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Ovarian Cancer

Most often found only after it has spread beyond the ovary1. Vague early symptoms delay diagnosis until advanced stages, which is why it is called "the silent killer." Standard oncology care is primary; holistic nutrition and lifestyle work alongside it to support recovery, mitigate side effects and support long-term health.

Hormonal & Women's Health Evidence-Based

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โš ๏ธ Treatment safety: please read first. The nutrition and supplement approaches on this page are meant to work alongside cancer treatment, never to replace or delay it. Never stop, delay or change your treatment without your oncology team's guidance. Doing so can be dangerous. Several supplements interact with chemotherapy and other cancer treatments, so talk to your oncology team or pharmacist before starting anything on this page.
Definition

What Is Ovarian Cancer?

Ovarian cancer is a malignancy that originates in the ovary or in the fallopian tube and adjacent peritoneal surfaces, with evidence that many high-grade serous cancers, the most common type, begin in the fimbriated end of the fallopian tube2.

Three broad histologic categories define ovarian cancer. Epithelial ovarian cancer accounts for most cases3 and arises from the surface epithelium of the ovary or fallopian tube. Germ cell tumors arise from the egg-producing cells and are much less common, occurring mostly in adolescents and young women3. Sex cord-stromal tumors arise from the hormone-producing cells (granulosa, theca, Sertoli, Leydig) and make up most of the remainder.

About 21,000 US women are diagnosed each year, and more than half of cases are found only after the cancer has spread to distant sites1. Staging follows the FIGO system (the international staging system for gynecologic cancers), I (confined to ovaries) through IV (distant metastasis), and dictates the surgical and adjuvant treatment plan.

Ovarian cancer, a tumor on one ovary, shown with the uterus and fallopian tubes

High-Grade Serous Carcinoma (HGSC, the most common type)

The most common and aggressive epithelial subtype. Usually presents at stage III or IV. Strongly associated with germline and somatic BRCA1/BRCA2 mutations and TP53 mutation.

  • โ†’Hallmarks: Late presentation, ascites, peritoneal carcinomatosis, elevated CA-⁠125
  • โ†’Standard care: Cytoreductive surgery plus platinum/​taxane chemotherapy3; PARP inhibitors for BRCA+
  • โ†’Markers: CA-⁠125 (sensitive but nonspecific), HE4, ROMA score, BRCA1/2 testing4

Low-Grade & Other Epithelial Subtypes

Includes low-grade serous, endometrioid, clear cell and mucinous carcinomas. Behave more indolently than HGSC but are also less chemo-sensitive. Endometrioid and clear cell types are associated with endometriosis. Often diagnosed at earlier stages, with better overall outcomes.

  • โ†’Hallmarks: Slower-growing pelvic mass, less ascites, KRAS or BRAF mutations common
  • โ†’Standard care: Surgical staging primary; chemo response variable; hormone therapy for low-grade serous
  • โ†’Markers: CA-⁠125 less reliable; CEA may be elevated in mucinous; consider Lynch syndrome workup

Germ Cell Tumors

Arise from the egg-producing cells. Most common in adolescents and women under 30. Highly chemo-sensitive, particularly to BEP (bleomycin/​etoposide/​cisplatin) regimens, with excellent cure rates even in advanced disease3.

  • โ†’Hallmarks: Young patient, rapidly growing unilateral mass, often palpable abdominal mass
  • โ†’Standard care: Fertility-sparing unilateral oophorectomy plus BEP chemotherapy when indicated
  • โ†’Markers: AFP, beta-hCG, LDH (instead of CA-⁠125); inhibin in some subtypes

Sex Cord-Stromal Tumors

Arise from hormone-producing cells. Granulosa cell tumors are most common and frequently estrogen-secreting, causing postmenopausal bleeding or precocious puberty. Sertoli-Leydig tumors may be androgen-secreting, causing virilization.

