups.
    Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.
  • Laparotomy: A surgical procedure in which an incision (cut) is made in the wall of the abdomen to check the inside of the abdomen for signs of disease. The size of the incision depends on the reason the laparotomy is being done. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Serum tumor marker test: A procedure in which a sample of blood is checked to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. An increased level of alpha fetoprotein (AFP) or human chorionic gonadotropin (HCG) in the blood may be a sign of ovarian germ cell tumor.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on:

  • The type of cancer.
  • The size of the tumor.
  • The stage of cancer (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).
  • The way the cancer cells look under a microscope.
  • The patient’s general health.

Ovarian germ cell tumors are usually cured if found and treated early.

Stages of Ovarian Germ Cell Tumors

Key Points

  • After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The following stages are used for ovarian germ cell tumors:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
  • Ovarian germ cell tumor can recur (come back) after it has been treated.

After ovarian germ cell tumor has been diagnosed, tests are done to find out if cancer cells have spread within the ovary or to other parts of the body.

The process used to find out whether cancer has spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. Unless a doctor is sure the cancer has spread from the ovaries to other parts of the body, an operation called a laparotomy is done to see if the cancer has spread. The doctor must cut into the abdomen and carefully look at all the organs to see if they have cancer in them. The doctor will cut out small pieces of tissue so they can be checked under a microscope for signs of cancer. The doctor may also wash the abdominal cavity with fluid, which is also checked under a microscope to see if it has cancer cells in it. Usually, the doctor will remove the cancer and other organs that have cancer in them during the laparotomy. It is important to know the stage in order to plan treatment.

Many of the tests used to diagnose ovarian germ cell tumor are also used for staging. The following tests and procedures may also be used for staging:

  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • Transvaginal ultrasound exam: A procedure used to examine the vagina, uterus, fallopian tubes, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The doctor can identify tumors by looking at the sonogram.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of tumor as the primary tumor. For example, if an ovarian germ cell tumor spreads to the liver, the tumor cells in the liver are actually cancerous ovarian germ cells. The disease is metastatic ovarian germ cell tumor, not liver cancer.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

The following stages are used for ovarian germ cell tumors:

Stage I

EnlargeThree-panel drawing of stage IA, stage IB, and stage IC; each panel shows the ovaries, fallopian tubes, uterus, cervix, and vagina. The first panel (stage IA) shows cancer inside one ovary. The second panel (stage IB) shows cancer inside both ovaries. The third panel (stage IC) shows cancer inside both ovaries and (a) the tumor in the ovary on the left has ruptured (broken open), (b) there is cancer on the surface of the ovary on the right, and (c) there are cancer cells in the pelvic peritoneal fluid (inset).
In stage IA, cancer is found inside a single ovary or fallopian tube. In stage IB, cancer is found inside both ovaries or fallopian tubes. In stage IC, cancer is found inside one or both ovaries or fallopian tubes and one of the following is true: (a) either the tumor or the capsule (outer covering) of the ovary has ruptured (broken open), or (b) cancer is also found on the surface of the ovary or fallopian tube, or (c) cancer cells are found in the pelvic peritoneal fluid.

In stage I, cancer is found in one or both ovaries or fallopian tubes. Stage I is divided into stage IA, stage IB, and stage IC.

  • Stage IA: Cancer is found inside a single ovary or fallopian tube.
  • Stage IB: Cancer is found inside both ovaries or fallopian tubes.
  • Stage IC: Cancer is found inside one or both ovaries or fallopian tubes and one of the following is true:

Stage II

EnlargeThree-panel drawing of stage IIA, stage IIB, and stage II primary peritoneal cancer; the first panel (stage IIA) shows cancer inside both ovaries that has spread to the fallopian tube and uterus. Also shown are the cervix and vagina. The second panel (stage IIB) shows cancer inside both ovaries that has spread to the colon. The third panel (primary peritoneal cancer) shows cancer in the pelvic peritoneum.
In stage IIA, cancer is found in one or both ovaries or fallopian tubes and has spread to the uterus and/or the fallopian tubes and/or the ovaries. In stage IIB, cancer is found in one or both ovaries or fallopian tubes and has spread to organs in the peritoneal cavity, such as the colon. In primary peritoneal cancer, cancer is found in the pelvic peritoneum and has not spread there from another part of the body.

In stage II, cancer is found in one or both ovaries or fallopian tubes and has spread into other areas of the pelvis, or primary peritoneal cancer is found within the pelvis. Stage II is divided into stage IIA and stage IIB.

  • Stage IIA: Cancer has spread from where it first formed to the uterus and/or the fallopian tubes and/or the ovaries.
  • Stage IIB: Cancer has spread from the ovary or fallopian tube to organs in the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).
EnlargeDrawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler.
Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).

Stage III

In stage III, cancer is found in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

  • In stage IIIA, one of the following is true:
    • Cancer has spread to lymph nodes behind the peritoneum only; or
    • Cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis, such as the omentum (a fold of the peritoneum that surrounds the stomach and other organs in the abdomen). Cancer may have spread to nearby lymph nodes.
      EnlargeDrawing of stage IIIA shows cancer inside both ovaries that has spread to (a) lymph nodes behind the peritoneum and (b) the omentum. The small intestine, colon, fallopian tubes, uterus, and bladder are also shown.
      In stage IIIA, cancer is found in one or both ovaries or fallopian tubes and (a) cancer has spread to lymph nodes behind the peritoneum only, or (b) cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis, such as the omentum. Cancer may have also spread to nearby lymph nodes.
  • Stage IIIB: Cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is 2 centimeters or smaller. Cancer may have spread to lymph nodes behind the peritoneum.
    EnlargeDrawing of stage IIIB shows cancer inside both ovaries that has spread to the omentum. The cancer in the omentum is 2 centimeters or smaller. An inset shows 2 centimeters is about the size of a peanut. Also shown are the small intestine, colon, fallopian tubes, uterus, bladder, and lymph nodes behind the peritoneum.
    In stage IIIB, cancer is found in one or both ovaries or fallopian tubes and has spread to the peritoneum outside the pelvis, such as the omentum. The cancer in the omentum is 2 centimeters or smaller. Cancer may have also spread to lymph nodes behind the peritoneum.
  • Stage IIIC: Cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is larger than 2 centimeters. Cancer may have spread to lymph nodes behind the peritoneum or to the surface of the liver or spleen.
    EnlargeDrawing of stage IIIC shows cancer inside both ovaries that has spread to the omentum. The cancer in the omentum is larger than 2 centimeters. An inset shows 2 centimeters is about the size of a peanut. Also shown are the small intestine, colon, fallopian tubes, uterus, bladder, and lymph nodes behind the peritoneum.
    In stage IIIC, cancer is found in one or both ovaries or fallopian tubes and has spread to the peritoneum outside the pelvis, such as the omentum. The cancer in the omentum is larger than 2 centimeters. Cancer may have also spread to lymph nodes behind the peritoneum or to the surface of the liver or spleen (not shown).

Stage IV

EnlargeDrawing of stage IV shows other parts of the body where ovarian cancer may spread, including the lung, liver, and lymph nodes in the groin. An inset on the top shows extra fluid around the lung. An inset on the bottom shows cancer cells spreading through the blood and lymph system to another part of the body where metastatic cancer has formed.
In stage IV, cancer has spread beyond the abdomen to other parts of the body. In stage IVA, cancer cells are found in extra fluid that builds up around the lungs. In stage IVB, cancer has spread to organs and tissues outside the abdomen, including the lung, liver, and lymph nodes in the groin.

In stage IV, cancer has spread beyond the abdomen to other parts of the body. Stage IV is divided into stage IVA and stage IVB.

Ovarian germ cell tumor can recur (come back) after it has been treated.

The cancer may come back in the other ovary or in other parts of the body.

Treatment Option Overview

Key Points

  • There are different types of treatment for patients with ovarian germ cell tumors.
  • The following types of treatment are used:
    • Surgery
    • Observation
    • Chemotherapy
    • Radiation therapy
  • New types of treatment are being tested in clinical trials.
    • High-dose chemotherapy with bone marrow transplant
    • New treatment options
  • Treatment for ovarian germ cell tumors may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.

There are different types of treatment for patients with ovarian germ cell tumors.

Different types of treatment are available for patients with ovarian germ cell tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

The following types of treatment are used:

Surgery

Surgery is the most common treatment of ovarian germ cell tumor. A doctor may take out the cancer using one of the following types of surgery.

