Understanding the Ovarian Cancer: The Silent Killer.
Dr. Disha Mittal, Ph.D.
Background:
The eighth most common cause of cancer-related mortality for women globally and the seventh most common cancer overall is ovarian cancer. According to data from GLOBOCAN 2022, it is the third most frequent cancer among Indian women. In Indian women, epithelial OC is becoming the third most frequent cancer after breast and cervical cancer. By 2035, the annual incidence of EOC is expected to increase by 55%, and the fatality rate is expected to increase by 67% (Ghosh et al., 2025). According to Caruso et al. (2025), 95% of patients have vague first symptoms such stomach pain, bloating, and urine urgency or frequency, making early detection challenging due to the lack of efficient screening measures.
The estimated 5-year survival for people with detected invasive epithelial ovarian cancer is 93% for localized (stage I) or regional (stage II or stage IIIA1 with regional lymph node involvement) disease, respectively, and 75% for distant disease (remaining stage III or stage IV), according to the Surveillance, Epidemiology, and End Results database. Unfortunately, ambiguous clinical signs at earlier stages and the absence of an efficient screening method mean that OC is typically discovered in advanced stages (stages III and IV) (Medina et al., 2025). 32,978 deaths and 47,333 instances of ovarian cancer were recorded in 2022, making it the third most frequent malignancy among Indian women (Singh et al., 2024).
Symptoms:
Most incidences of OC happen after menopause. Women between the ages of 55 and 70 are most commonly affected by ovarian cancer. Incidence peaks between the ages of 55 and 59. According to the International Federation of Gynecology and Obstetrics (FIGO III and IV), over 70% of ovarian tumors are discovered at an advanced stage (Smolarz et al., 2025). Advanced-stage OC is characterized by bloating (77%), increased stomach size (64%), abdominal pain (22%), constipation (24%), back pain (45%), pelvic discomfort (26%), exhaustion (34%), and urgency or frequency of urination (16–34%). Timely detection is made much more difficult by the fact that the majority of early-stage OCs are asymptomatic. (Hong et al 2025).
The other signs of OC: vaginal bleeding; lower abdominal pain; persistent abdominal or pelvic pain; lumbar back pain; difficulties urinating (due to the tumor’s pressure on nearby organs); digestive system symptoms, such as bloating, enlargement of the abdominal circumference, fullness, belching, constipation, or diarrhea; persistent, extreme fatigue; and inexplicable weight loss. Carrying mutations in the BRCA1 and BRCA2 genes is one of the most well-known risk factors for OC; there is a genetic basis for 10–15% of all ovarian malignancies. Carriers of BRCA1 mutations have an around 44% chance of developing OC, whereas those with BRCA2 mutations have a roughly 17% chance. About 10% of ovarian cancers are caused by Lynch syndrome, a genetic illness marked by an increased propensity to develop multiple malignancies, including ovarian, endometrial, and urinary tract cancers. Lynch syndrome is a family history of non-polyposis colorectal cancer (Smolarz et al., 2025).
Diagnosis:
Although its diagnostic accuracy varies, transvaginal ultrasound (TVUS) is a potential method for OC diagnosis. A comprehensive study found that TVUS by itself had a sensitivity of 84.9% and a specificity of 98.2%, but a combination of TVUS and CA-125 had an enhanced sensitivity and specificity of 89.4% and 99.8%, respectively. MRI, CT, and ultrasound are examples of imaging modalities that basically support biomarkers. For the diagnosis of cancer, all three modalities show a high overall accuracy (Hong and Ding, 2025).
When identifying malignant ovarian masses, MRI is more accurate than Doppler ultrasonography and CT. According to reports, MRI may detect ovarian cancers with a sensitivity of 98% and a specificity of 83%. Furthermore, with a sensitivity and specificity of 86.7% and 81.9%, respectively, MRI has demonstrated efficacy in the diagnosis of ovarian endometriosis. Staging and treatment planning may be enhanced by integrated molecular imaging methods, especially [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. By influencing staging, therapy planning, and recurrence detection, PET/CT has completely changed the way that OC is managed (Hong and Ding, 2025).
Although serum CA-125 has long been the main biomarker for OC detection, its use in population-based screening and early-stage diagnosis is restricted. It can have a high diagnostic sensitivity for non-cancerous diseases but a low sensitivity for early-stage illness. Assays that combine the human epididymis secretory protein 4 (HE4) and CA-125 have shown increased diagnostic efficacy. To detect ovarian tumors with a high risk of cancer, CA-125 and a TVUS-based tumor-morphology index (MI) work well together. To improve diagnostic accuracy, multiplex panels that combine the CA-125, HE4, and additional instruments such the ROMA and OVA1 have been developed (Hong and Ding 2025).
With a sensitivity and specificity of 68.7% and 80%, respectively, a microfluidic platform distinguished cases from controls using a four-marker panel (CA-125, HE4, MMP-7, and CA72-4) with excellent specificity and low cross-reactivity. The sensitivity and specificity of CA-125 in conjunction with transthyretin and apolipoprotein A1 were reported to be 95% and 97%, respectively, greatly enhancing early-stage detection (Hong and Ding 2025).
