Ovarian cancer happens
when cells that are not normal grow in one or both of your
ovaries. This topic is about epithelial ovarian
cancer, the most common type.
This cancer is often cured when it
is caught early. But most of the time, the cancer has already spread by the
time it is found.
It is frightening to hear that you or someone
you love may have ovarian cancer. It may help to talk with your doctor or join
a support group to deal with your feelings.
What causes ovarian cancer?
We do not know what
causes it. Some women who have it also have a family history of cancer. But
most do not.
Some women are more likely than others to get this
rare cancer. Women who are past menopause or who have never been pregnant are
more likely to get ovarian cancer.
What are the symptoms?
Ovarian cancer does not
usually cause symptoms at first. But most women do have some symptoms in the 6
to 12 months before ovarian cancer is found. The most common symptoms are gas
and pain or swelling in the belly. Other symptoms are diarrhea or constipation,
or an upset stomach.
But these symptoms are so general that they
are more likely to be blamed on a number of other causes. Most of the time, the
cancer has already spread by the time it is found.
How is ovarian cancer diagnosed?
Sometimes the
doctor may feel a lump in or on an ovary during a routine
pelvic exam. Often a lump may be seen during an
ultrasound. Most lumps are not cancer.
The only way to know for sure that a woman has ovarian cancer is with
biopsies taken during surgery. The doctor makes an
incision in the belly so that he or she can look inside. The doctor will remove
bits of any tumors that are found and send them to a lab to confirm that they
contain cancer.
There is a blood test called CA-125 (cancer
antigen 125) that is sometimes done to look for cancer in women at high risk.
So far, there is not enough proof to show that this test works to find ovarian
cancer early in most women. Too much CA-125 in the blood can be caused by many
things, like the menstrual cycle, endometriosis, and uterine fibroids, as well
as many types of cancer.
How is it treated?
Surgery is the main treatment.
The doctor will remove any tumors that he or she can see. This usually means
taking out one or both ovaries. It may also mean taking out the fallopian tubes
and uterus. After surgery, most women have several months of
chemotherapy, which means taking drugs that kill
cancer cells.
This cancer often comes back after treatment. So you
will need regular checkups for the rest of your life. If your cancer does come
back, treatment may help you feel better and live longer.
Ovarian
cancer is very serious, but many women do survive it. It depends on your age
and overall health, how far the cancer has spread, and how much cancer is left
behind during surgery.
It may help to talk to other women who are
going through the same thing. People who take part in support groups usually
feel better, sleep better, and feel more like eating. Your doctor or your local
branch of the American Cancer Society can help you find a support group. You
can also look on the Internet to find support sites where women with this
cancer can talk to each other.
What are your chances of getting ovarian cancer?
This cancer most often affects women who are past
menopause. Women are more likely to get ovarian cancer
if others in their family have had it. They are more likely to get it if they
have had breast cancer.
You may also be more likely to get this
cancer if:
You never had a baby.
You started
your menstrual cycles before age 12 and went through menopause after age 50.
The cause of
ovarian cancer is not known. Genetics are a risk
factor for some women. A
family history of ovarian or breast cancer is found in 10% to 20% of women with
ovarian cancer.1 In general, fewer than 2 in 100 women
(less than 2%) will get ovarian cancer in their lifetime. That risk goes up to
4 or 5 in 100 if one family member has had ovarian cancer, and 7 in 100 if two
relatives have had it. But if at least two first-degree relatives (meaning
mother, sister, or daughter) have had ovarian cancer, the risk is 25 to 50 in
100 (25% to 50%).2
Women who inherit
changes (genetic mutations) in the
BRCA1 and BRCA2 genes have a higher chance of
developing ovarian cancer and breast cancer. Women who inherit the gene change
in BRCA1 have a lifetime chance of 20 to 60 out of 100 of getting ovarian
cancer. For women who inherit the gene change in BRCA2, the lifetime chance is
10 to 35 out of 100.3
You have a higher
chance of developing ovarian cancer if you:
Have not used hormonal
birth control methods. Hormonal methods change the
normal cycle of the female hormones,
estrogen and
progesterone, so ovulation does not occur each
month.