  • Unilateral salpingo-oophorectomy: A surgical procedure to remove one ovary and one fallopian tube.
  • Total hysterectomy: A surgical procedure to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
    EnlargeHysterectomy; drawing shows the female reproductive anatomy, including the ovaries, uterus, vagina, fallopian tubes, and cervix. Dotted lines show which organs and tissues are removed in a total hysterectomy, a total hysterectomy with salpingo-oophorectomy, and a radical hysterectomy. An inset shows the location of two possible incisions on the abdomen: a low transverse incision is just above the pubic area and a vertical incision is between the navel and the pubic area.
    Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.
  • Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
  • Tumor debulking: A surgical procedure in which as much of the tumor as possible is removed. Some tumors cannot be completely removed.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

After chemotherapy for an ovarian germ cell tumor, a second-look laparotomy may be done. This is similar to the laparotomy that is done to find out the stage of the cancer. Second-look laparotomy is a surgical procedure to find out if tumor cells are left after primary treatment. During this procedure, the doctor will take samples of lymph nodes and other tissues in the abdomen to see if any cancer is left. This procedure is not done for dysgerminomas.

Observation

Observation is closely watching a patient’s condition without giving any treatment unless signs or symptoms appear or change.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is treatment using more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

For more information, see Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

High-dose chemotherapy with bone marrow transplant

High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

New treatment options

Combination chemotherapy (the use of more than one anticancer drug) is being tested in clinical trials.

Treatment for ovarian germ cell tumors may cause side effects.

For information about side effects caused by treatment for cancer, visit our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).

Treatment of Stage I Ovarian Germ Cell Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.

Treatment of dysgerminoma may include:

Treatment of other ovarian germ cell tumors may include:

  • unilateral salpingo-oophorectomy followed by careful observation; or
  • unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Stage II Ovarian Germ Cell Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.

Treatment of dysgerminoma may include:

Treatment of other ovarian germ cell tumors may include:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Stage III Ovarian Germ Cell Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.

Treatment of dysgerminoma may include:

Treatment of other ovarian germ cell tumors may include:

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.
  • Unilateral salpingo-oophorectomy followed by chemotherapy.
  • Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).
  • A clinical trial of a new treatment.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Stage IV Ovarian Germ Cell Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.

Treatment of dysgerminoma may include:

Treatment of other ovarian germ cell tumors may include:

  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.
  • Unilateral salpingo-oophorectomy followed by chemotherapy.
  • Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain).
  • A clinical trial of a new treatment.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Recurrent Ovarian Germ Cell Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment depends on whether the tumor is a dysgerminoma or another type of ovarian germ cell tumor.

Treatment of dysgerminoma may include:

Treatment of other ovarian germ cell tumors may include:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Ovarian Germ Cell Tumors

For more information from the National Cancer Institute about ovarian germ cell tumors, see:

For general cancer information and other resources from the National Cancer Institute, visit:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of ovarian germ cell tumors. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Ovarian Germ Cell Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/ovarian/patient/ovarian-germ-cell-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389363]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Ovarian Low Malignant Potential Tumors Treatment (PDQ®)–Patient Version

Ovarian Low Malignant Potential Tumors Treatment (PDQ®)–Patient Version

General Information About Ovarian Low Malignant Potential
Tumors

Go to Health Professional Version

Key Points

  • Ovarian low malignant potential tumor is a disease in which abnormal cells form in the tissue covering the ovary.
  • Signs and symptoms of ovarian low malignant potential tumor include pain or swelling in the abdomen.
  • Tests that examine the ovaries are used to diagnose and stage ovarian low malignant potential tumor.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

Ovarian low malignant potential tumor is a disease in which abnormal cells form in the tissue covering the ovary.

Ovarian low malignant potential tumors have abnormal cells that may become cancer, but usually do not. This disease usually remains in the ovary. When disease is found in one ovary, the other ovary should also be checked carefully for signs of disease.

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones.

EnlargeAnatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina.
Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Signs and symptoms of ovarian low malignant potential tumor include pain or swelling in the abdomen.

Ovarian low malignant potential tumor may not cause early signs or symptoms. If you do have signs or symptoms, they may include the following:

These signs and symptoms may be caused by other conditions. If they get worse or do not go away on their own, check with your doctor.

Tests that examine the ovaries are used to diagnose and stage ovarian low malignant potential tumor.

The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
    EnlargePelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups.
    Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
    EnlargeAbdominal ultrasound; drawing shows a woman on an exam table during an abdominal ultrasound procedure. A diagnostic sonographer (a person trained to perform ultrasound procedures) is shown passing a transducer (a device that makes sound waves that bounce off tissues inside the body) over the surface of the patient’s abdomen. A computer screen shows a sonogram (computer picture).
    Abdominal ultrasound. An ultrasound transducer connected to a computer is passed over the surface of the abdomen. The ultrasound transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).

    Other patients may have a transvaginal ultrasound.

    EnlargeTransvaginal ultrasound; drawing shows a side view of the female reproductive anatomy during a transvaginal ultrasound procedure. An ultrasound probe (a device that makes sound waves that bounce off tissues inside the body) is shown inserted into the vagina. The bladder, uterus, right fallopian tube, and right ovary are also shown. The inset shows the diagnostic sonographer (a person trained to perform ultrasound procedures) examining a woman on a table, and a computer screen shows an image of the patient’s internal tissues.
    Transvaginal ultrasound. An ultrasound probe connected to a computer is inserted into the vagina and is gently moved to show different organs. The probe bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • CA 125 assay: A test that measures the level of CA 125 in the blood. CA 125 is a substance released by cells into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other condition.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The tissue is usually removed during surgery to remove the tumor.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

  • The stage of the disease (whether it affects part of the ovary, involves the whole ovary, or has spread to other places in the body).
  • What type of cells make up the tumor.
  • The size of the tumor.
  • The patient’s general health.

Patients with ovarian low malignant potential tumors have a good prognosis, especially when the tumor is found early.

Stages of Ovarian Low Malignant Potential Tumors

Key Points

  • After ovarian low malignant potential tumor has been diagnosed, tests are done to find out if abnormal cells have spread within the ovary or to other parts of the body.
  • The following stages are used for ovarian low malignant potential tumor:
    • Stage I
    • Stage II
    • Stage III
    • Stage IV
  • Ovarian low malignant potential tumors can recur (come back) after they have been treated.

After ovarian low malignant potential tumor has been diagnosed, tests are done to find out if abnormal cells have spread within the ovary or to other parts of the body.

The process used to find out whether abnormal cells have spread within the ovary or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Certain tests or procedures are used for staging. Staging laparotomy (a surgical incision made in the wall of the abdomen to remove ovarian tissue) may be used. Most patients are diagnosed with stage I disease.

The following stages are used for ovarian low malignant potential tumor:

Stage I

In stage I, the tumor is found in one or both ovaries or fallopian tubes. Stage I is divided into stage IA, stage IB, and stage IC.

  • Stage IA: The tumor is found inside a single ovary or fallopian tube.
  • Stage IB: The tumor is found inside both ovaries or fallopian tubes.
  • Stage IC: The tumor is found inside one or both ovaries or fallopian tubes and one of the following is true:

Stage II

In stage II, the tumor is found in one or both ovaries or fallopian tubes and has spread into other areas of the pelvis, or primary peritoneal cancer is found within the pelvis. Stage II is divided into stage IIA and stage IIB.

  • Stage IIA: The tumor has spread from where it first formed to the uterus and/or the fallopian tubes and/or the ovaries.
  • Stage IIB: The tumor has spread from the ovary or fallopian tube to organs in the peritoneal cavity (the space that contains the abdominal organs).

Stage III

EnlargeDrawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler.
Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).

In stage III, the tumor is found in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

  • In stage IIIA, one of the following is true:
    • The tumor has spread to lymph nodes in the area outside or behind the peritoneum only; or
    • Tumor cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis, such as the omentum (a fold of the peritoneum that surrounds the stomach and other organs in the abdomen). The tumor may have spread to nearby lymph nodes.
  • Stage IIIB: The tumor has spread to the peritoneum outside the pelvis, such as the omentum, and the tumor in the peritoneum is 2 centimeters or smaller. The tumor may have spread to lymph nodes behind the peritoneum.
  • Stage IIIC: The tumor has spread to the peritoneum outside the pelvis, such as the omentum, and the tumor in the peritoneum is larger than 2 centimeters. The tumor may have spread to lymph nodes behind the peritoneum or to the surface of the liver or spleen.

Stage IV

In stage IV, tumor cells have spread beyond the abdomen to other parts of the body. Stage IV is divided into stage IVA and stage IVB.

Ovarian low malignant potential tumors can recur (come back) after they have been treated.

The tumors may come back in the other ovary or in other parts of the body.

Treatment Option Overview

Key Points

  • There are different types of treatment for patients with ovarian low malignant potential tumor.
  • Two types of standard treatment are used:
    • Surgery
    • Chemotherapy
  • New types of treatment are being tested in clinical trials.
  • Treatment for ovarian low malignant potential tumors may cause side effects.
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their treatment.
  • Follow-up tests may be needed.

There are different types of treatment for patients with ovarian low malignant potential tumor.

