Understanding Ovarian Cancer

The ovaries are a pair of small, almond-shaped organs located on either side of the uterus within the female pelvis. They serve two essential functions: producing eggs (ova) for reproduction and secreting the hormones estrogen and progesterone that regulate the menstrual cycle. Despite their small size, the ovaries can give rise to one of the most lethal cancers affecting women. In 2026, the American Cancer Society estimates that approximately 21,010 women in the United States will receive a new ovarian cancer diagnosis and roughly 12,450 will die from the disease.

What makes ovarian cancer so deadly is not that it is untreatable – it is that it is so often caught too late. The five-year survival rate for ovarian cancer diagnosed while it is still confined to the ovary (localized stage) is approximately 92%. Once the cancer spreads to nearby structures in the pelvis, survival drops to about 71%. When it reaches distant organs – which is where the majority of patients are diagnosed – the five-year survival rate falls to roughly 31%. The gap between early and late detection is not just a statistical abstraction. It is the difference between a curable disease and a death sentence.

Types of Ovarian Cancer

Ovarian cancer is not a single disease. It encompasses several distinct tumor types that arise from different cell populations within or around the ovary, each with its own biological behavior, prognosis, and treatment response. Understanding these distinctions is important both for patients navigating a diagnosis and for evaluating whether a diagnostic failure constituted a departure from the standard of care.

Why Ovarian Cancer Is Called the “Silent Killer”

Ovarian cancer has earned the grim nickname “silent killer” because it typically produces no obvious symptoms in its earliest, most curable stages. Unlike breast cancer, which may form a palpable lump, or cervical cancer, which can be detected through routine Pap smears, early-stage ovarian cancer develops deep within the abdominal cavity where it cannot be seen or felt during a standard pelvic exam.

The biology of the disease compounds the problem. The most common form – high-grade serous carcinoma – does not grow as a solid mass within the ovary the way most cancers develop in other organs. Instead, abnormal cells originate on the ovary or fallopian tube, then shed into the abdominal and pelvic cavity where they implant on the surfaces of other organs. By the time these implants grow large enough to cause noticeable symptoms, the cancer has already advanced to Stage III or IV. This biological pattern is the primary reason that more than three-quarters of ovarian cancers are diagnosed at an advanced stage.

Symptoms: What Patients Experience

For decades, the medical community believed ovarian cancer was truly “silent” until it reached an advanced stage. More recent research has changed that understanding. Studies now show that the majority of women with ovarian cancer – including many with early-stage disease – do experience symptoms. The problem is not that symptoms are absent; it is that the symptoms are vague, common, and easily mistaken for other conditions.

The Core Symptom Pattern

In 2007, the American Cancer Society, the Gynecologic Cancer Foundation, and the Society of Gynecologic Oncologists jointly issued a consensus statement identifying four symptoms that are significantly more likely to occur in women with ovarian cancer than in the general population: persistent abdominal bloating or increased abdominal size; pelvic or abdominal pain; difficulty eating or feeling full quickly (early satiety); and urinary urgency or frequency. The key qualifier is persistence – these symptoms occurring almost daily for more than two to three weeks, representing a change from the patient’s normal baseline.

The Diagnostic Confusion: Why Symptoms Are Missed

The symptoms of ovarian cancer overlap substantially with several common, benign conditions. Bloating and abdominal discomfort are hallmarks of irritable bowel syndrome (IBS). Urinary frequency and urgency suggest urinary tract infections or overactive bladder. Pelvic pain may be attributed to endometriosis, ovarian cysts, or uterine fibroids. Feeling full quickly may be dismissed as acid reflux or a dietary issue. Women approaching or past menopause may have their symptoms attributed to hormonal changes.

This overlap creates a diagnostic trap. Research has found that women with ovarian cancer visit their primary care physician an average of three or more times with relevant symptoms before cancer is considered as a possible diagnosis. The average time from symptom onset to diagnosis is approximately five months – and for some women, well over a year. Each month of delay allows the cancer to advance, potentially moving from a stage where cure is likely to a stage where it is not.

The medical literature is clear: when a woman – particularly one over age 50 – presents with new, persistent symptoms in the bloating-pain-fullness-urinary symptom cluster, the standard of care requires that ovarian cancer be included in the differential diagnosis. Prescribing antacids for “reflux,” recommending a high-fiber diet for “IBS,” or prescribing antibiotics for a presumed urinary tract infection without any pelvic imaging is a failure that allows a treatable cancer to become a lethal one.