  • โ†’Hallmarks: Hormonal symptoms (bleeding, virilization), often confined unilateral mass
  • โ†’Standard care: Surgical resection primary; long-term surveillance because of late-recurrence risk
  • โ†’Markers: Inhibin B, AMH, estradiol or testosterone depending on subtype
By the Numbers

Ovarian Cancer by the Numbers

~21,000
new US cases projected for 2026 1
1.1%
lifetime risk of ovarian cancer for US women, about 1 in 90 (2021 to 2023 data)1
39 to 58%
lifetime risk with a harmful BRCA1 variant, and 13 to 29% with BRCA2 5
54%
of US cases are diagnosed after the cancer has spread to distant sites; 22% are found while still confined to the ovary1
52%
five-year relative survival for all stages combined: about 92% when confined to the ovary and 32% after distant spread (US, 2016 to 2022)1
202,638
women randomly assigned in the UK screening trial, where annual screening did not significantly reduce deaths from ovarian cancer6
Signs & Symptoms

Symptoms of Ovarian Cancer

Ovarian cancer earned the nickname "the silent killer" because early symptoms are vague and easy to dismiss as digestive or stress-related. What matters is frequency and newness: the main symptoms below, happening roughly 12 or more times a month, need to be checked by a doctor7.

SymptomWhat happens
Abdominal & Pelvic Symptoms
Persistent Bloating & Abdominal DistensionA feeling of abdominal swelling most days that usual measures do not resolve.
Early Satiety & Loss of AppetiteFeeling full after only a few bites, then unable to eat more.
Pelvic or Abdominal Pain / PressureDull, persistent pressure in the lower abdomen or pelvis, sometimes with sharper episodes, often described as a constant low-grade period cramp. Unlike menstrual or ovulatory pain, it does not cycle.
Urinary Urgency & FrequencyNeeding to urinate more often or with sudden urgency, even when the bladder is not full. Driven by pelvic mass effect on the bladder.
New-Onset Constipation or Bowel ChangesA persistent shift in bowel habits, typically constipation, sometimes with obstruction or stool caliber change. New, unexplained constipation in a woman over 50 warrants imaging.
Postmenopausal or Abnormal BleedingVaginal bleeding after menopause, or unusual intermenstrual bleeding in premenopausal women, can occur with hormone-secreting stromal tumors (granulosa cell) and occasionally with epithelial disease. Postmenopausal bleeding is never normal and requires gynecologic workup.
Systemic & Late-Stage Symptoms
Unintended Weight LossLoss of more than 5% of body weight over 6 months without dietary or activity change. Always warrants workup, especially with the abdominal symptoms above.
Profound Fatigue & WeaknessA new, deep fatigue that does not improve with rest, often progressing over weeks.
Shortness of BreathDifficulty breathing on exertion or when lying flat, often due to ascites elevating the diaphragm or pleural effusion (fluid in the chest) from peritoneal seeding.
Leg Swelling or DVTUnilateral leg swelling, redness or pain may indicate deep vein thrombosis, a known complication of ovarian cancer because the tumor raises clotting risk. Get a same-day appointment for a painful, swollen leg. Call 911 or go to the emergency department if you also have breathlessness or chest pain, since a clot may have reached the lungs (pulmonary embolism, PE). A DVT or PE in a postmenopausal woman without other risk factors should trigger gynecologic workup.
Nausea, Vomiting & IndigestionPersistent indigestion, reflux or nausea that does not respond to typical GERD measures and is new.
โš ๏ธ Frequency matters: New bloating, early fullness, pelvic pain or urinary urgency happening roughly 12 or more times a month needs a doctor's assessment; the usual first test is a CA-⁠125 blood test, with an ultrasound scan if it is raised7.
Causes

Causes of Ovarian Cancer

The risk of ovarian cancer rises with age, and most cases are in women over 50 8. Inherited genes and reproductive history cannot be changed; weight and smoking can.

CauseHow It Contributes to Ovarian CancerWhat Helps
Inherited genesA harmful BRCA1 variant raises lifetime risk to 39 to 58%, and BRCA2 to 13 to 29%, against about 1.1% in the general population5; Lynch syndrome genes also raise risk8Genetic assessment when ovarian or breast cancer runs in the family; for carriers, risk-reducing removal of the tubes and ovaries4
Reproductive history and hormonal contraceptionPeriods starting young, menopause after 55 and not having a baby mean more ovulations and higher risk, and never having used hormonal contraception also raises it8Reproductive history cannot be changed; it is weighed with family history when deciding on genetic assessment4
Menopausal hormone therapyCurrent use raises risk even when taken for less than 5 years: about one extra ovarian cancer for every 1,000 women who use it for 5 years from around age 50 9A conversation with your doctor that weighs this against the benefits for menopause symptoms9
Endometriosis and diabetesBoth are listed among the conditions that raise the chance of ovarian cancer8Getting new, frequent symptoms checked promptly, as the signs section describes7
Excess weightBeing overweight raises the chance of ovarian cancer8Staying a healthy weight, or losing weight if you are overweight, with the diet section's eating pattern8
SmokingSmoking is listed among the factors that raise the chance of ovarian cancer8Stopping smoking
Diagnosis

How Ovarian Cancer Is Diagnosed

There is no validated population-wide screening test for ovarian cancer, which is part of why advanced presentation is so common.