Different types of treatment are available for patients with ovarian low malignant potential tumor. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer, tumors, and related conditions. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Two types of standard treatment are used:

Surgery

The type of surgery (removing the tumor in an operation) depends on the size and spread of the tumor and the woman’s plans for having children. Surgery may include the following:

  • Unilateral salpingo-oophorectomy: Surgery to remove one ovary and one fallopian tube.
  • Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
  • Total hysterectomy and bilateral salpingo-oophorectomy: Surgery to remove the uterus, cervix, and both ovaries and fallopian tubes. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
    EnlargeHysterectomy; drawing shows the female reproductive anatomy, including the ovaries, uterus, vagina, fallopian tubes, and cervix. Dotted lines show which organs and tissues are removed in a total hysterectomy, a total hysterectomy with salpingo-oophorectomy, and a radical hysterectomy. An inset shows the location of two possible incisions on the abdomen: a low transverse incision is just above the pubic area and a vertical incision is between the navel and the pubic area.
    Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.
  • Partial oophorectomy: Surgery to remove part of one ovary or part of both ovaries.
  • Omentectomy: Surgery to remove the omentum (a piece of the tissue lining the abdominal wall).

After the doctor removes all disease that can be seen at the time of the surgery, the patient may be given chemotherapy after surgery to kill any tumor cells that are left. Treatment given after the surgery, to lower the risk that the tumor will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI website.

Treatment for ovarian low malignant potential tumors may cause side effects.

For information about side effects caused by treatment for cancer, visit our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the medical research process. Clinical trials are done to find out if new treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for disease are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way diseases will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose disease has not gotten better. There are also clinical trials that test new ways to stop a disease from recurring (coming back) or reduce the side effects of treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the disease may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the disease has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of Early Stage Ovarian Low Malignant Potential Tumors (Stage I and II)

For information about the treatments listed below, see the Treatment Option Overview section.

Surgery is the standard treatment for early stage ovarian low malignant potential tumor. The type of surgery usually depends on whether a woman plans to have children.

For women who plan to have children, surgery is either:

To prevent recurrence of disease, most doctors recommend surgery to remove the remaining ovarian tissue when a woman no longer plans to have children.

For women who do not plan to have children, treatment may be hysterectomy and bilateral salpingo-oophorectomy.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Late Stage Ovarian Low Malignant Potential Tumors (Stage III and IV)

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment for late stage ovarian low malignant potential tumor may be hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A lymph node dissection may also be done.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Recurrent Ovarian Low Malignant Potential
Tumors

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment for recurrent ovarian low malignant potential tumor may include the following:

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Ovarian Low Malignant Potential Tumors

For general cancer information and other resources from the National Cancer Institute, visit:

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of ovarian low-malignant potential tumors. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Adult Treatment Editorial Board. PDQ Ovarian Low Malignant Potential Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/ovarian/patient/ovarian-low-malignant-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389247]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Advances in Ovarian Cancer Research

Advances in Ovarian Cancer Research

Image from a mouse model of ovarian cancer in color-enhanced 3D detail.

An ovarian tumor grown in a mouse using human cells. Special techniques were used to create the high-resolution, 3-D view of the cancer’s cell structure and inner workings.

Credit: Chris Booth, Kyle Cowdrick, Frank C. Marini. National Cancer Institute Comprehensive Cancer Center of Wake Forest Univ.

The most common ovarian cancers are those that begin in the epithelial cells that line the fallopian tubes or ovaries. These, along with cancers that form in the peritoneum, are called epithelial ovarian cancers. Other types of ovarian cancer arise in other cells, including germ cell tumors, which start in the cells that make eggs, and stromal cell tumors, which start in supporting tissues. 

NCI-funded researchers are working to advance our understanding of how to prevent, detect early, and treat ovarian cancer.

This page highlights some of what’s new in the latest research in ovarian cancer, including clinical advances that may soon translate into improved care, NCI-supported programs that are fueling progress, and research findings from recent studies.

Prevention of Ovarian Cancer

Women who carry harmful or potentially harmful mutations in the BRCA1 or BRCA2 genes are at increased risk of developing ovarian cancer.  Surgery to remove the ovaries and fallopian tubes in these women is the recommended treatment method and can reduce their lifetime risk of getting ovarian cancer by 95%. However, having this surgery causes immediate menopause. This may cause health problems if it is much earlier than naturally occurring menopause.

Research has shown that the most common type of ovarian cancer begins in the fallopian tubes, not in the ovaries. This discovery has led doctors to reconsider ways of preventing ovarian cancer.

  • Removing fallopian tubes only. An ongoing NCI-supported clinical trial is testing whether removing the fallopian tubes but delaying removal of the ovaries will be as safe and effective to reduce the risk of ovarian cancer in women with BRCA1 mutations as removing both the ovaries and fallopian tubes at the same time. This would allow women to maintain premenopausal levels of hormones produced by the ovaries and delay many of the complications associated with menopause.
  • Removal of fallopian tubes in people seeking to prevent pregnancy. The discovery that epithelial ovarian cancers most often start in the fallopian tubes has also led to changes in the way some gynecologists approach surgery to prevent pregnancy. Women seeking tubal ligation to prevent pregnancy (often called having your tubes tied) may be offered the option of having their tubes removed instead. Doing so might reduce the possibility of ovarian cancer in the future. 
  • Removal of fallopian tubes in people undergoing a hysterectomy. Similarly, some gynecologists recommend that their patients who are undergoing a hysterectomy also have their fallopian tubes removed.
  • Testing relatives for gene mutations. NCI is funding efforts to test the relatives of women who have been diagnosed with ovarian cancer in the past.  Researchers are locating women diagnosed with ovarian cancer with the hope to test them and/or their family members for ovarian cancer-related gene mutations. As a result, family members who learn they carry a mutation can take steps to reduce their risk. The overall goal is not only to prevent ovarian cancer, but also to find the best ways to communicate sensitive genetic information to ovarian cancer patients and their family members.

Ovarian Cancer Treatment

Surgery and chemotherapy are the main treatments for ovarian cancer. The location and type of cells where the cancer begins, and whether the cancer is high-grade or low-grade, influences how the cancer is treated. Surgery can cure most people with early-stage ovarian cancer that has not spread beyond the ovaries. For advanced ovarian cancer, the goal of surgery is to remove as much of the cancer as possible, called surgical debulking. 

Platinum-based chemotherapy drugs, such as cisplatin or carboplatin, given in combination with other drugs, such as the targeted therapy bevacizumab (Avastin), are usually effective in treating epithelial ovarian cancer at any stage. However, in most people with advanced ovarian cancer, the cancer comes back. Treating the cancer again with platinum drugs may work, but eventually the tumors become resistant to these drugs.

Targeted Therapy

Targeted therapy uses drugs or other agents to attack specific types of cancer cells. PARP inhibitors are a type of targeted therapy that can stop a cancer cell from repairing its damaged DNA, causing the cell to die. Cancers in people who have certain mutations in the BRCA genes are considered particularly susceptible to PARP inhibitors. That’s because BRCA genes are involved in the repair of some types of DNA damage, so cancers with alterations in these genes already have defects in DNA repair.

The use of PARP inhibitors has transformed treatment for people with advanced epithelial ovarian cancer who have harmful mutations in a BRCA gene. Since the 2014 approval of olaparib (Lynparza), the first PARP inhibitor to be approved, the number of PARP inhibitors has grown and their uses for people with ovarian cancer have expanded. Now researchers are studying the benefits of combining PARP inhibitors with other drugs.

Clinical trials have shown that using PARP inhibitors as long-term therapy in women with advanced epithelial ovarian cancer delayed progression of the cancer. 

A different targeted therapy, mirvetuximab soravtansine (Elahere), is now available to treat women with ovarian cancer that is no longer responding to platinum drugs. FDA recently approved the drug to treat people with platinum-resistant ovarian tumors that produce an excess of a protein called FR-α. Results from a large clinical trial showed that people with this type of ovarian cancer treated with mirvetuximab lived longer overall than people treated with standard chemotherapy.

Treatment after Cancer Progression

Typically, chemotherapy and targeted therapies are stopped once ovarian cancer begins to come back. Clinical trials have shown that where there was more than a 6 month delay between stopping treatment and cancer being found again, resuming the drug bevacizumab (Avastin) in combination with platinum-based chemotherapy for patients previously treated with bevacizumab slowed the growth of platinum-sensitive disease. And in women who no longer benefited from platinum-based chemotherapy, non–platinum-based chemotherapy combined with bevacizumab kept the cancer in check longer than chemotherapy alone.

Targeted therapies may also be helpful for people with low-grade ovarian cancer. A trial of the drug trametinib in women with low-grade serous ovarian cancer that had come back showed that it delayed the cancer’s growth compared with treating the cancer with chemotherapy again.