Risk Factors: Who Is Most Vulnerable

Age and Reproductive History

Ovarian cancer risk increases with age. Half of all ovarian cancers are diagnosed in women over 62, with the average age at diagnosis being 63. Risk also rises with the total number of lifetime ovulatory cycles a woman experiences. Factors that increase ovulatory cycles – never having been pregnant (nulliparity), early onset of menstruation (before age 12), and late menopause (after age 52) – are all associated with increased risk. Conversely, factors that suppress ovulation, such as pregnancy, breastfeeding, and oral contraceptive use, are associated with decreased risk. Five or more years of oral contraceptive use reduces ovarian cancer risk by approximately 50%.

Genetic and Family History

Inherited genetic mutations account for an estimated 15–25% of all ovarian cancers. The most significant are mutations in the BRCA1 and BRCA2 genes. Women who carry a BRCA1 mutation have a lifetime ovarian cancer risk of approximately 35–70%, compared to roughly 1.3% in the general population. BRCA2 carriers face a lifetime risk of approximately 10–30%. Mutations in other DNA repair genes – including RAD51C, RAD51D, BRIP1, and genes associated with Lynch syndrome (MLH1, MSH2, MSH6, PMS2) – also confer elevated risk.

A family history of ovarian cancer in a first-degree relative (mother, sister, or daughter) increases a woman’s own risk even when no known genetic mutation has been identified. Family history of breast, colorectal, or endometrial cancer may also signal inherited syndromes that include ovarian cancer risk. The standard of care requires that physicians take a thorough family cancer history and refer patients with concerning patterns for genetic counseling and testing.

Other Established Risk Factors

Hormone replacement therapy (HRT) containing estrogen, particularly when used for five or more years after menopause, has been associated with an increased risk of ovarian cancer. Endometriosis – a condition in which uterine tissue grows outside the uterus – has been linked to increased risk of certain ovarian cancer subtypes, particularly clear cell and endometrioid carcinomas. Obesity, particularly after menopause, is associated with a modestly increased risk.

Diagnosis: How Ovarian Cancer Should Be Identified

There is currently no validated screening test for ovarian cancer in the general population. Major clinical trials – including the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial and the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) – found that annual screening with CA-125 blood tests and transvaginal ultrasound did not reduce mortality in average-risk women and led to complications from unnecessary surgeries prompted by false-positive results. For this reason, routine population-based screening is not recommended.

This means that the diagnosis of ovarian cancer depends almost entirely on the clinical acumen of the treating physician. When a patient presents with suspicious symptoms, or when imaging reveals an unexpected finding, the physician must act promptly and methodically. Delay, dismissal, or failure to follow up is where the vast majority of ovarian cancer malpractice claims originate.

Transvaginal Ultrasound: The First-Line Imaging Tool

Transvaginal ultrasound (TVUS) is the primary imaging modality used to evaluate suspected ovarian pathology. A high-frequency ultrasound probe is inserted into the vagina, providing detailed images of the ovaries, fallopian tubes, and surrounding pelvic structures. TVUS can detect ovarian cysts, solid masses, and the presence of free fluid in the cul-de-sac (the space between the uterus and rectum, also known as the pouch of Douglas).

Several ultrasound findings warrant further evaluation and should not be dismissed as benign without appropriate workup:

CA-125: An Important but Imperfect Blood Test

CA-125 (Cancer Antigen 125) is a protein produced on the surface of ovarian cancer cells that can be detected in the bloodstream. A level above 35 U/mL is generally considered elevated. CA-125 is elevated in approximately 80% of women with advanced epithelial ovarian cancer and about 50% of those with early-stage disease.

CA-125 has significant limitations. It is not specific to ovarian cancer and can be elevated in many benign conditions, including endometriosis, uterine fibroids, pelvic inflammatory disease, liver disease, and even menstruation. It can also be normal in women who do have ovarian cancer, particularly in early stages or in certain histologic subtypes such as mucinous or clear cell carcinomas. For these reasons, CA-125 is not used as a standalone screening test.

However, CA-125 becomes a critical tool when used in context. When a woman has an adnexal mass or other suspicious pelvic findings, an elevated CA-125 significantly increases the probability that the finding is malignant. The standard of care requires that CA-125 be ordered as part of the workup when imaging reveals a suspicious ovarian finding – particularly in postmenopausal women, where benign causes of CA-125 elevation are less common. Failure to order a CA-125 when imaging shows a suspicious ovarian mass or unexplained pelvic free fluid is a deviation from the accepted standard of care.