Treatment:
Individualized maintenance therapy, systemic chemotherapy, and cytoreductive surgery are commonly used in the treatment of advanced-stage epithelial ovarian cancer. Prior to adjuvant platinum-based chemotherapy, primary cytoreductive surgery (hysterectomy with bilateral salpingooophorectomy and omentectomy) is advised for patients with advanced-stage ovarian cancer that is imaging-resectable and at low risk of perioperative complications. Resection of enlarged retroperitoneal pelvic and para-aortic lymph nodes, spleen, colon, and diaphragm may be necessary for patients with ovarian cancer that has spread to other organs (Caruso et al., 2025).
Regardless of the clinical advancement stage, performing appropriate cytoreductive surgery is a vital step that affects the patient’s treatment approach. The main procedure entails the excision of the pelvic and paraaortic lymph nodes up to the level of the left renal vein, as well as the total removal of the uterus and its appendages, including the ovaries and fallopian tubes (Smolarz et al., 2025).
Combining treatment with platinum derivatives (other cytostatic medications) and paclitaxel (a cytostatic medicine) is necessary for OC. Chemotherapy usually consists of six courses. At the moment, radiotherapy has little use in the battle against ovarian cancer. It is typically applied as a symptomatic or palliative measure. If the disease is in its early stages, the treatment entails the unilateral removal of the fallopian tube and the afflicted ovary, as well as a thorough inspection of the stage using microscopic and surgical techniques. These individuals have a better chance of surviving than those who have major surgery (Smolarz et al., 2025).
The goal of hormone therapy in supportive treatment is to enhance quality of life and slow the progression of cancer. Cancer cells with hormone receptors are hormone-sensitive. Among the hormonal medications used to treat ovarian cancer include gonadotropin-releasing hormones (goserelin), aromatase inhibitors (letrozole, analogues), and selective estrogen receptor modulators (tamoxifen) (Smolarz et al., 2025). Patients with advanced-stage ovarian cancer may be eligible for maintenance therapy with bevacizumab and/or PARP inhibitors (olaparib or niraparib) following initial treatment, contingent on their response to chemotherapy, histology, BRCA/HRD status, and comorbidities (Caruso et al., 2025). It is recommended to consult clinician for better understanding of treatment as it varies from case to case and individual to individual.
Prevention:
It is advised that people who carry the BRCA1/2 gene mutation and have a genetic burden of breast cancer and OC undergo follow-up medical and imaging tests. In the initial phase of treatment for families with a high, genetic risk of either ovarian or breast cancer, individuals with a high, hereditary risk of both cancers are identified. A thorough family history is taken, and genetic testing is done if there are any medical indications. In the second stage, a woman who has a high, genetic risk of developing OC receives specialized care. To promptly identify any anomalies, these ladies are monitored by routine diagnostic examinations and medical consultations (Smolarz et al 2025).
Every woman should have routine gynecological exams. For women over 18, a yearly gynecological examination is advised, and for those over 35, an annual rectal examination. This allows you to assess the size and shape of the ovaries and surrounding organs by feeling them. Hereditary breast and ovarian cancer syndrome is the most advantageous situation for the preventative removal of the ovaries and fallopian tubes. The risk of ovarian cancer can be lowered by 70–85% as a result. Overall mortality is decreased by 60–70% and breast cancer risk is decreased by 54% with preventive resection. Depending on the mutation, ovariectomy timing varies (Smolarz et al 2025).
This is due to the fact that the average age at diagnosis for cancer caused by a mutation in the BRCA1 gene is approximately 10 years younger than that of cancer caused by a mutation in the BRCA2 gene, and the diagnosis is made even later in the case of mutations in the genes that cause hereditary OC (RAD51C, RAD51D, and BRIP1) (Smolarz et al 2025).
For women who refuse ovariectomy or who wish to have their ovaries sterilized, fallopian tube resection is an option. Preventing ovarian cancer primarily involves maintaining a healthy lifestyle and scheduling routine gynecological exams, which include transvaginal ultrasounds.
Author:
Dr. Disha Mittal., Ph.D. (Zoology), Department of Zoology, University of Delhi.
References:
- 1. Ghosh, R., Lahiri, D., Ghosh, D., Sen, K., Chakraborty, D., Maji, T., … & Chakrabarti, J. (2025). Bevacizumab in recurrent epithelial ovarian cancer: real-world experience from a tertiary cancer hospital in India. ecancermedicalscience, 19, 1897.
- 2. Caruso, G., Weroha, S. J., &Cliby, W. (2025). Ovarian cancer: a review. Jama.
- 3. Medina, J. E., Annapragada, A. V., Lof, P., Short, S., Bartolomucci, A. L., Mathios, D., … &Velculescu, V. E. (2025). Early detection of ovarian cancer using cell-free DNA fragmentomes and protein biomarkers. Cancer discovery, 15(1), 105-118.
- 4. Singh, L., Sehrawat, A., N, S., Philips, A. O., Panda, S. S., Cyriac, S. L., … & Ganesan, P. (2024). Unveiling primary platinum resistant ovarian cancer: Demographic and clinical perspectives from multicenter cancer registry in India.
- 5. Smolarz, B., Biernacka, K., Łukasiewicz, H., Samulak, D., Piekarska, E., Romanowicz, H., &Makowska, M. (2025). Ovarian Cancer—Epidemiology, Classification, Pathogenesis, Treatment, and Estrogen Receptors’ Molecular Backgrounds. International Journal of Molecular Sciences, 26(10), 4611.
- 6. Hong, M. K., & Ding, D. C. (2025). Early diagnosis of ovarian cancer: A comprehensive review of the advances, challenges, and future directions. Diagnostics, 15(4), 406.