Secondary Surgery

For women with advanced epithelial ovarian cancer that has come back after being in remission, clinical trials have studied the use of secondary surgery or surgery to remove more tumor after the initial surgery with varying results. 

In the Chinese and European trials, and in an analysis of 64 clinical trials and other studies, the benefits of secondary surgery were observed only in women who had all of their visible cancer removed.

NCI-Supported Research Programs

Many NCI-funded researchers at the National Institutes of Health campus, and across the United States and the world, are seeking ways to address ovarian cancer more effectively. Some research is basic, exploring questions as diverse as the biological underpinnings of ovarian cancer and the social factors that affect cancer risk. And some is more clinical, seeking to translate this basic information into improving patient outcomes.

The Women’s Malignancies Branch in NCI’s Center for Cancer Research conducts basic and clinical research in breast and gynecologic cancers, including early-phase clinical trials at the NIH Clinical Center in Bethesda, Maryland. 

The Ovarian Specialized Programs of Research Excellence (SPOREs) promote collaborative translational cancer research. This group works to improve prevention and treatment approaches, along with molecular diagnostics, in the clinical setting to help people with ovarian cancer.

The Ovarian Cancer Cohort Consortium, part of the NCI Cohort Consortium, is an international consortium of more than 20 cohort studies that follow people with ovarian cancer to improve understanding of ovarian cancer risk, early detection, tumor differences, and prognosis. 

NCI’s clinical trials programs, the National Clinical Trials Network, Experimental Therapeutics Clinical Trials Network, and NCI Community Oncology Research Program, all conduct or support clinical studies of ovarian cancer.

Clinical Trials for Ovarian Cancer

NCI funds and oversees both early- and late-phase clinical trials to develop new treatments and improve patient care. Trials are available for the treatment of ovarian cancer.

Ovarian Cancer Research Results

The following are some of our latest news articles on ovarian cancer research:

View the full list of Ovarian Cancer Research Results and Study Updates.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention (PDQ®)–Patient Version

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention (PDQ®)–Patient Version

What Is Prevention?

Go to Health Professional Version

Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.

To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk, but it does not mean that you will not get cancer.

Different ways to prevent cancer are being studied, including:

  • Changing lifestyle or eating habits.
  • Avoiding things known to cause cancer.
  • Taking medicines to treat a precancerous condition or to keep cancer from starting.

General Information About Ovarian, Fallopian Tube, and Primary Peritoneal Cancers

Key Points

  • Ovarian, fallopian tube, and primary peritoneal cancers are diseases in which malignant (cancer) cells form in the ovaries, fallopian tubes, or peritoneum.
  • Ovarian cancer is the leading cause of death from cancer of the female reproductive system.

Ovarian, fallopian tube, and primary peritoneal cancers are diseases in which malignant (cancer) cells form in the ovaries, fallopian tubes, or peritoneum.

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones (chemicals that control the way certain cells or organs work in the body).

The fallopian tubes are a pair of long, slender tubes, one on each side of the uterus. Eggs pass from the ovaries, through the fallopian tubes, to the uterus. Cancer sometimes begins at the end of the fallopian tube near the ovary and spreads to the ovary.

The peritoneum is the tissue that lines the abdominal wall and covers organs in the abdomen. Primary peritoneal cancer is cancer that forms in the peritoneum and has not spread there from another part of the body. Cancer sometimes begins in the peritoneum and spreads to the ovary.

EnlargeAnatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina.
Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Ovarian cancer is the leading cause of death from cancer of the female reproductive system.

Ovarian cancer is most common in postmenopausal women. From 2012 to 2021, the number of new cases of ovarian cancer decreased slightly each year. There was also a slight decrease in the number of deaths from ovarian cancer each year from 2013 to 2022.

Women who have a family history of ovarian cancer and/or have inherited certain changes in genes, such as the BRCA1 or BRCA2 gene, have a higher risk than those who do not have a family history or who have not inherited these gene changes. For women with inherited risk, genetic counseling and genetic testing can be used to find out more about their likelihood of developing ovarian cancer.

It is hard to find ovarian cancer early. Early ovarian cancer may not cause any symptoms. When symptoms do appear, ovarian cancer is often advanced.

Other PDQ summaries containing information related to ovarian, fallopian tube, and primary peritoneal cancers include:

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention

Key Points

  • Avoiding risk factors and increasing protective factors may help prevent cancer.
  • The following are risk factors for ovarian, fallopian tube, and primary peritoneal cancers:
    • Family history of ovarian, fallopian tube, and primary peritoneal cancers
    • Inherited risk
    • Hormone replacement therapy
    • Weight and height
    • Endometriosis
  • The following are protective factors for ovarian, fallopian tube, and primary peritoneal cancers:
    • Oral contraceptives
    • Tubal ligation
    • Giving birth
    • Salpingectomy
    • Breastfeeding
    • Risk-reducing salpingo-oophorectomy
  • It is not clear whether the following affect the risk of ovarian, fallopian tube, and primary peritoneal cancers:
    • Diet
    • Alcohol
    • Aspirin and nonsteroidal anti-inflammatory drugs
    • Talc
    • Infertility treatment
  • Cancer prevention clinical trials are used to study ways to prevent cancer.
  • New ways to prevent ovarian, fallopian tube, and primary peritoneal cancers are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, having overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following are risk factors for ovarian, fallopian tube, and primary peritoneal cancers:

Family history of ovarian, fallopian tube, and primary peritoneal cancers

A woman whose mother or sister had ovarian cancer has an increased risk of ovarian cancer. A woman with two or more relatives with ovarian cancer also has an increased risk of ovarian cancer.

Inherited risk

The risk of ovarian cancer is increased in women who have inherited certain changes in genes, such as the BRCA1 or BRCA2 gene.

The risk of ovarian cancer is also increased in women who have certain inherited syndromes, such as:

Hormone replacement therapy

There is a slightly increased risk of ovarian cancer in women who are taking hormone replacement therapy (HRT) after menopause. There is also an increased risk of ovarian cancer in women who have recently used HRT, even if they used it for less than 5 years. The risk of ovarian cancer is the same for HRT with estrogen only or with combined estrogen and progestin. HRT taken through the skin may have a lower risk than HRT taken by mouth. When HRT is stopped, the risk of ovarian cancer decreases over time. The risk of ovarian cancer is not affected by the age of the woman when taking HRT.

Weight and height

Having excess body weight or obesity is linked to an increased risk of ovarian cancer. Obesity is also linked to an increased risk of death from ovarian cancer. Being tall may also be linked to a slight increase in the risk of ovarian cancer.

Endometriosis

Women who have endometriosis have an increased risk of ovarian cancer.

The following are protective factors for ovarian, fallopian tube, and primary peritoneal cancers:

Oral contraceptives

Taking oral contraceptives (“the pill”) lowers the risk of ovarian cancer. The longer oral contraceptives are used, the lower the risk may be. The decrease in risk may last up to 30 years after a woman has stopped taking oral contraceptives.

Taking oral contraceptives increases the risk of blood clots. This risk is higher in women who also smoke.

Tubal ligation

The risk of ovarian cancer is decreased in women who have a tubal ligation (surgery to close both fallopian tubes).

Giving birth

Women who have given birth have a decreased risk of ovarian cancer compared to women who have not given birth. Giving birth to more than one child further decreases the risk of ovarian cancer.

Salpingectomy

Some studies have shown that salpingectomy (surgery to remove one or both fallopian tubes) is linked to a decreased risk of ovarian cancer. When both fallopian tubes are removed, the risk of ovarian cancer is lowered more than when one fallopian tube is removed.

Breastfeeding

Breastfeeding is linked to a decreased risk of ovarian cancer. The longer a woman breastfeeds, the lower her risk of ovarian cancer. Women who breastfeed for at least 8 to 10 months have the greatest decrease in risk of ovarian cancer.

Risk-reducing salpingo-oophorectomy

Some women who have a high risk of ovarian cancer may choose to have a risk-reducing salpingo-oophorectomy (surgery to remove the fallopian tubes and ovaries when there are no signs of cancer). This includes women who have inherited certain changes in the BRCA1 or BRCA2 gene or have an inherited syndrome.

It is very important to have a cancer risk assessment and counseling before making this decision. These and other factors may be discussed:

  • Infertility.
  • Early menopause: The drop in estrogen levels caused by removing the ovaries can cause early menopause. Symptoms of menopause can worsen and include:

    These symptoms may not be the same in all women. Hormone replacement therapy (HRT) may be used to lessen these symptoms.

  • Risk of ovarian cancer in the peritoneum: Women who have had a risk-reducing salpingo-oophorectomy continue to have a small risk of ovarian cancer in the peritoneum (thin layer of tissue that lines the inside of the abdomen). This is rare, but may occur if ovarian cancer cells had already spread to the peritoneum before the surgery or if some ovarian tissue remains after surgery.