TestWhat it shows
Before the Appointment
These tools do not replace medical evaluation, but help identify women who should be checked promptly:
Symptom DiaryTrack the frequency, duration and severity of bloating, early satiety, pelvic pressure, urinary urgency and bowel changes for at least 4 weeks. New symptoms happening roughly 12 or more times a month are the ones to report7.
Family-History & Genetic Risk AssessmentMap first- and second-degree relatives with breast, ovarian, uterine, colon or pancreatic cancer. Formal genetic counseling and BRCA1/BRCA2/Lynch testing are advised for anyone with a close relative with ovarian cancer, relatives with the other cancers above (especially under 50) or Ashkenazi Jewish ancestry; your clinician can check whether your family history qualifies. Carrier status changes screening, prevention and treatment decisions.
Clinical & Lab Workup
Transvaginal Ultrasound (TVUS)The first-line imaging study. Identifies ovarian masses, characterizes them (simple cyst vs. complex, septated, solid component, vascularity) and detects ascites. Sensitivity for early epithelial cancer is limited, which is why it is combined with tumor markers.
CA-⁠125 & HE4 Tumor MarkersCA-⁠125 is often raised in epithelial ovarian cancer but is nonspecific: other cancers and benign conditions such as endometriosis also raise it2. HE4 is more specific for malignancy. The ROMA score (Risk of Ovarian Malignancy Algorithm) combines both with menopausal status for better risk stratification.
BRCA1 / BRCA2 & Multigene Panel TestingUS cancer guidelines from the National Comprehensive Cancer Network (NCCN) recommend genetic testing for every woman diagnosed with epithelial ovarian cancer, regardless of family history4. Panels typically include BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, PALB2 and Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2). Positive results guide PARP-inhibitor eligibility and family screening.
CT & PET Imaging for StagingOnce malignancy is suspected, contrast-enhanced CT of the chest, abdomen and pelvis is the standard staging study. These define peritoneal disease burden, lymph-node involvement and distant metastases, which guide whether primary surgery or neoadjuvant chemotherapy is chosen.
Histologic Diagnosis & Molecular ProfilingDefinitive diagnosis requires tissue, obtained at surgical staging or, in poor surgical candidates, by image-guided biopsy or paracentesis cytology. Modern pathology includes tumor molecular profiling (somatic BRCA, HRD score, MMR/MSI, folate-receptor alpha), which now drives targeted-therapy selection.
Treatment Comparison

Conventional and Holistic Treatment for Ovarian Cancer

For ovarian cancer, standard oncology is the primary, life-saving treatment. The holistic approach described here is complementary, designed to be used alongside surgery, chemotherapy and targeted therapy under oncology supervision, not in place of them.

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Supports the body through standard treatment, mitigates side effects and optimizes recovery

Primary Role
Supportive nutrition, microbiome and gut care, chemo-side-effect mitigation and recovery
Duration
Continuous, from diagnosis through active treatment and into survivorship
Effect on Disease
Exercise during treatment improves fitness, strength and fatigue10; evidence for other diet changes during treatment is very limited, and none replaces tumor-directed therapy
Goal
Optimal recovery, lower toxicity, durable survivorship

Full Holistic Approach Includes

  • Pre-chemo nutritional optimization, protein about 0.5 to 0.7 g per pound (1.2 to 1.5 g/kg), anti-inflammatory whole-food eating, baseline vitamin D and ferritin correction
  • During chemo, small protein-anchored meals, ginger and peppermint for nausea, hydration, gut microbiome support to reduce dysbiosis
  • Targeted supportive supplements with oncology approval, vitamin D3, B-complex, probiotics
  • Gentle movement, walking 20 to 30 minutes daily, restorative yoga, lymphatic drainage as tolerated
  • Sleep optimization and circadian rhythm support, especially during chemo cycles
  • Mind-body care, breathwork, meditation, counseling for diagnosis-related distress; evidence supports benefit for distress and quality of life
  • Survivorship phase, anti-inflammatory diet, weight management, low-glycemic eating for general health
โš ๏ธ Note on supplements during chemo: Several supplements and foods (high-dose antioxidants, St. John's wort, grapefruit, some herbal extracts) interfere with chemotherapy. Always disclose every supplement to your oncology team and pharmacist before and during treatment, and consider working with an integrative oncology clinician.
Supplement Protocol