If you have a strong family history of ovarian or breast
cancer, you may want to talk with your doctor or a
genetic counselor about having a blood test to look
for BRCA1 and BRCA2 gene changes. Women who inherit these changes in one or
both of these genes have a higher chance of developing ovarian cancer, breast
cancer, or both.
Symptoms
Ovarian cancer does not cause many
symptoms in its early
stages. This is why most cases are not found until the
cancer has spread.4 Most women do have symptoms in the
6 to 12 months before ovarian cancer is found. Symptoms that occur in later
stages are most likely caused by the pressure of the growing cancer. Symptoms
include:
Ongoing cramps or pain in your belly.
Ongoing pain in
your pelvis or lower back.
Abnormal bleeding from your vagina,
especially after
menopause if you are not using any hormonal
medicines.
Abnormal discharge from your vagina, containing mucus
that may be tinged with blood.
Pain or bleeding during
sex.
Nausea or loss of appetite, or you cannot eat
normally.
Ongoing bloating or intestinal gas that is not relieved
by home treatment measures.
Bigger belly size or a lump that can be
felt in your belly.
Decreased energy level.
A change in
your bowel habits, such as constipation or diarrhea.
A change in
your bladder habits, such as urinary frequency or urgency.
Weight loss.
What Happens
Ovarian cancer
spreads when cancerous (malignant) cells enter the
abdominal cavity. The cancer cells then grow on the
peritoneal lining of the abdomen and other abdominal
organs. In its advanced
stage, ovarian cancer usually spreads to the
lymph nodes and to other organs in the pelvis. This
may cause kidney and bowel problems. Cancer may also spread to other organs in
the body, such as the liver and lungs.
Cancer from other areas of
the body can also spread to the ovaries. This most commonly occurs in cancers
that involve the breast, stomach, colon, and the lining of the uterus
(endometrium).4
Ovarian cancer usually is
not found in its early stages because it causes few, if any, symptoms.
Laparotomy surgery is done to confirm that cancer is
present, to provide initial treatment, and to stage the cancer with
biopsies of abdominal tissue,
peritoneal fluid, and
lymph nodes. The
long-term outcome (prognosis) depends on the stage of
your ovarian cancer when it is diagnosed.
A family history. Between 10% and 20% of women
with ovarian cancer have a close female relative who had ovarian or breast
cancer.1 Women with a family history may develop
ovarian cancer at an earlier age, such as in their 40s, rather than at the more
typical age of postmenopausal women in their 50s. Women who have BRCA1 or BRCA2
gene mutations have between a 16% and 60% chance of
developing ovarian cancer during their lifetime.5
Increasing age. Ovarian cancer most often affects
postmenopausal women.
Never having a baby.
Starting menstrual cycles before age 12 and going through
menopause at an older age. The more menstrual cycles
you have, the more risk you have for ovarian cancer.
Being unable
to become pregnant (infertility). Women who do not use
birth control and are sexually active but who are unable to become pregnant may
have a higher chance for ovarian cancer.
Use of
estrogen or
hormone replacement therapy. Some studies have shown
that some women who use these hormones have a slightly increased risk of
developing ovarian cancer, and other studies have shown no increased
risk.6, 7, 8 In general, experts advise women considering hormone
replacement therapy for symptoms of menopause to take the smallest dose
possible to control symptoms, and to take the medicine for the shortest time
that they can.
Women who are of Ashkenazi Jewish ancestry (Jews
whose ancestors came from Eastern Europe) may have an increased risk because of
changes to the
BRCA1 or BRCA2 genes. Women with this ancestry have
higher rates of these gene changes.
Diets high in lactose (a milk sugar), which is
found in foods such as milk and ice cream.11
When To Call a Doctor
Ovarian cancer
does not cause many symptoms in its early stages. And having symptoms does not
always mean you have cancer. These symptoms may be caused by other problems. It
is important to talk to your doctor if you have any new symptoms, such
as:
Ongoing cramps or pain in your belly.
Ongoing pain in
your pelvis or lower back.
