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Health condition · Clinically reviewed

Ovarian cancer, the "silent" cancer — modern BRCA-informed treatment and PARP inhibitors.

High-grade serous ovarian cancer is the most common subtype. BRCA + HRD testing guides treatment — PARP inhibitors (olaparib, niraparib) have transformed maintenance therapy.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced, not summarised

    Every claim is checked against NICE, BGCS or a peer-reviewed source you can see at the end.

  • 03

    Updated for 2026

    Reflects current UK guidance on BRCA/HRD testing, cytoreductive surgery and PARP inhibitor maintenance.

Key facts

Ovarian cancer at a glance.

The essentials, in plain English — what it is, how common it is, how it’s diagnosed in the UK today, and how treatment is chosen.

  • What it is

    Epithelial ovarian cancer is the most common form — high-grade serous carcinoma accounts for the majority.

  • How common

    Around 7,500 new cases each year in the UK.

  • Inherited risk

    A family history of ovarian, breast or colorectal cancer — and BRCA1/2 or Lynch syndrome mutations — significantly raises risk.

  • How it is diagnosed

    CA-125, transvaginal ultrasound and the risk of malignancy index (RMI) or IOTA rules triage suspected cases.

  • Standard treatment

    Cytoreductive (debulking) surgery combined with platinum-based chemotherapy remains the backbone.

  • What has changed

    PARP inhibitor maintenance (olaparib, niraparib) has transformed outcomes in BRCA-mutated and HRD-positive disease.

Why this guide matters

Symptoms are subtle — but the treatment map has changed.

Persistent bloating, early satiety and pelvic discomfort deserve attention. And once diagnosed, BRCA/HRD testing and PARP inhibitors have reshaped what treatment looks like.

  • Symptoms are vague — take them seriously

    Persistent bloating, early satiety and pelvic pain in a woman over 50 warrant CA-125 and ultrasound.

  • BRCA / HRD testing changes treatment

    Genetic and tumour testing now guide who benefits most from PARP inhibitor maintenance.

  • Surgery + platinum chemo remain central

    Optimal debulking surgery and platinum-based chemotherapy still drive the biggest survival gains.

How the diagnosis is made

From first symptoms to a clear plan.

The pathway UK gynae-oncology teams now follow, in order — so you know what to expect and why.

  1. 01

    Assessing

    Symptom review

    Persistent bloating, early satiety, pelvic pain and urinary or bowel change — especially new symptoms in women over 50 — are taken seriously.

  2. 02

    Assessing

    CA-125

    A blood test for the CA-125 tumour marker — interpreted alongside symptoms and imaging, not in isolation.

  3. 03

    Assessing

    Pelvic ultrasound (transvaginal)

    The first-line scan to characterise any ovarian mass and look for ascites.

  4. 04

    Confirming

    Risk of malignancy index (RMI)

    CA-125, ultrasound features and menopausal status combined into a risk score to guide the next step.

  5. 05

    Confirming

    CT chest / abdomen / pelvis

    Staging imaging to assess spread beyond the pelvis and plan surgery.

  6. 06

    Planning

    BRCA + HRD testing

    Germline and somatic testing for BRCA1/2 and homologous recombination deficiency — this drives eligibility for PARP inhibitors.

  7. 07

    Planning

    Gynae-oncology MDT

    A specialist multi-disciplinary team recommends the surgical and systemic treatment plan tailored to you.

Typical timeline: 4–8 weeks from first symptoms to a treatment plan.

Symptoms

What ovarian cancer actually shows up as.

Symptoms are often vague and easy to dismiss. New, persistent symptoms — especially in women over 50 — deserve attention.

  • Persistent bloating

    New, persistent abdominal bloating — most days for three weeks or more — is the classic ovarian cancer symptom.

  • Early satiety

    Feeling full quickly, loss of appetite or unexplained indigestion that doesn’t settle.

  • Pelvic / abdominal pain

    Persistent pelvic or lower abdominal discomfort that isn’t explained by other causes.

  • Weight change

    Unexplained weight loss, or a rising waistband from ascites rather than fat.

  • Urinary frequency

    Needing to pass urine more often or more urgently, without infection.

  • Bowel change

    New constipation, altered bowel habit or unexplained bowel symptoms in a woman over 50.

  • Family history BRCA/Lynch

    A family history of ovarian, breast, bowel or endometrial cancer — or a known BRCA or Lynch mutation — raises risk substantially.

  • Red flag

    Bowel obstruction, tense ascites or breathlessness (pleural effusion) — urgent gynae-oncology assessment.

Treatment

How ovarian cancer is treated in the UK.

Debulking surgery and platinum-based chemotherapy remain the backbone. BRCA/HRD status now shapes maintenance therapy — with PARP inhibitors as a genuine change of era.

  • Cytoreductive (debulking) surgery

    The cornerstone of treatment — removing as much visible disease as possible, ideally to no macroscopic residual.

  • Platinum-based chemotherapy

    Carboplatin combined with paclitaxel — typically six cycles alongside surgery.