It is not clear whether the following affect the risk of ovarian, fallopian tube, and primary peritoneal cancers:

Diet

Studies of dietary factors have not found a strong link to ovarian cancer.

Alcohol

Studies have not shown a link between drinking alcohol and the risk of ovarian cancer.

Aspirin and nonsteroidal anti-inflammatory drugs

Some studies of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) have found a decreased risk of ovarian cancer and others have not.

Talc

Studies of women who used talcum powder (talc) dusted on the perineum (the area between the vagina and the anus) have not found clear evidence of an increased risk of ovarian cancer.

Infertility treatment

Overall, studies in women using fertility drugs have not found clear evidence of an increased risk of ovarian cancer. The risk of invasive ovarian cancer may be higher in women who do not get pregnant after taking fertility drugs.

Cancer prevention clinical trials are used to study ways to prevent cancer.

Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials include healthy people who may or may not have an increased risk of cancer. Other prevention trials include people who have had cancer and are trying to prevent recurrence or a second cancer.

The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.

New ways to prevent ovarian, fallopian tube, and primary peritoneal cancers are being studied in clinical trials.

Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about ovarian, fallopian tube, and primary peritoneal cancers prevention. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/ovarian/patient/ovarian-prevention-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389375]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Research Results and Study Updates

Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Research Results and Study Updates

See Advances in Ovarian Cancer Research for an overview of recent findings and progress, plus ongoing projects supported by NCI.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening (PDQ®)–Patient Version

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening (PDQ®)–Patient Version

What Is Screening?

Go to Health Professional Version

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

General Information About Ovarian, Fallopian Tube, and Primary Peritoneal Cancers

Key Points

  • Ovarian, fallopian tube, and primary peritoneal cancers are diseases in which malignant (cancer) cells form in the ovaries, fallopian tubes, or peritoneum.
  • In the United States, ovarian cancer is the sixth-leading cause of death from cancer in women.
  • Different factors increase or decrease the risk of getting ovarian, fallopian tube, and primary peritoneal cancers.

Ovarian, fallopian tube, and primary peritoneal cancers are diseases in which malignant (cancer) cells form in the ovaries, fallopian tubes, or peritoneum.

The ovaries are a pair of organs in the female reproductive system. They are in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries make eggs and female hormones (chemicals that control the way certain cells or organs work in the body).

The fallopian tubes are a pair of long, slender tubes, one on each side of the uterus. Eggs pass from the ovaries, through the fallopian tubes, to the uterus. Cancer sometimes begins at the end of the fallopian tube near the ovary and spreads to the ovary.

The peritoneum is the tissue that lines the abdominal wall and covers organs in the abdomen. Primary peritoneal cancer is cancer that forms in the peritoneum and has not spread there from another part of the body. Cancer sometimes begins in the peritoneum and spreads to the ovary.

Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer form in the same type of tissue. Studies of screening tests look at these cancers together.

EnlargeAnatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina.
Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Other PDQ summaries containing information related to ovarian, fallopian tube, and primary peritoneal cancers include:

In the United States, ovarian cancer is the sixth-leading cause of death from cancer in women.

Although ovarian cancer is rare, it is the sixth-leading cause of death from cancer in women. It is also the leading cause of death from cancer of the female reproductive system. The number of new cases of ovarian cancer have been decreasing slightly each year since at least the 1970s. There was also a slight decrease in the number of deaths from ovarian cancer each year from 2004 to 2022.

Different factors increase or decrease the risk of getting ovarian, fallopian tube, and primary peritoneal cancers.

Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor. Talk to your doctor if you think you may be at risk for ovarian cancer.

To learn more, visit Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening

Key Points

  • Tests are used to screen for different types of cancer when a person does not have symptoms.
  • Screening for ovarian cancer may not help a person live longer.
  • Screening tests that have been studied include:
    • Pelvic exam
    • Transvaginal ultrasound
    • CA-125 blood test
  • Screening tests for ovarian, fallopian tube, and primary peritoneal cancers are being studied in clinical trials.

Tests are used to screen for different types of cancer when a person does not have symptoms.

Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) helps a person live longer or decreases a person’s chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

Screening for ovarian cancer may not help a person live longer.

Screening tests that have been studied include:

Pelvic exam

Pelvic exams to screen for ovarian cancer have not been shown to decrease the number of deaths from the disease. A pelvic exam is an exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina, and the doctor or nurse looks at the vagina and cervix for signs of disease. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.

EnlargePelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups.
Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.

Transvaginal ultrasound

Transvaginal ultrasound (TVU) to screen for ovarian cancer has not been shown to decrease the number of deaths from the disease. TVU is a procedure used to examine the vagina, uterus, fallopian tubes, ovaries, and bladder. An ultrasound transducer (probe) is inserted into the vagina and used to bounce high-energy sound waves off internal tissues or organs in the pelvis. These sound waves make echoes that form a picture of body tissues called a sonogram.

EnlargeTransvaginal ultrasound; drawing shows a side view of the female reproductive anatomy during a transvaginal ultrasound procedure. An ultrasound probe (a device that makes sound waves that bounce off tissues inside the body) is shown inserted into the vagina. The bladder, uterus, right fallopian tube, and right ovary are also shown. The inset shows the diagnostic sonographer (a person trained to perform ultrasound procedures) examining a woman on a table, and a computer screen shows an image of the patient’s internal tissues.
Transvaginal ultrasound. An ultrasound probe connected to a computer is inserted into the vagina and is gently moved to show different organs. The probe bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).

CA-125 blood test

A CA-125 blood test measures the level of CA-125, a substance released by cells into the bloodstream. An increased CA-125 level may be a sign of certain types of cancer, including ovarian cancer, or other conditions.

Studies have also shown that using CA-125 levels and TVU together to screen for ovarian cancer does not decrease the number of deaths from ovarian cancer.

Screening tests for ovarian, fallopian tube, and primary peritoneal cancers are being studied in clinical trials.

Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Risks of Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening

Key Points

  • Screening tests have risks.
  • The risks of ovarian, fallopian tube, and primary peritoneal cancers screening tests include:
    • Finding ovarian, fallopian tube, and primary peritoneal cancers may not improve health or help a woman live longer.
    • False-negative test results can occur.
    • False-positive test results can occur.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful, and most have risks. Before having any screening test, you may want to talk about the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of ovarian, fallopian tube, and primary peritoneal cancers screening tests include:

Finding ovarian, fallopian tube, and primary peritoneal cancers may not improve health or help a woman live longer.

Screening may not improve your health or help you live longer if you have advanced ovarian cancer or if it has already spread to other places in your body.

False-negative test results can occur.

Screening test results may appear to be normal even though ovarian cancer is present. A woman who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn’t) can cause anxiety and is usually followed by more tests and procedures (such as a laparoscopy or a laparotomy to see if cancer is present), which also have risks. Problems caused by tests used to diagnose ovarian cancer include infection, blood loss, bowel injury, and heart and blood vessel problems. A false-positive test result can also lead to an unneeded oophorectomy (removal of one or both ovaries).

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about ovarian, fallopian tube, and primary peritoneal cancers screening. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”

The best way to cite this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/ovarian/patient/ovarian-screening-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389490]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening (PDQ®)–Health Professional Version

Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening (PDQ®)–Health Professional Version

Overview

Go to Patient Version

Note: The Overview section summarizes the published evidence on this topic. The rest of the summary describes the evidence in more detail.

Other PDQ summaries containing information related to ovarian, fallopian tube, and primary peritoneal cancers screening include the following:

Evidence of Lack of Mortality Benefit Associated With Screening

Single-threshold cancer antigen 125 (CA-125) levels and transvaginal ultrasound (TVU)

There is solid evidence to indicate that screening women aged 55 to 74 years at average risk of developing ovarian cancer with the serum marker CA-125 (at a fixed threshold for a positive result of 35 U/mL) annually for 6 years and TVU for 4 years does not result in a decrease in ovarian cancer mortality, after a median follow-up of 17 years.

Magnitude of Effect: The ovarian cancer mortality rate was 4.4 deaths per 10,000 person-years in the intervention arm and 3.8 deaths per 10,000 person-years in the usual-care arms, respectively (rate ratio, 1.18; 95% confidence interval [CI], 0.98–1.4).[1]

  • Study Design: Evidence obtained from one randomized controlled trial.
  • Internal Validity: Good.
  • Consistency: One trial has evaluated the impact on mortality from ovarian cancer.
  • External Validity: Good.