Abnormal bleeding from your vagina,
especially after
menopause if you are not using any hormonal
medicines.
Abnormal discharge from your vagina, containing mucus
that may be tinged with blood.
Pain or bleeding during
sex.
Nausea or loss of appetite or you cannot eat
normally.
Ongoing bloating or intestinal gas that is not relieved
by home treatment measures.
Bigger belly size or a lump that can be
felt in your belly.
Decreased energy level.
A change in
your bowel habits, such as constipation or diarrhea.
A change in
your bladder habits, such as urinary frequency or urgency.
Weight loss.
Watchful Waiting
Watchful waiting is a period of time during which you
and your doctor observe your condition or symptoms without using medical
treatment. Watchful waiting is not appropriate if you have symptoms that do not
go away. If you are concerned about your symptoms and you have a higher risk
for ovarian cancer, call and make an appointment with your doctor.
Who To See
Health professionals who can evaluate your symptoms
and your risk for ovarian cancer include:
Doctors who can manage your cancer treatment
include:
Gynecologic oncologist. Your long-term
outcome (prognosis) is improved if you are under the care of an experienced
gynecologic oncologist. His or her expertise can help determine the best
treatment choices at the time of the initial surgery.12
Some initial exams
and tests are done before surgery if ovarian cancer is suspected. These tests
include:
Your
medical history, to check what symptoms you have and
what your chance of developing ovarian cancer is.
A physical exam,
including a
pelvic exam and
Pap test. An ovarian lump may be felt during a pelvic
exam. A
rectovaginal exam may also be done to feel the pelvic
organs.
For most women, the United States Preventive
Services Task Force (USPSTF) does not recommend having a CA-125 blood test or a
transvaginal ultrasound to find ovarian cancer early.13
There is no evidence that having regular tests helps women live longer by
finding ovarian cancer early. Still, experts recommend that women who have
inherited a BRCA gene change and have not had their ovaries removed have a
transvaginal ultrasound and a CA-125 blood test at least once a year, starting
at age 35. Women who have inherited a BRCA1 gene change (not a BRCA2 gene
change) may want to start having these regular tests as early as age
25.14
Treatment Overview
The choice of treatment and the
long-term outcome (prognosis) for women who have
ovarian cancer depends on the type and
stage of cancer. Your age, overall health, quality of
life, and desire to have children (preserve fertility) must also be
considered.
Surgery is done to confirm and treat cancer.
Removal of all cancerous tissue and taking
biopsies to check for the spread of cancer (surgical staging) is important for diagnosis and treatment, because the amount of
cancer remaining (residual cancer) after the initial surgery may affect your
outcome.
Chemotherapy,
which uses medicines to kill cancer cells, is recommended after surgery for
most stages of ovarian cancer. Recent studies show that the addition of
chemotherapy after surgery improves the outcome for some early-stage ovarian
cancer.15 Chemotherapy is also recommended for all
other stages of ovarian cancer. Chemotherapy that is given after a surgery is
called
adjuvant therapy.
Initial treatment
The goal of the initial surgery
is to remove all visible cancer. The type of surgery you will need depends on
the stage of your cancer and if you want to be able to
have children after having the surgery.
If you have
early-stage (stage I and low-grade [grade 1]) cancer and
you wish to have children, your surgery may include:
Because this surgery removes all the reproductive organs,
you will not be able to become pregnant after having it.
Chemotherapy is recommended after surgery for most
women. The current standard of treatment is 6 cycles of paclitaxel (Taxol) and
carboplatin or cisplatin. Each chemotherapy cycle is scheduled every 3 to 4
weeks, so chemotherapy may last 4 to 6 months. Studies are looking at
delivering chemotherapy directly into the belly (intraperitoneal chemotherapy).
One study compared women with stage III ovarian cancer who had already had
surgery. In that study, one group had treatment with paclitaxel delivered into
a vein (intravenous) followed by intravenous cisplatin; the
other group had treatment with intravenous paclitaxel followed by
intraperitoneal cisplatin and paclitaxel. Although the intraperitoneal group
had more severe side effects, overall survival was better than for the
intravenous group.16
Home treatment
measures may help relieve some of the common side effects of cancer treatment,
such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.