Additional Diagnostic Tools

When initial imaging and blood work raise suspicion for ovarian cancer, additional studies are typically ordered to further characterize the mass and assess for spread. CT scan of the abdomen and pelvis provides a comprehensive view of the extent of disease, including involvement of lymph nodes, the omentum (fatty tissue lining the abdominal cavity), and distant organs. MRI of the pelvis offers superior soft-tissue contrast and can help distinguish between benign and malignant ovarian masses when ultrasound findings are indeterminate. PET/CT may be used to evaluate for distant metastatic disease.

However, no imaging study can definitively diagnose ovarian cancer. Surgical biopsy – typically performed during a staging laparotomy or laparoscopy by a gynecologic oncologist – is the only way to confirm the diagnosis. This is why the standard of care requires prompt referral to a gynecologic oncologist when ovarian cancer is suspected, rather than a prolonged period of “watchful waiting” that allows the cancer to spread.

Referral to a Gynecologic Oncologist: The Standard of Care

Multiple professional organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the Society of Gynecologic Oncology (SGO), have issued guidelines stating that women with suspected ovarian malignancy should be referred to a gynecologic oncologist for surgical evaluation and treatment. Research consistently demonstrates that patients with ovarian cancer who are operated on by a gynecologic oncologist – rather than a general gynecologist or general surgeon – receive more complete surgical staging, more thorough debulking of tumor, and experience significantly better survival outcomes.

The standard of care requires that general gynecologists, primary care physicians, and emergency room physicians recognize the signs that suggest possible ovarian malignancy and make this referral promptly. Failure to refer a patient with a complex ovarian mass, elevated CA-125, or other concerning findings to a gynecologic oncologist is a departure from the standard of care that can have fatal consequences.

Treatment: Staging, Surgery, and Chemotherapy

FIGO Staging: Determining the Extent of Disease

Ovarian cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) system, which is determined surgically. Accurate staging is essential because it dictates treatment and prognosis:

Primary Cytoreductive (Debulking) Surgery

Surgery is the cornerstone of ovarian cancer treatment. The primary goal is complete resection of all visible tumor – a concept known as “optimal debulking” or “optimal cytoreduction.” Residual tumor of less than 1 cm after surgery has historically been considered “optimal,” but the current goal at specialized centers is complete gross resection with no visible residual disease. The extent of surgery achieved is one of the single most important predictors of survival.

A standard surgical procedure for ovarian cancer includes total hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of both ovaries and both fallopian tubes), omentectomy (removal of the omentum), pelvic and para-aortic lymph node dissection, and removal of any other tumor deposits visible in the abdominal cavity. In advanced cases, debulking may require bowel resection, diaphragm stripping, splenectomy, or resection of liver surface metastases.

Chemotherapy

With the exception of some Stage I A tumors, virtually all ovarian cancers require chemotherapy following surgery. The standard first-line regimen for epithelial ovarian cancer is a combination of a platinum-based drug (carboplatin) and a taxane (paclitaxel), typically administered intravenously every three weeks for six cycles. Some patients may be candidates for intraperitoneal (IP) chemotherapy, where drugs are delivered directly into the abdominal cavity, or for neoadjuvant chemotherapy (NACT), where chemotherapy is given before surgery to shrink the tumor and improve surgical outcomes.

For patients with BRCA mutations or other homologous recombination deficiency (HRD), maintenance therapy with PARP inhibitors (olaparib, niraparib, or rucaparib) following completion of chemotherapy has been shown to significantly extend progression-free survival and has become a standard part of treatment.

When Ovarian Cancer Misdiagnosis Becomes Medical Malpractice

Not every ovarian cancer that is diagnosed at an advanced stage is the result of medical negligence. The biology of the disease makes early detection inherently challenging, and no currently available screening test can reliably catch ovarian cancer in asymptomatic women. However, there is a critical distinction between a cancer that was genuinely undetectable and one that was detectable but missed because a physician failed to act on available clinical information.

Medical malpractice in the ovarian cancer context most commonly falls into one of several patterns: failure to investigate persistent symptoms consistent with ovarian cancer; failure to follow up on abnormal imaging findings (particularly free pelvic fluid, complex cysts, or adnexal masses); failure to order appropriate blood work (CA-125) when imaging raises concern; failure to refer the patient to a gynecologic oncologist when malignancy is suspected; and misinterpretation of diagnostic tests that delays the correct diagnosis.

Under New York law, a plaintiff in a medical malpractice case must prove four elements: that the physician owed a duty of care to the patient; that the physician breached the accepted standard of care; that the breach was a proximate cause of the patient’s injuries; and that the patient suffered actual damages as a result. In cancer cases, the damages are often catastrophic – the difference between a curable, early-stage cancer and a terminal, advanced-stage cancer that claims the patient’s life.