Screening with TVU alone or with multimodal screening with CA-125 levels, assessed using the Risk of Ovarian Cancer Algorithm (ROCA), with TVU

Screening with TVU alone or with multimodal screening with CA-125 levels, assessed using the ROCA, combined with TVU in the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) did not show a mortality benefit of screening with either approach based on a predetermined primary endpoint among women undergoing 7 to 11 screens and a median of 16.3 years of follow-up.[2]

Magnitude of Effect: Multimodal screening was associated with no significant difference in mortality compared with no screening (hazard ratio [HR], 0.94; 95% CI, 0.83–1.08). Ultrasound only screening also resulted in no significant difference in mortality compared with no screening (HR, 0.94; 95% CI, 0.82–1.08).[2] Screening complications were less than 1% for both TVU only and multimodality screening strategies.[3]

  • Study Design: Evidence obtained from one randomized controlled trial.
  • Internal Validity: Good.
  • Consistency: One trial has evaluated the impact on mortality from ovarian cancer using this specific approach.
  • External Validity: Good—based on data from other studies assessing complementary endpoints.

Statement of harms

Based on solid evidence, screening for ovarian cancer results in false-positive test results. Screened women had higher rates of oophorectomy and other minor complications such as fainting and bruising.

Magnitude of Effect:

  • Of screened women, 9.6% had false-positive results, resulting in 6.2% undergoing surgery. The surgical complication rate was 1.2% for all screened women.
  • Oophorectomy rates were 85.7 per 10,000 person-years among screened women and 64.2 per 10,000 person-years among usual-care women.
  • Minor complications with screening: 58.3 cases per 10,000 women screened with CA-125 and 3.3 cases per 10,000 women screened with transvaginal sonogram.
  • Study Design: Evidence obtained from one randomized controlled trial.
  • Internal Validity: Good.
  • Consistency: Not applicable.
  • External Validity: Good.

In the TVU-only arm of the UKCTOCS, there were 50 false-positive surgical procedures, and in the multimodality arm, there were 14 false-positive operations per 10,000 screens.[3]

In the general population, screening is targeted to postmenopausal women, and the major complications are related to surgery. Among younger women, the potential target group among BRCA1/2 mutation carriers, oophorectomy at younger than 45 years may increase mortality secondary to cardiovascular disease. Oophorectomy, if performed among younger women, may also reduce risk of estrogen receptor–positive breast cancers, which occur with elevated frequency among carriers of BRCA2 mutations.

References
  1. Pinsky PF, Miller EA, Zhu CS, et al.: Overall mortality in men and women in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. J Med Screen 26 (3): 127-134, 2019. [PUBMED Abstract]
  2. Menon U, Gentry-Maharaj A, Burnell M, et al.: Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 397 (10290): 2182-2193, 2021. [PUBMED Abstract]
  3. Jacobs IJ, Menon U, Ryan A, et al.: Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 387 (10022): 945-56, 2016. [PUBMED Abstract]

Incidence and Mortality

Ovarian cancer is rare; the lifetime risk of being diagnosed with ovarian cancer is 1.12%.[1]

Ovarian carcinoma is the sixth-leading cause of cancer death among women in the United States and has the highest mortality rate of all gynecologic cancers. It is estimated that 20,890 new cases of ovarian cancer will be diagnosed in the United States in 2025, and 12,730 women will die of this disease. Ovarian cancer incidence rates have been declining since at least the 1970s and have decreased by 1.6% per year from 2012 to 2021. Ovarian cancer mortality rates decreased by 2.4% per year from 2004 to 2022.[2] The prognosis for survival from ovarian carcinoma largely depends on stage, which is strongly associated with histopathological type. Approximately 70% of women with ovarian carcinoma have high-grade serous carcinoma, which is usually diagnosed at an advanced stage, leading to poor survival.[3]

References
  1. Surveillance Research Program, National Cancer Institute: SEER*Explorer: An interactive website for SEER cancer statistics. Bethesda, MD: National Cancer Institute. Available online. Last accessed December 30, 2024.
  2. American Cancer Society: Cancer Facts and Figures 2025. American Cancer Society, 2025. Available online. Last accessed January 16, 2025.
  3. Koshiyama M, Matsumura N, Konishi I: Subtypes of Ovarian Cancer and Ovarian Cancer Screening. Diagnostics (Basel) 7 (1): , 2017. [PUBMED Abstract]

Types of Ovarian, Fallopian Tube, and Primary Peritoneal Cancers

The term ovarian cancer encompasses a heterogeneous group of malignant tumors of ovarian origin that may arise from germ cells, stromal tissue, or epithelial tissue within the ovary. Epithelial cancers are the most common type of ovarian cancer and are further classified into five main types: high-grade serous, endometrioid, clear cell, mucinous, and low-grade serous carcinomas.[1] Data from detailed pathology reviews of specimens removed during risk-reducing surgery from carriers of BRCA1/BRCA2 mutations have demonstrated a putative precursor of high-grade serous carcinoma in the fimbria of the fallopian tube (serous tubal intraepithelial carcinoma [STIC]), suggesting that many carcinomas in this group previously classified as ovarian are actually tubal primary tumors. Similar lesions have been found in noncarriers of BRCA1/2 mutations, but most data from this group are limited by the presence of concurrent bulky carcinomas throughout the pelvis. STIC is not found in all cases of high-grade serous carcinoma, suggesting other possible origins of these tumors. Many endometrioid and clear cell carcinomas are postulated to arise from endometriosis, a benign lesion that may result from implantation and persistence of exfoliated menstrual endometrium.

Malignant germ cell tumors and stromal tumors such as granulosa cell tumors are rare and account for 10% or less of malignant ovarian tumors.[2]

References
  1. Prat J: Ovarian carcinomas: five distinct diseases with different origins, genetic alterations, and clinicopathological features. Virchows Arch 460 (3): 237-49, 2012. [PUBMED Abstract]
  2. Cramer DW: The epidemiology of endometrial and ovarian cancer. Hematol Oncol Clin North Am 26 (1): 1-12, 2012. [PUBMED Abstract]

Risk Factors

For a complete description of factors associated with an increased or decreased risk of ovarian cancer, see the Factors With Adequate Evidence of an Increased Risk of Ovarian, Fallopian Tube, and Primary Peritoneal Cancers section in Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention. Several cancer family syndromes, such as BRCA1 and BRCA2 hereditary breast-ovarian syndrome and Lynch syndrome are associated with a marked increased risk of ovarian cancer.[1,2] For more information about these syndromes and other genetic risk factors for ovarian cancer, see the Autosomal Dominant Inheritance of Breast and Gynecologic Cancer Predisposition section in Genetics of Breast and Gynecologic Cancers.

References
  1. Hunn J, Rodriguez GC: Ovarian cancer: etiology, risk factors, and epidemiology. Clin Obstet Gynecol 55 (1): 3-23, 2012. [PUBMED Abstract]
  2. Cramer DW: The epidemiology of endometrial and ovarian cancer. Hematol Oncol Clin North Am 26 (1): 1-12, 2012. [PUBMED Abstract]

Evidence of Lack of Mortality Benefit Associated With Different Screening Modalities

Ovarian cancer often presents with persistent but vague symptoms, usually occurring after the cancer has metastasized. Some investigators have proposed the use of symptom indices as a method of screening for ovarian cancer.[1,2] Because this is not, by definition, asymptomatic screening, it is not considered further in this summary.

Gynecologic examination usually includes a manual pelvic examination, but this procedure is commonly viewed as lacking sensitivity for detection of early-stage disease.[3,4] There is no evidence of the benefit of this test for the early detection of and decreased mortality from ovarian cancer, so it is not further considered.

Other screening tests include transvaginal ultrasound (TVU) and the serum cancer antigen 125 (CA-125) assay. These tests are often performed in combination. Several biomarkers with potential application to ovarian cancer screening are under development but have not yet been validated or evaluated for efficacy in early detection and mortality reduction.

A U.S. Food and Drug Administration Safety Communication issued in September 2016 recommends against using currently offered screening tests to screen for ovarian cancer in any population of women. Asymptomatic high-risk women who have a false-negative screening test may delay effective preventive treatments.