If both of your ovaries are removed, you are likely to experience
menopausal symptoms after surgery. Home treatment
measures may relieve some of these symptoms. If home treatment does not help
your menopausal symptoms, talk to your doctor about other ways to manage your
symptoms.
If you have recently been diagnosed with
ovarian cancer, you may experience a wide variety of
emotions in reaction to having cancer. Most women feel some denial, anger, and
grief. There is no "normal" or "right" way to react to having cancer. You can
take steps to manage your
emotional reactions to learning that you have ovarian
cancer. Some women find that talking with family and friends is comforting,
while others may need to spend time alone to understand their feelings about
their cancer.
If your emotions are interfering with your ability
to make decisions about your health and to move forward with your life, it is
important to talk with your doctor. Your cancer treatment center may offer
counseling services. You may also contact your local chapter of the American
Cancer Society to help you find a support group. Talking with other women who
have had similar feelings after being diagnosed with cancer such as yours can
help you accept and deal with your cancer.
What to think about during initial treatment
In
about 70% of women with ovarian cancer, the cancer has already spread
(metastasized) outside the pelvis by the time it is diagnosed.17 Advanced-stage cancer spreads most commonly to the
lining of the abdominal cavity, the pelvic
lymph nodes, and the fatty tissue around some of the
abdominal organs.
Your long-term outcome depends on your age, the
stage and grade of your cancer, and the amount of cancer remaining after your
initial surgery.
Your quality of life becomes a critical issue
when considering your treatment choices. Be sure to discuss your personal
preferences with your
oncologist when he or she recommends treatment.
You may be interested in participating in research studies called
clinical trials. Clinical trials are designed to find
better ways to treat cancer patients and are based on the most up-to-date
information. Women who do not want standard treatments or are not cured using
standard treatments may want to participate in clinical trials. These are
ongoing in most parts of the United States and in some other countries for all
stages of ovarian cancer.
For more information about specific
ovarian cancer treatments, see the topics:
After initial treatment for
ovarian cancer, it is important to receive follow-up
care. Your
emotional reactions may continue throughout the course
of your treatment, depending on your prognosis, the treatment methods used, and
your quality-of-life decisions.
Your
gynecologic oncologist or
oncologist will schedule regular checkups, usually
every 3 months for the first 2 years after treatment. Your doctor may then
recommend checkups every 6 to 12 months depending on your stage of cancer.
These checkups will include:
A physical exam of your neck, lungs, and
abdomen, and a
pelvic exam to check for recurring cancer or swollen
lymph nodes.
A
CA-125 blood test to see if the cancer has
returned.
An
abdominal and pelvic CT scan or
MRI to check to see if cancer has spread, especially
when new symptoms, such as belly pain, are present or if CA-125 levels are
high.
Second-look surgery, after 6 cycles of chemotherapy, may
be done in research studies or clinical trials if no sign of cancer is found
during a physical exam; in blood tests; or with X-ray, CT, or MRI. Additional
biopsies are done at the time of second-look surgery to determine the need for
more treatment. Second-look surgery is not recommended as standard treatment
because of the chance of complications and because it does not clearly increase
survival rates.
Treatment if the condition gets worse
The
long-term outcome (prognosis) for
ovarian cancer that has returned after treatment (is
recurrent) depends on whether the cancer has spread. Even with no sign of
cancer after treatment, between 30% and 50% of women who are treated for
ovarian cancer have cancer return within 5 years.4
Women who have cancer return within 6 months after their initial treatment are
less likely to respond to more treatment with the same chemotherapy medicines
than women whose cancer has returned more than 6 months after their initial
treatment. Other chemotherapy medicines may be recommended for further
treatment.3
Palliative care
If your cancer gets worse, you may want to think about
palliative care. Palliative care is a kind of care for
people who have illnesses that do not go away and often get worse over time. It
is different from care to cure your illness, called curative treatment.
Palliative care focuses on improving your quality of life-not just in your
body, but also in your mind and spirit. Some people combine palliative care
with curative care.