Evidence-Based Supplements for Ovarian Cancer

Supportive supplements during and after cancer treatment must be coordinated with the oncology team. Several common supplements interact with chemotherapy14 or targeted therapies, and high-dose antioxidants in particular may blunt treatment effect. The list below sets out common supportive options and what the evidence shows for each; always confirm with your oncologist before adding any. If you are losing weight, ask your care team for a nutrition plan, which may include a protein supplement your dietitian chooses.

Supplement What it is for Typical range Timing Notes & cautions
Vitamin D3 (with K2)Low 25-⁠OH-D is associated with poorer outcomes in observational studies, but in a randomized trial of 25,871 adults, vitamin D did not lower cancer rates15. Restoring adequate levels supports immune function, calcium balance and bone health (especially relevant after surgical menopause).D3: set the dose with your clinician; most adults need no blood test first; K2 (MK-⁠7): 100 to 200 mcg per dayWith a fat-containing meal, morningDiscuss with oncologist before/​during treatment. If you take warfarin, clear any vitamin K supplement with the clinician managing your anticoagulation before starting or stopping it: vitamin K antagonizes warfarin, and changing your intake destabilizes the INR.
Omega-⁠3 EPA/DHAStudied for weight and muscle loss during cancer treatment, but a Cochrane review found too little evidence that it works better than placebo16.Not recommended for weight and muscle loss (a Cochrane review found too little evidence that it works better than placebo)Not applicableDiscuss with oncologist; hold before surgery per surgical team protocol. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day17, so check any fish oil supplement with your clinician first. At higher doses fish oil can increase bleeding risk; tell your clinician if you take a blood thinner or have heavy bleeding.
Magnesium GlycinateCommonly depleted during chemotherapy, and used to correct a low level. It has not been shown to prevent or treat chemotherapy nerve damage18.300 to 400 mg elemental magnesium per day.Evening, 30 to 60 min before bedAdjust dose if loose stools occur. Ask your care team first if your kidney function is reduced, since side effects of high magnesium intake mainly occur then19. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common.
B-ComplexSupports energy production, neurotransmitter synthesis and methylation pathways.1 capsule per day per product labelMorning with foodFolic acid works for people with MTHFR variants; methylfolate is an alternative, not a requirement. Avoid high-dose individual folic acid in some cancers; discuss with your oncologist.
Probiotic (Multi-Strain)Supports gut microbiome recovery during and after antibiotics and chemo, reduces chemo-related diarrhea and mucositis in some studies.25 to 50 billion CFU per day, multi-strainEmpty stomach or with light mealAvoid while your white cell count is very low (an absolute neutrophil count, ANC, below 500) without oncology approval. Resume in recovery phase.
L-GlutamineSupports intestinal lining repair and may reduce chemo-related mucositis and diarrhea. Also supports muscle recovery.5 to 10 g 2 to 3 times dailyBetween meals, mixed in waterDiscuss with oncologist; some controversy regarding tumor metabolism in specific cancers. Safety of doses this high in pregnancy is not established; check with your midwife or doctor.
MelatoninStrong circadian regulator. Early unblinded studies suggested benefits, but in a placebo-controlled trial in advanced cancer with weight loss, 20 mg a night made no difference to appetite, weight, symptoms or survival20.Not recommended for ovarian cancer (the trial in advanced cancer used 20 mg a night)Not applicableMelatonin is commonly sold at doses well above what is needed, and more is not better. Discuss it with your prescriber if you take sedatives, anticoagulants or immunosuppressants. Its safety in pregnancy and breastfeeding has not been researched; check with your midwife or doctor21.
Ginger Capsules / TeaIt is uncertain whether ginger adds anything to standard anti-nausea treatment for chemotherapy22. Well-tolerated; it does not replace prescribed anti-nausea medicine.500 to 1,500 mg per day in divided dosesBefore and during chemo days; with mealsStop 1 week before surgery (mild antiplatelet effect). If you take a blood thinner, check with your care team first. Coordinate with oncology pharmacist. Ginger supplements may be safe in pregnancy, but check with your midwife or doctor first22.
Iron (only if documented deficiency)Cancer-related anemia is common. Iron should be supplemented only when iron studies confirm true deficiency, not anemia of chronic disease.25 to 65 mg elemental iron per day if deficientEmpty stomach with vitamin C; or oral every other day for absorptionConfirm with ferritin and iron studies. Discuss with oncologist before/​during treatment. The top of this range sits above the 45 mg/day tolerable upper intake level for adults. That is appropriate only when correcting a confirmed deficiency under clinical supervision, not as general supplementation. Test ferritin first, and retest rather than staying on it indefinitely.
Vitamin C (Oral, Dietary)Supports collagen synthesis and immune function. Oral dietary intake (food and modest supplementation) is supportive; high-dose IV vitamin C is a separate, oncology-supervised intervention.500 to 1,000 mg per day (oral) from food and supplementDivided doses with mealsAvoid high-dose oral antioxidants during specific chemo cycles without oncology guidance.
What to Expect