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

TVU (or transvaginal sonogram [TVS]) has been proposed as a screening method for ovarian cancer because of its ability to reliably measure ovarian size and detect small masses.[5]

In the UKCTOCS, outcomes among 50,623 postmenopausal women aged 50 to 74 years who were randomly assigned to 7 to 11 rounds of annual screening with TVU alone and 50,625 who underwent multimodal screening with CA-125 testing and TVU (see below) were compared with results from a comparison group of 101,299 women who were not screened. Women were recruited in 13 trial centers across the United Kingdom from 2001 to 2005. After trial initiation, but before analysis, the protocol was amended twice: 1) the study was extended to achieve greater power and 2) criteria for referral in the multimodal arm were liberalized to increase the percentage of positive screens.[6] Because the number of events were less than anticipated on the planned censorship date, the authors extended the follow-up period. No formal adjustments were made to account for the previously analyzed data in 2015, rather the authors acknowledged the P values were not adjusted for multiplicity. Additionally, the authors changed the statistical analysis plan for the extended follow-up analysis from a Cox version of the log-rank test to the versatile test in efforts to be sensitive to delayed mortality effects in screening trials.[7]

TVUs were scored as normal, resulting in continued annual screening; intermediate, leading to repeat CA-125 and TVU at 3 months; or abnormal, requiring repeat testing within 6 weeks. In the TVU arm, 445 cancers were diagnosed and 291 ovarian cancer–related deaths occurred compared with the nonscreened arm, in which 905 cancers were diagnosed and 619 ovarian cancer–related deaths occurred. TVU screening resulted in 50 surgeries per 10,000 women for a false-positive screen. Complications occurred in less than 1% of screening examinations and 3.4% of surgeries. Over a median of 16.3 years, ovarian cancer deaths occurred among 0.6% of screened women and 0.6% of unscreened women.[6–8]

CA-125 Serum Testing for Ovarian Cancer Screening

CA-125 is a tumor-associated antigen that is used clinically to monitor patients with epithelial ovarian carcinomas.[9,10] Measurement of CA-125 concentrations has been proposed as a potential marker for the early detection of ovarian cancer, either as a single test with a threshold cutpoint or in algorithms examining the change in levels over time. The two randomized trials have included CA-125 either in parallel or sequentially with TVU for multimodality screening. The most commonly reported CA-125 reference value that designates a positive screening test is 35 U/mL; this was the reference value used in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Screening Trial (NCT01696994) to define an abnormal test result. The measurement of CA-125 levels, in parallel combination with TVU,[11] is the ovarian screening intervention evaluated in the PLCO trial.[12,13] Elevated CA-125 levels are not specific to ovarian cancer and have been observed in patients with nongynecological cancers,[10] endometriosis,[14] liver disease, congestive heart failure, pleural or peritoneal fluid accumulation, and in the first trimester of pregnancy.[15,16] The sensitivity of the CA-125 test for the detection of ovarian cancer was estimated in two nested case-control studies using serum banks.[17,18] The sensitivity for CA-125 levels of at least 35 U/mL ranged from 20% to 57% for cases occurring within the first 3 years of follow-up; the specificity was 95%.

A phase II/III biomarker study was conducted to evaluate the sensitivity of several markers of ovarian cancer, including CA-125 concentrations, using specimens collected from ovarian cancer patients at four sites. The estimated sensitivity for early-stage disease (stage I and II ovarian cancer) was 56% (95% CI, 49%–72%) for a cutpoint set to obtain a fixed specificity of 95%. The threshold for the cutpoint for CA-125 at 95% specificity was 24 U/mL. For all cases (56% of cases had stage III or IV disease at diagnosis), the sensitivity was 73% (95% CI, 64%–84%). When the clinical cutpoint of 35 U/mL was used, the sensitivity decreased.[19]

The Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial: Single-Threshold CA-125 Levels and TVU

The PLCO trial evaluated the effect of screening on ovarian cancer mortality among women aged 55 to 74 years on the basis of six annual screens with serum CA-125 testing at a threshold for positive of 35 U/mL and four annual screens with TVU. Women were randomly assigned to screening (n = 39,105) or usual care (n = 39,111) at ten screening centers across the United States between November 1993 and July 2001. Participants and their health care practitioners received the screening test results and managed evaluation of abnormal results. The usual-care group was not offered screening with CA-125 or TVU but received their usual medical care. Participants were initially monitored for a maximum of 13 years (median, 12.4 years; range, 10.9–13.0 years) for cancer diagnoses and death until February 28, 2010. Mortality from ovarian cancer, including primary peritoneal and fallopian tube cancers, was the main outcome measure. Secondary outcomes included ovarian cancer incidence and complications associated with screening examinations and diagnostic procedures.[20] After transition of PLCO trial participants to a centralized follow-up process, follow-up for mortality was extended until the end of 2012, for a maximum of 19.2 years and a median of 14.7 years.[21]

Compliance with screening ranged from 85% at the initial round to 73% at the sixth round, while contamination in the usual-care group ranged from about 3.0% for CA-125 to 4.6% for TVU. Across the first four screening rounds, 11.1% of women had at least one positive test, 8.1% had at least one positive TVU, and 3.4% had at least one positive CA-125 test. The yields of both tests were similar. Ovarian cancer was diagnosed in 212 women (5.7 per 10,000 person-years) in the intervention group and 176 women (4.7 per 10,000 person-years) in the usual-care group (rate ratio, 1.21; 95% CI, 0.99–1.48). The stage distributions were similar by study group, with stage III and IV cancers comprising most cases in both the intervention group (163 cases, 77%) and the usual-care group (137 cases, 78%). The cancer case treatment distributions were very similar between groups within each stage. Through the original period of follow-up (maximum, 13 years), ovarian cancer caused 118 deaths (3.1 per 10,000 person-years) in the intervention group and 100 deaths (2.6 per 10,000 person-years) in the usual-care group (mortality rate ratio, 1.18; 95% CI, 0.82–1.71). Long-term follow-up of a median of 17 years for women with at least one ovary demonstrated an ovarian cancer mortality rate of 4.4 deaths per 10,000 person-years (246 ovarian cancer deaths) in the intervention arm and 3.8 deaths per 10,000 person-years (209 ovarian cancer deaths) in the usual-care arm (rate ratio, 1.18; 95% CI, 0.98–1.4).[22]

Of the 3,285 women with false-positive results, 1,080 underwent surgical follow-up. Of the 1,080 women who underwent surgical follow-up, 163 women experienced at least one serious complication (15%). A total of 1,771 women in the intervention group (7.7%) and 1,304 in the usual-care group (5.8%) reported oophorectomy. There were 2,924 deaths resulting from other causes (excluding ovarian, colorectal, and lung cancer) (76.6 per 10,000 person-years) in the intervention group and 2,914 such deaths (76.2 per 10,000 person-years) in the usual-care group (rate ratio, 1.01; 95% CI, 0.96–1.06).[20,23]

In the PLCO trial, women with visualized ovaries were at slightly higher risk of ovarian cancer (hazard ratio, 1.42; 95% CI, 1.00–2.01) than were women who had nonvisualized ovaries.[24] A nested analysis found that ovarian volume increases were detectable 1 to 2 years before diagnosis, but the magnitude of change did not appear translatable to clinical management. Thus, among women in the general U.S. population, simultaneous screening with CA-125 and TVU did not reduce ovarian cancer mortality when compared with usual care.[20]

The Shizuoka Cohort Study of Ovarian Cancer Screening randomly assigned women to either a screening group (n = 41,668) or a control group (n = 40,799) between 1985 and 1999 at 212 hospitals in the Shizuoka prefecture of Japan. The screening protocol comprised ultrasound and CA-125 tests annually. Women with abnormal findings were referred to a gynecological oncologist. Ovarian cancer diagnoses were determined by record linkage to the Shizuoka Cancer Registry in 2002. The annual death certificate file in Shizuoka was checked to ascertain vital status. The mean follow-up time was 9.2 years, and the mean number of screens per woman was 5.4. There were 35 ovarian cancers detected in the screening group and 32 in the control group, with a nonstatistically significant difference in the stage distribution. Nine percent of regular screening attendees had at least one false-positive result.[25] Mortality results from this trial are not available.

Ovarian Cancer Screening Using CA-125 Analyzed According to the Risk of Ovarian Cancer Algorithm (ROCA) for a Positive Test Result in Combination With TVU

The UKCTOCS trial evaluated longitudinal CA-125 measurements using the ROCA, which defines a positive test as a statistically significant increase in a woman’s serial measurements based on the algorithm, irrespective of the absolute level. The goal of this approach is to detect cancers earlier by identifying subtle within-person changes. The UKCTOCS multimodal screen incorporated a two-stage approach with ROCA as the primary screen and TVS as a secondary screen (based on results of the ROCA) for its impact on ovarian cancer mortality compared with observation without screening. Of 50,078 women in the multimodality screening arm, 452 women were diagnosed with ovarian cancer and 296 died of the disease. In this arm, less than 1% of screens led to complications, and 3.1% of women developed surgical complications. Using multimodal screening, 14 per 10,000 screens led to surgery for a false-positive result.