Some treatments for recurrent ovarian cancer,
such as chemotherapy and radiation, are considered palliative care. These
treatments cannot cure your cancer, but they can extend your life, control your
symptoms, reduce your pain, and make you feel more comfortable.
In
addition to helping your body feel better, palliative care can help you feel
better emotionally and spiritually. Talking with a palliative care provider may
help you cope with your feelings about living with a long-term illness. It may
also help your loved ones better understand your illness and how to support
you. Or it could help you make future plans concerning your health and medical
care.
If you are interested in palliative care, talk to your
doctor. He or she may be able to manage your care or refer you to a doctor who
specializes in this type of care.
In addition to
conventional medical treatment, you may wish to try
complementary therapies to help manage your symptoms.
But complementary therapies are not a substitute for conventional medical
treatment that is recommended for ovarian cancer. Complementary therapies
include:
Before you try any of these therapies, discuss their
possible benefits and side effects with your doctor. Let him or her know if you
are already using any such therapies. For more information, see the topic
Complementary Medicine.
What To Think About
Some women with ovarian cancer
may be interested in participating in research studies called
clinical trials. Clinical trials are designed to find
better ways to treat cancer patients and are based on the most up-to-date
information. Women who do not want standard treatments or are not cured using
standard treatments may want to participate in clinical trials. These are
ongoing in most parts of the United States and in some other countries, for all
stages of ovarian cancer.
Most treatments for ovarian cancer cause
side effects. The side effects that you have depend on the type of treatment
used, your age, and your overall health. Your doctor can talk to you about your
treatment choices and the side effects associated with each treatment.
Side effects of
chemotherapy may include loss of appetite, nausea,
vomiting, diarrhea, mouth sores, or hair loss.
Side effects of
surgery depend on how much surgery was done to treat
the stage of your cancer.
Nausea and vomiting are side effects of chemotherapy for
ovarian cancer. Your doctor can prescribe
medicines to control nausea and vomiting.Talk to your
doctor about what to expect and when you should call if you are having nausea
or vomiting. Home treatment measures can also help you manage other side
effects of treatment.
End-of-life issues
Some women with
advanced-stage cancer may choose not to have treatment focused on prolonging
life because they decide that for them the time, costs, and side effects of
treatment are greater than the benefits. Making the decision about when to stop
medical treatment aimed at prolonging life and shift the focus to end-of-life
care can be difficult. For more information, see the following topics:
Ovarian cancer
cannot be prevented, but you may be able to reduce some of your chances for
developing it.
Studies have found that the use of a combined
estrogen and
progestin birth control pill for more than 5 years
reduces a woman's risk of ovarian cancer.2 One study
showed that the low-dose combined pills are most effective for reducing
risk.18 Another showed that the protective effect lasts
for several years after the woman stops taking the combined pills.19 Women who have a family history of ovarian cancer may also
lower their risk by using birth control pills. The results are not clear from
studies on the use of birth control pills in women who have BRCA
gene changes.
Having surgery to close or
tie off your fallopian tubes (bilateral
tubal ligation) will lower your chances of developing
ovarian cancer.2 But, you will not be able to become
pregnant after having this surgery. Talk to your doctor about whether this
choice is right for you.
Having one or more babies lowers your
chances for ovarian cancer. Breast-feeding for at least one year also lowers
your chances.20
A small number of women
with ovarian cancer have a first-degree female relative-such as a sister,
mother, or daughter-or a second-degree female relative-such as an aunt or
grandmother-who has had ovarian cancer. Changes (mutations) in two major genes,
BRCA1 and BRCA2, are most closely related to a higher lifetime chance for
ovarian cancer in these families.5 You may consider a
BRCA gene test if you have a
family history of ovarian cancer. Most experts
recommend that women with known BRCA mutations have their uterus, ovaries, and
fallopian tubes removed while these organs are still healthy, to reduce their
lifetime chance of developing ovarian cancer. You will not be able to become
pregnant, but studies have shown that this surgery lowers your chance of
getting ovarian cancer by about 95%.1, 21
There is still a small chance of getting
ovarian cancer, even after the ovaries are removed. This is because there can
already be a tiny cancer growing before the ovaries are removed. Those cancer
cells can remain in the body after the surgery, where they continue to
grow.22 It is also possible to develop cancer on the
smooth tissue lining the abdominal cavity (peritoneum).