What to Expect Over Time

Surgery and platinum-based chemotherapy treat ovarian cancer; nutrition and exercise help you get through that treatment3.

Treatment and supportive care, together
First Weeks

Imaging and a CA-⁠125 test, then genetic testing, which is recommended for everyone with epithelial ovarian cancer because it guides PARP inhibitor treatment4. The team decides whether surgery or chemotherapy comes first. Give them your full supplement list14.

Months 1 to 3

Surgery and chemotherapy. Keeping up protein and energy and preserving muscle are linked with better tolerance and fewer dose reductions11, and exercise during treatment improves fitness, strength and fatigue10.

Months 3 to 12

After chemotherapy, some women take maintenance treatment, such as a PARP inhibitor where genetic or tumor testing supports it4. Fluid in the abdomen or a bowel blockage changes the diet advice, and the specialist team's guidance comes first23.

Long Term

Regular follow-up with your team. CA-⁠125 is used to monitor known disease, not to screen women without symptoms6. Genetic results also matter for relatives4.

When to Seek Care

Call 911 or go to the emergency department for abdominal pain that comes on suddenly or is severe, or if you cannot pass stool or gas24. During chemotherapy, a fever of 100.5ยฐF (38ยฐC) or higher is an emergency: call your care team at once25. Call 911 or go to the emergency department for breathlessness or chest pain, which can mean a clot in the lungs. Get a same-day appointment for a painful, swollen leg. See a doctor promptly for bloating, feeling full quickly, pelvic or abdominal pain or an urgent need to pee that is new and happens roughly 12 or more times a month7.

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Next Steps

Supporting Treatment With Nutrition

Surgery and platinum-based chemotherapy treat ovarian cancer; nutrition and exercise help you get through that treatment. Keeping up protein and energy and preserving muscle are linked with better tolerance, and the specialist team's guidance comes first. Give them your full supplement list.

Explore Uterine / Endometrial Cancer โ†’ Explore Endometriosis โ†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.26 Nothing on this page treats ovarian cancer. Cytoreductive surgery and platinum-based chemotherapy, with PARP inhibitors where indicated, are what treat it. What nutrition and lifestyle can do is help you tolerate that treatment, maintain strength and weight, manage side effects and recover afterward, and those are worth real effort. Two specific cautions. Several supplements interact with platinum and taxane chemotherapy, and high-dose antioxidants during treatment may reduce its effectiveness, so your oncology team needs your full supplement list. And be alert to bloating, early satiety, pelvic or abdominal pain or urinary urgency that is new and happens roughly 12 or more times a month, particularly after menopause: these are the symptoms ovarian cancer actually presents with, and they are easy to attribute to something else. Diet and supplements are not an alternative to surgery, chemotherapy, radiation therapy or immunotherapy, and no dietary change should delay or replace treatment decided with your oncology team.

