Types of Ovarian Cancer: Epithelial, Germ Cell, and Stromal

If you or someone you love just heard the words "ovarian cancer," your head is probably spinning. One of the first questions people ask is simple: What kind is it? That question matters more than it might seem. "Ovarian cancer" is not a single disease. It is a family of different cancers that start in different cells, behave in different ways, and are treated differently.

This guide walks through the main types of ovarian cancer, epithelial, germ cell, and stromal, in plain language. Knowing the type won't change how you feel overnight. But it can help you ask better questions, understand your care plan, and feel a little more steady in an uncertain moment.

Why the type of ovarian cancer matters

Doctors group ovarian cancers by the kind of cell where they start. Each type tends to show up at different ages, grow at different speeds, and respond to different treatments.

This is why two people can both have "ovarian cancer" and face very different journeys. The type, along with the stage (how far the cancer has spread), helps your care team choose surgery, chemotherapy, hormone therapy, or other options that fit your specific situation.

Here is the honest part: most ovarian cancers are found at a later stage. Only about 1 in 5 are caught early. That is because early symptoms, bloating, feeling full quickly, belly or pelvic pain, needing to pee often, are vague and easy to brush off. There is also no reliable routine screening test for ovarian cancer in women at average risk, the way a Pap test screens for cervical cancer. That makes knowing your body, and speaking up early, all the more important.

The 3 main types of ovarian cancer

Ovarian cancers fall into three broad groups, named for the cells where they begin.

1. Epithelial ovarian cancer (the most common type)

Epithelial tumors begin in the thin layer of cells that covers the outer surface of the ovary, and, researchers now believe, often in the fallopian tubes. This is by far the most common type. According to the American Cancer Society, epithelial cancers make up about 85% to 90% of ovarian cancers.

Because it is so common, epithelial ovarian cancer is what most people picture when they hear the diagnosis. It is found more often in women who have gone through menopause, though it can happen earlier.

Epithelial ovarian cancer is not just one thing, either. It includes several subtypes:

• High-grade serous carcinoma, the most common subtype; tends to grow quickly
• Low-grade serous carcinoma, usually slower-growing
• Endometrioid carcinoma
• Clear cell carcinoma
• Mucinous carcinoma

You may also hear about borderline tumors (also called tumors of low malignant potential). These epithelial tumors grow slowly and are less life-threatening than most ovarian cancers. They tend to affect younger women and generally have a good outlook.

#### A note on fallopian tube and primary peritoneal cancers

You might see fallopian tube cancer and primary peritoneal cancer mentioned alongside ovarian cancer. These are closely related to epithelial ovarian cancer, they look similar under the microscope and are often treated the same way. In fact, current research suggests many "ovarian" cancers may actually start in the fallopian tubes.

2. Germ cell ovarian tumors

Germ cell tumors start in the cells that make the eggs (ova). They are much less common, the American Cancer Society notes that germ cell tumors make up less than 2% of all ovarian cancers.

What sets this group apart:

• They more often affect teenagers and women in their 20s, rather than older women.
• They tend to grow in just one ovary.
• Many germ cell cancers respond very well to treatment, and the outlook is often good, especially when found early.

For younger women, fertility is often a major concern. Because germ cell tumors frequently affect just one ovary, it is sometimes possible to treat the cancer while preserving the ability to have children later. This is a deeply personal conversation to have with a gynecologic oncologist.

3. Stromal ovarian tumors

Stromal tumors (sometimes called sex cord-stromal tumors) start in the structural tissue that holds the ovary together and makes the hormones estrogen and progesterone. They are rare, even less common than germ cell tumors.

A few things make stromal tumors distinct:

• Because they can make hormones, they sometimes cause noticeable symptoms, like unusual vaginal bleeding, or signs linked to extra estrogen or testosterone.
• They are often found at an early stage, partly because those hormone-related symptoms can prompt women to seek care sooner.
• They can occur at any age, including in younger women and girls.

How doctors figure out the type

You can't tell the type from symptoms alone. Confirming the type of ovarian cancer usually involves a combination of:

• A pelvic exam and imaging, such as a transvaginal ultrasound, to look at the ovaries.
• Blood tests, such as CA-125 and others, which can offer clues (though they are not perfect and can't diagnose cancer on their own).
• Surgery and a biopsy, where a sample of tissue is examined under a microscope. This is how the specific type and subtype are confirmed.

A specialist called a gynecologic oncologist leads this work. Research shows that being treated by a gynecologic oncologist is linked to more guideline-based care and better outcomes, so it is worth asking whether one is part of your care team.

Key takeaways

• "Ovarian cancer" is really a group of diseases. The three main types, epithelial, germ cell, and stromal, start in different cells and are treated differently.
• Epithelial is by far the most common, making up roughly 85% to 90% of cases (American Cancer Society).
• Germ cell and stromal tumors are rare, more often affect younger women, and frequently have a favorable outlook, especially when found early.
• There is no reliable routine screening test for ovarian cancer in average-risk women, and most cases are found at a later stage. Knowing your body and acting on persistent symptoms matters.
• Ask to see a gynecologic oncologist. The right specialist and an accurate diagnosis shape the whole treatment plan.

You don't have to face this alone

Understanding the type of ovarian cancer is one piece of a much bigger picture. The next step is a real conversation with a clinician you trust, ideally a gynecologic oncologist, who can look at your specific situation, explain your options, and answer the questions that keep you up at night.

If symptoms like bloating, pelvic pain, feeling full quickly, or needing to pee often last two weeks or longer and aren't normal for you, don't wait. Bring them to a doctor. You know your body better than anyone.

At HopeCare Global, we believe every woman, no matter her background, income, or zip code, deserves clear information, early detection, and support that meets her where she is. This is especially urgent for Black women, who face higher odds of a late-stage diagnosis and higher mortality from ovarian cancer, driven largely by gaps in timely diagnosis and access to care, not biology. Our work in symptom education, patient navigation, and community-rooted outreach exists to help close that gap. You are not a statistic. You are a person worth fighting for.

Medical disclaimer

This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. It does not provide individualized medical guidance. Always talk with a qualified healthcare provider about your specific situation, symptoms, and care decisions. Never disregard or delay seeking professional medical advice because of something you read here.