  • Interval debulking + neoadjuvant chemo

    When upfront surgery isn’t feasible, chemotherapy is given first to shrink disease before interval debulking.

  • Bevacizumab

    An anti-angiogenic antibody added to chemotherapy and continued as maintenance in selected cases.

  • PARP inhibitor maintenance

    Olaparib or niraparib as maintenance therapy — transformative in BRCA-mutated and HRD-positive disease.

  • Immunotherapy trials

    Checkpoint inhibitors are being studied in ovarian cancer, mainly through clinical trials.

  • Palliative surgery for obstruction

    Surgery, stenting or drainage to relieve bowel obstruction in advanced disease.

  • Best supportive care

    Symptom control, ascites and pleural drainage, and specialist palliative input alongside active treatment.

What this guide is based on

The sources behind every number on this page.

UK and European guidance, specialist society standards and patient-organisation resources, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or gynae-oncology team knows your history and can tell you which parts apply to you.

  • National Institute for Health and Care Excellence (NICE). Ovarian cancer: recognition and initial management (NG122).

  • British Gynaecological Cancer Society (BGCS). Guidelines for the management of epithelial ovarian cancer.

  • Target Ovarian Cancer. Patient information and symptom resources.

  • European Society for Medical Oncology (ESMO). Clinical practice guidelines for ovarian cancer.

Red flags

When ovarian cancer becomes an emergency.

These are the situations — before, during and after treatment — where you should act today rather than wait.

  • Bowel obstruction

    Vomiting, absolute constipation and abdominal distension — attend A&E for urgent assessment.

  • Ascites decompensation

    Rapidly worsening abdominal distension and breathlessness needs urgent drainage and review.

  • Pleural effusion / dyspnoea

    New or worsening breathlessness in known ovarian cancer may reflect a malignant pleural effusion — seek urgent care.

  • Post-op fistula

    Faeculent or bilious discharge from a wound or drain after surgery needs same-day surgical review.

  • Neutropenic sepsis

    Fever, shivers or feeling unwell on chemotherapy — call your acute oncology hotline immediately.

  • PARP inhibitor cytopenias

    Unusual bruising, bleeding or profound tiredness on olaparib or niraparib needs urgent blood counts.

  • BRCA family cascade

    A BRCA-mutated ovarian cancer should trigger genetic counselling and cascade testing for female relatives.

  • Recurrent ovarian cancer

    A rising CA-125 or new symptoms after treatment needs prompt gynae-oncology review.

  • Palliative-stage crisis

    Uncontrolled pain, vomiting, obstruction or delirium in advanced disease — contact the palliative care team urgently.

Living with it

A long-term journey, with structured support.

Four things that make the biggest difference day to day — CA-125 trends, treatment tolerance, genetics and specialist follow-up.

A quiet reminder

Ask about genetics and support early.

Genetic counselling, symptom-control input and structured follow-up all work best when they’re set up from the start.

  1. 01 Monitoring

    CA-125 is a trend, not a moment

    Your CA-125 pattern over time — read alongside how you feel and imaging — matters far more than any single number.

  2. 02 Side effects

    Chemo and PARP inhibitor tolerance

    Nausea, fatigue, neuropathy and cytopenias are managed proactively — tell your team early rather than pushing through.

  3. 03 Genetics

    BRCA changes the whole family

    A BRCA or Lynch mutation has implications for you and your relatives — genetic counselling is part of standard care.

  4. 04 Reviews

    Structured follow-up

    Regular gynae-oncology follow-up with CA-125 and, when needed, CT keeps recurrence detection on track.

Frequently asked

Everything we get asked about ovarian cancer.

Quick answers on CA-125, BRCA testing, PARP inhibitors and when to worry.

  • What is ovarian cancer?

    Epithelial ovarian cancer is the most common form — high-grade serous carcinoma accounts for the majority of cases. Around 7,500 women are diagnosed each year in the UK.

  • Why is ovarian cancer called the "silent" cancer?

    Symptoms — persistent bloating, early satiety, pelvic pain, urinary or bowel change — are often vague and easy to attribute to other causes. New, persistent symptoms in women over 50 should always be taken seriously.

  • What is CA-125 and how reliable is it?

    CA-125 is a blood tumour marker used alongside ultrasound and clinical assessment. It can be raised by many benign conditions, so it is interpreted in context — never in isolation.

  • Why does BRCA / HRD testing matter?

    BRCA1, BRCA2 and homologous recombination deficiency (HRD) status determine eligibility for PARP inhibitor maintenance therapy — which has transformed outcomes in high-grade serous ovarian cancer.

  • What are PARP inhibitors?

    Olaparib and niraparib are oral targeted drugs given as maintenance after platinum-based chemotherapy. They significantly prolong progression-free survival, particularly in BRCA-mutated and HRD-positive disease.

  • When should I worry about symptoms?

    Bowel obstruction, tense ascites or new breathlessness in known ovarian cancer needs urgent assessment. A rising CA-125 or new symptoms after treatment should prompt a prompt gynae-oncology review.

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