  1. On US statistics: SEER projects 21,010 new cases of ovarian cancer and 12,450 deaths in the US in 2026, and estimates lifetime risk at about 1.1% (2021 to 2023 data). Of cases, 22% are diagnosed while confined to the ovary, 18% after regional spread and 54% after distant spread. Five-year relative survival (2016 to 2022) was 52.0% overall: 91.9% when confined to the ovary, 70.1% after regional spread and 31.5% after distant spread, SEER, ovarian cancer. ↩
  2. On origin and CA-⁠125: National Cancer Institute treatment guidance states that findings from risk-reducing surgery support the hypothesis that many high-grade serous ovarian cancers, the most common subtype, arise from precursor lesions in the fimbriae of the fallopian tubes, and that CA-⁠125 can be raised by other cancers and by benign gynecologic problems such as endometriosis, NCI PDQ, ovarian epithelial cancer treatment. ↩
  3. On subtypes and treatment: epithelial ovarian cancer, predominantly high-grade serous, accounts for most cases and is treated with cytoreductive surgery and platinum/​taxane chemotherapy. Germ cell and sex cord-stromal tumors behave differently and occur in younger women; they often permit fertility-sparing surgery with excellent cure rates. Subtype changes everything, including which markers are useful. ↩
  4. On genetic risk: BRCA1 and BRCA2 pathogenic variants and Lynch syndrome substantially raise risk, and risk-reducing salpingo-oophorectomy is offered on that basis, supported by a meta-analysis quantifying the risk reduction in BRCA carriers, PubMed 19141781. Genetic testing is recommended for all women diagnosed with epithelial ovarian cancer, because it guides PARP inhibitor use and has implications for relatives. This is the one area where early identification genuinely changes outcomes. ↩
  5. On BRCA1 and BRCA2: the National Cancer Institute states that about 39 to 58% of women who inherit a harmful change in BRCA1, and 13 to 29% of those with BRCA2, will develop ovarian cancer (including fallopian tube and primary peritoneal cancer) during their lifetime, against about 1.1% of women in the general population, NCI, BRCA gene changes. ↩
  6. On screening, and why there is none. Large randomized trials, PLCO in the United States and UKCTOCS in the United Kingdom, tested CA-⁠125 with or without transvaginal ultrasound in average-risk women. Neither demonstrated a reduction in ovarian cancer mortality: UKCTOCS randomized over 200,000 women and found no significant reduction in deaths after long-term follow-up, PubMed 33991479, and in PLCO, of the women who had surgery after a false-positive result, 15% suffered at least one serious complication, PubMed 21642681. Population screening is therefore not recommended. CA-⁠125 remains useful for monitoring known disease, not for finding it in well women. Anyone promising early ovarian cancer detection through a blood test or a supplement is selling something the trials could not deliver. ↩
  7. On symptoms: NHS guidance lists the main symptoms of ovarian cancer as frequently, roughly 12 or more times a month, having a swollen belly or bloating, belly or pelvic pain, no appetite or feeling full quickly, and an urgent or more frequent need to pee, and advises seeing a doctor for any of them, or again if symptoms have not gone away or are worse. The doctor may arrange a CA-⁠125 blood test, followed by an ultrasound scan if the level is high, NHS, symptoms of ovarian cancer. ↩
  8. On risk factors: NHS guidance states that ovarian cancer risk increases with age and most cases are in women over 50, and lists inherited faulty genes such as BRCA or Lynch syndrome genes, previous breast or colorectal cancer, previous radiation therapy, endometriosis or diabetes, periods starting young, menopause after 55 or not having a baby, never having used hormonal contraception, taking hormone replacement therapy, being overweight and smoking. It advises staying a healthy weight and asking a doctor about genetic testing when ovarian cancer runs in the family, NHS, causes of ovarian cancer. ↩
  9. On menopausal hormone therapy: pooling 52 studies with 12,110 ovarian cancers, current use raised risk even with less than 5 years of use, similarly for estrogen-only and estrogen-progestin preparations, with about one extra ovarian cancer per 1,000 women using it for 5 years from around age 50, PubMed 25684585. ↩
  10. On exercise during treatment: an ASCO guideline based on 52 systematic reviews and 23 further randomized trials found that exercise during cancer treatment improved fitness, strength and fatigue, and recommends regular aerobic and resistance exercise during treatment given with curative intent; it found the evidence for other diet and weight-loss interventions during treatment very limited, PubMed 35576506. ↩
  11. On nutrition during chemotherapy: maintaining protein and energy intake, managing nausea and taste change, and preserving muscle mass are associated with better treatment tolerance and fewer dose reductions. Malnutrition and sarcopenia predict worse outcomes. This is where dietary attention does concrete work. ↩