The “Loss of Chance” Doctrine in Cancer Cases

A recurring question in cancer malpractice cases is whether the patient would have survived if the cancer had been diagnosed earlier. New York courts have recognized that a delayed diagnosis can deprive a patient of a “substantial possibility” of a better outcome, even if survival was not guaranteed. Under the loss-of-chance doctrine, a plaintiff does not need to prove that earlier diagnosis would have certainly saved the patient’s life – only that the delay diminished the patient’s chance of survival or subjected the patient to more aggressive and harmful treatments that would not have been necessary at an earlier stage. Goldberg v. Horowitz, 73 A.D.3d 691 (N.Y. App. Div. 2d Dep’t 2010).

In ovarian cancer cases, the stage-migration analysis is particularly powerful. Because survival rates drop so dramatically between Stage I (approximately 92% five-year survival) and Stage III (approximately 39%), even a relatively short diagnostic delay that allows the cancer to advance from one stage to the next can represent a catastrophic loss of survival probability. Expert testimony from a gynecologic oncologist can establish what stage the cancer likely occupied at the time the physician should have acted, compared to the stage at which it was ultimately diagnosed, and the difference in survival probability between those two stages.

Ovarian Cancer Malpractice Case Digests

The following case digests illustrate the real-world consequences of diagnostic failures in ovarian cancer. The first case was handled by this firm; the remaining cases are drawn from independent court records, verdict reporters, and legal publications to provide broader context on how courts have evaluated these claims.

Common Patterns of Negligence in Ovarian Cancer Cases

1. Failure to Investigate Persistent Symptoms

Patients who present repeatedly with bloating, pelvic pain, early satiety, and urinary changes deserve a workup that includes pelvic imaging. When a physician treats these symptoms as IBS, reflux, or a urinary tract infection without ever ordering an ultrasound – particularly in a woman over 50 – the physician has failed to include ovarian cancer in the differential diagnosis. If the cancer was diagnosable at the time the symptoms were first reported, and later becomes incurable due to the delay, this failure constitutes a departure from the standard of care.

2. Failure to Follow Up on Abnormal Imaging

This is the pattern seen in Mahamad v. Mosberg. A transvaginal ultrasound reveals a finding that is new, abnormal, or concerning – free fluid, a complex cyst, a solid mass – and the physician either dismisses it as normal or makes a mental note to “monitor it” without creating a concrete follow-up plan. The finding is buried in the chart, the patient is not informed of its significance, and no further evaluation is ordered. Months or years later, the cancer that was signaling its presence through that finding is diagnosed at an advanced, incurable stage.

3. Failure to Order a CA-125 Blood Test

When imaging reveals a suspicious ovarian finding in a postmenopausal woman, the standard of care requires a CA-125 blood test. While CA-125 is not useful as a general screening test, it is an essential component of the workup when there is already a clinical reason to suspect ovarian pathology. A physician who identifies a complex ovarian mass on ultrasound but does not order CA-125 has omitted a simple, inexpensive, widely available test that could have prompted the referral and evaluation that leads to timely diagnosis.

4. Failure to Refer to a Gynecologic Oncologist

When the combination of symptoms, imaging, and blood work raises a reasonable suspicion of ovarian cancer, the standard of care requires referral to a gynecologic oncologist – not continued monitoring by a general gynecologist, not reassurance that “it’s probably nothing,” and not a general surgical consultation. Gynecologic oncologists have specialized training in the surgical management of gynecologic cancers, and outcomes data consistently shows that patients operated on by these specialists have better survival than those treated by non-specialists.

5. Laboratory Errors and Misinterpretation of Test Results

Less common but equally devastating are cases where laboratory errors lead to false-negative results – a CA-125 test that is incorrectly reported as normal, a pathology specimen that is misread, or an imaging report that fails to mention a significant finding. In these cases, the malpractice may lie with the laboratory, the pathologist, or the radiologist rather than the treating gynecologist.

Statute of Limitations in New York

Under N.Y. C.P.L.R. § 214-a, the statute of limitations for medical malpractice in New York is two years and six months from the date of the alleged malpractice, or from the last date of a continuous course of treatment by the physician whose negligence caused the injury. For wrongful death claims, the statute is two years from the date of death under N.Y. E.P.T.L. § 5-4.1.

Because cancer cases involve a period of latency between the negligent act (failing to diagnose) and the discovery of the true diagnosis, determining when the statute of limitations begins to run can be complex. Patients and families who suspect that an ovarian cancer diagnosis was delayed by medical negligence should consult with an attorney as soon as possible to ensure that applicable deadlines are not missed.

Frequently Asked Questions About Ovarian Cancer Malpractice