There was a 39.2% (95% CI, 16.1–66.9) higher incidence of stage I or II disease and a 10.2% (95% CI, -21.3 to 2.4) lower incidence of stage III and IV disease in the multimodality screening arm compared with the no screening arm. However, despite the stage shift, at a median follow-up of 16.3 years, there was no significant difference in mortality, with 0.6% deaths in the multimodality screening arm compared with 0.6% in the observation arm.[7]

A post hoc nested study was conducted within the PLCO trial to determine if the use of ROCA could potentially improve the identification of early-stage (stage I and stage II) ovarian cancer.[26] The study evaluated the potential impact under two scenarios: best case and stage shift. Best-case scenario assumed that all cancers that would have been detected earlier with ROCA than with single-threshold CA-125 concentrations would have avoided mortality. The stage-shift scenario applied the observed PLCO early-stage survival rates to cases detected at an earlier stage with ROCA. The risk of death from ovarian cancer with ROCA was lower, but estimates were not statistically significant (relative risk [RR] of 0.90 for best-case scenario [95% CI, 0.69–1.17] and RR of 0.95 for stage-shift scenario [95% CI, 0.74–1.23]).

Another retrospective study using annual CA-125 concentrations from the PLCO trial examined the potential impact of parametric empirical Bayes (PEB) longitudinal algorithm for the earlier detection of 44 incident ovarian cancers identified in the PLCO trial. Setting the specificity at 99%, PEB signaled “abnormal” CA-125 concentrations, on average, 10 months earlier than with the single-threshold cutpoint.[27] An analysis of serial CA-125 concentrations from the UKCTOCS trial demonstrated superior performance characteristics for ovarian cancer screening using longitudinal algorithms, compared with a single CA-125 threshold.[28] Whether either of these approaches translates into a mortality benefit could not be determined.

CA-125 velocity has also been examined using a multiple logistic regression model within the PLCO trial as a predictor for the development of ovarian cancer.[29] Both CA-125 velocity and time intervals between screening tests were associated with the development of ovarian cancer. The risk of ovarian cancer increased as velocity (measured as U/mL per month) increased, and the risk of ovarian cancer decreased when the time intervals between screening tests increased.

References
  1. Goff BA, Mandel LS, Melancon CH, et al.: Frequency of symptoms of ovarian cancer in women presenting to primary care clinics. JAMA 291 (22): 2705-12, 2004. [PUBMED Abstract]
  2. Lim AW, Mesher D, Gentry-Maharaj A, et al.: Predictive value of symptoms for ovarian cancer: comparison of symptoms reported by questionnaire, interview, and general practitioner notes. J Natl Cancer Inst 104 (2): 114-24, 2012. [PUBMED Abstract]
  3. Smith LH, Oi RH: Detection of malignant ovarian neoplasms: a review of the literature. I. Detection of the patient at risk; clinical, radiological and cytological detection. Obstet Gynecol Surv 39 (6): 313-28, 1984. [PUBMED Abstract]
  4. Hall DJ, Hurt WG: The adnexal mass. J Fam Pract 14 (1): 135-40, 1982. [PUBMED Abstract]
  5. Higgins RV, van Nagell JR, Woods CH, et al.: Interobserver variation in ovarian measurements using transvaginal sonography. Gynecol Oncol 39 (1): 69-71, 1990. [PUBMED Abstract]
  6. Jacobs IJ, Menon U, Ryan A, et al.: Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 387 (10022): 945-56, 2016. [PUBMED Abstract]
  7. Menon U, Gentry-Maharaj A, Burnell M, et al.: Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet 397 (10290): 2182-2193, 2021. [PUBMED Abstract]
  8. Sharma A, Apostolidou S, Burnell M, et al.: Risk of epithelial ovarian cancer in asymptomatic women with ultrasound-detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS). Ultrasound Obstet Gynecol 40 (3): 338-44, 2012. [PUBMED Abstract]
  9. Bast RC, Feeney M, Lazarus H, et al.: Reactivity of a monoclonal antibody with human ovarian carcinoma. J Clin Invest 68 (5): 1331-7, 1981. [PUBMED Abstract]
  10. Bast RC, Klug TL, St John E, et al.: A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med 309 (15): 883-7, 1983. [PUBMED Abstract]
  11. Jacobs I, Stabile I, Bridges J, et al.: Multimodal approach to screening for ovarian cancer. Lancet 1 (8580): 268-71, 1988. [PUBMED Abstract]
  12. Buys SS, Partridge E, Greene MH, et al.: Ovarian cancer screening in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol 193 (5): 1630-9, 2005. [PUBMED Abstract]
  13. Gohagan JK, Levin DL, Prorok JC, et al., eds.: The Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. Control Clin Trials 21(6 suppl): 249S-406S, 2000.
  14. Jacobs I, Bast RC: The CA 125 tumour-associated antigen: a review of the literature. Hum Reprod 4 (1): 1-12, 1989. [PUBMED Abstract]
  15. Niloff JM, Knapp RC, Schaetzl E, et al.: CA125 antigen levels in obstetric and gynecologic patients. Obstet Gynecol 64 (5): 703-7, 1984. [PUBMED Abstract]
  16. Haga Y, Sakamoto K, Egami H, et al.: Evaluation of serum CA125 values in healthy individuals and pregnant women. Am J Med Sci 292 (1): 25-9, 1986. [PUBMED Abstract]
  17. Zurawski VR, Orjaseter H, Andersen A, et al.: Elevated serum CA 125 levels prior to diagnosis of ovarian neoplasia: relevance for early detection of ovarian cancer. Int J Cancer 42 (5): 677-80, 1988. [PUBMED Abstract]
  18. Helzlsouer KJ, Bush TL, Alberg AJ, et al.: Prospective study of serum CA-125 levels as markers of ovarian cancer. JAMA 269 (9): 1123-6, 1993. [PUBMED Abstract]
  19. Cramer DW, Bast RC, Berg CD, et al.: Ovarian cancer biomarker performance in prostate, lung, colorectal, and ovarian cancer screening trial specimens. Cancer Prev Res (Phila) 4 (3): 365-74, 2011. [PUBMED Abstract]
  20. Buys SS, Partridge E, Black A, et al.: Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA 305 (22): 2295-303, 2011. [PUBMED Abstract]
  21. Pinsky PF, Yu K, Kramer BS, et al.: Extended mortality results for ovarian cancer screening in the PLCO trial with median 15years follow-up. Gynecol Oncol 143 (2): 270-275, 2016. [PUBMED Abstract]
  22. Pinsky PF, Miller EA, Zhu CS, et al.: Overall mortality in men and women in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. J Med Screen 26 (3): 127-134, 2019. [PUBMED Abstract]
  23. Partridge E, Kreimer AR, Greenlee RT, et al.: Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol 113 (4): 775-82, 2009. [PUBMED Abstract]
  24. Bodelon C, Pfeiffer RM, Buys SS, et al.: Analysis of serial ovarian volume measurements and incidence of ovarian cancer: implications for pathogenesis. J Natl Cancer Inst 106 (10): , 2014. [PUBMED Abstract]
  25. Kobayashi H, Yamada Y, Sado T, et al.: A randomized study of screening for ovarian cancer: a multicenter study in Japan. Int J Gynecol Cancer 18 (3): 414-20, 2008 May-Jun. [PUBMED Abstract]
  26. Pinsky PF, Zhu C, Skates SJ, et al.: Potential effect of the risk of ovarian cancer algorithm (ROCA) on the mortality outcome of the Prostate, Lung, Colorectal and Ovarian (PLCO) trial. Int J Cancer 132 (9): 2127-33, 2013. [PUBMED Abstract]
  27. Drescher CW, Shah C, Thorpe J, et al.: Longitudinal screening algorithm that incorporates change over time in CA125 levels identifies ovarian cancer earlier than a single-threshold rule. J Clin Oncol 31 (3): 387-92, 2013. [PUBMED Abstract]
  28. Blyuss O, Burnell M, Ryan A, et al.: Comparison of Longitudinal CA125 Algorithms as a First-Line Screen for Ovarian Cancer in the General Population. Clin Cancer Res 24 (19): 4726-4733, 2018. [PUBMED Abstract]
  29. Xu JL, Commins J, Partridge E, et al.: Longitudinal evaluation of CA-125 velocity and prediction of ovarian cancer. Gynecol Oncol 125 (1): 70-4, 2012. [PUBMED Abstract]

Latest Updates to This Summary (04/09/2025)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Incidence and Mortality

Updated statistics with estimated new cases and deaths for 2025 (cited American Cancer Society as reference 2). Also revised text to state that ovarian cancer incidence rates have been declining since at least the 1970s and have decreased by 1.6% per year from 2012 to 2021.

This summary is written and maintained by the PDQ Screening and Prevention Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® Cancer Information for Health Professionals pages.

About This PDQ Summary

Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about ovarian, fallopian tube, and primary peritoneal cancers screening. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.

Reviewers and Updates

This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).

Board members review recently published articles each month to determine whether an article should:

  • be discussed at a meeting,
  • be cited with text, or
  • replace or update an existing article that is already cited.

Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.

Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website’s Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Levels of Evidence

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

Permission to Use This Summary

PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”

The preferred citation for this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /types/ovarian/hp/ovarian-screening-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389336]

Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.

Disclaimer

The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s Email Us.