  12. On sugar and fast food: the World Cancer Research Fund advises limiting foods and drinks with added sugars and "fast foods" high in fat, starches or sugars, because they lack important nutrients and eating them often can lead to weight gain, and states there is strong evidence that regularly drinking sugar-sweetened drinks leads to weight gain, World Cancer Research Fund, sugar and cancer. ↩
  13. On what Group 1 means: the World Health Organization explains that IARC classifications describe the strength of the evidence that something causes cancer, not the level of risk, so agents in the same group, such as processed meat and tobacco smoking, are not equally dangerous; the link for processed meat is with colorectal cancer, WHO, carcinogenicity questions and answers. ↩
  14. On supplement interactions: high-dose antioxidant supplementation during chemotherapy is generally advised against on mechanistic grounds and on a signal of worse outcomes seen in a breast cancer chemotherapy trial, where antioxidant use before and during treatment carried a higher hazard of recurrence that did not reach statistical significance, PubMed 31855498. That study was not in ovarian cancer, and a 2024 review of 24 systematic reviews found the evidence mixed, PubMed 39078314, so this is a question for the oncology team rather than a settled rule. St. John's wort induces CYP3A4 and reduces levels of several anticancer agents, with clinically significant interactions documented for imatinib and irinotecan, PubMed 23394826. Grapefruit inhibits it, through furanocoumarins such as bergamottin, PubMed 37307228. Anticoagulant interactions matter in a population already at raised thrombotic risk. ↩
  15. On vitamin D and cancer: in the VITAL trial, 25,871 adults randomly assigned to 2,000 IU of vitamin D a day or placebo for a median of 5.3 years had no lower rate of invasive cancer, PubMed 30415629. ↩
  16. On omega-⁠3 for weight loss in cancer: a Cochrane review of randomized trials of EPA, an omega-⁠3 fat from fish oil, for cancer cachexia found insufficient data to establish that it works better than placebo, PubMed 17253515. ↩
  17. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
  18. On magnesium and chemotherapy nerve damage: an American Society of Clinical Oncology guideline update found that no agents are recommended to prevent chemotherapy-induced peripheral neuropathy, and that duloxetine is the only agent with appropriate evidence for established painful neuropathy, PubMed 32663120. ↩
  19. On magnesium and the kidneys: MedlinePlus states that side effects from high magnesium intake are not common, except in people with significantly reduced kidney function, MedlinePlus, magnesium in diet. ↩
  20. On melatonin in advanced cancer: earlier studies suggesting benefit were not blinded or placebo-controlled. In a double-blind trial of 20 mg of melatonin a night against placebo in people with advanced cancer and weight loss, the trial was closed for futility after 48 patients, with no difference in appetite, symptoms, weight, quality of life or survival over 28 days, PubMed 23439759. ↩
  21. On melatonin in pregnancy: the NIH National Center for Complementary and Integrative Health notes that there has been a lack of research on the safety of melatonin in pregnant or breastfeeding women, NCCIH, melatonin. ↩
  22. On ginger: the NIH National Center for Complementary and Integrative Health states that it is uncertain whether ginger is a helpful addition to standard treatment for nausea and vomiting from cancer chemotherapy, that ginger supplements may be safe in pregnancy but anyone considering them while pregnant should consult a health care provider, and that little is known about ginger while breastfeeding, NCCIH, ginger. ↩
  23. On ascites and bowel obstruction: malignant ascites and bowel obstruction are common in advanced disease and change dietary management substantially, sometimes requiring low-residue eating or non-oral nutrition. General dietary advice on this page does not apply in those situations, and the specialist team's guidance takes precedence. ↩
  24. On belly pain that is an emergency: NHS guidance advises calling emergency services or going to an emergency department for any of these: a stomach ache that comes on very suddenly or is severe; pain when the stomach is touched; being unable to pass stool or gas; being unable to pee; or vomiting blood, NHS, stomach ache. ↩
  25. On fever during treatment: the National Cancer Institute states that infections during cancer treatment can be life-threatening and need urgent medical attention, that treatments such as chemotherapy raise the risk, and lists a fever of 100.5ยฐF (38ยฐC) or higher among the signs, NCI, infection and neutropenia. ↩
  26. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