This type of cancer-called peritoneal cancer-looks like ovarian cancer, has
similar symptoms, and is treated in the same way.
Including lots of fruits and vegetables in your diet may
help protect against ovarian cancer.6
Home Treatment
During medical treatment for any stage
of
ovarian cancer, there are things you can do at home to
help manage the side effects that may be caused by the cancer or its treatment.
Home treatment may help manage the following common problems. If your doctor
has given you instructions or medicines to treat these symptoms, be sure to
follow them. In general, healthy habits such as eating a balanced diet and
getting enough sleep and exercise can help control your symptoms.
Home treatment for nausea or vomiting
includes watching for and treating early signs of
dehydration, such as a dry mouth, sticky saliva, and
reduced urine output with dark yellow urine. Older adults can quickly become
dehydrated from vomiting. Chemotherapy medicines used to treat ovarian cancer
can cause severe nausea and vomiting. Your doctor also can prescribe
medicines to control nausea and vomiting. Contact your
doctor if you have ongoing nausea and vomiting. For more information on how to
deal with these side effects, see:
Home treatment for diarrhea includes
waiting to eat for several hours after having diarrhea to rest your stomach and
watching for signs of dehydration. Check with your doctor before using any
nonprescription medicines for your diarrhea.
Home treatment for constipation includes drinking a lot of fluids and
including fruits, vegetables, and fiber in your diet each day. Do not use a
laxative without consulting your doctor.
Other issues that may arise include:
Sleep problems. If you have trouble sleeping,
some tips for
managing sleep problems may be helpful, such as having
a regular bedtime, getting some exercise during the day, and avoiding
naps.
Fatigue. If you have very little energy and become weak
easily, you can help your
fatigue by getting extra rest, eating a well-balanced
diet, and reducing your stress.
Urinary problems caused either by
ovarian cancer or its treatment. You can help manage your urinary problems by
eliminating caffeinated drinks from your diet and establishing a schedule of
urinating every 3 to 4 hours, regardless of whether you feel the
need.
Hot flashes, especially if both ovaries
were removed in your surgery. Some
tips for managing hot flashes include drinking cold
beverages rather than hot ones, limiting your intake of caffeine and alcohol,
and dressing in layers so you can remove clothing as needed.
Hair loss. This may be unavoidable, but using mild
shampoos and not using damaging hair products will lower the irritation of your
scalp.
Many women with ovarian cancer face emotional issues as a
result of their cancer or its treatment.
Finding out that you have cancer and having
treatment are stressful.
Managing stress may include expressing your feelings
to others. Learning relaxation techniques may also be helpful. Relaxation
techniques-such as meditation-and support groups may be
helpful.
Your feelings about your body may change following
treatment for cancer. Managing your body image issues may involve talking
openly about your concerns with your partner and discussing your feelings with
your doctor. Your doctor may also be able to refer you to organizations that
can offer additional support and information.
Not all forms of cancer or cancer treatment cause pain. If
pain occurs, many treatments are available to relieve
it. If your doctor has given you instructions or medicines to treat pain, be
sure to follow them. Talk to your doctor if prescribed medicines are not
controlling your pain.
For mild pain, you can take pain relievers
that you can buy without a prescription, such as acetaminophen (Tylenol),
ibuprofen (for example, Advil or Motrin) or
similar medicines. Or you may try an alternative
therapy, such as
biofeedback, to help your physical and mental
well-being. Be sure to tell your doctor about any home treatment you use for
pain.
Some women who have advanced-stage cancer may choose not to
have treatment because they decide that for them the time, costs, and side
effects outweigh the benefits. Making the decision about when to stop medical
treatment aimed at prolonging life and shift the focus to end-of-life care can
be difficult. For more information, see the following topics:
Chemotherapy is
used to shrink
ovarian cancer and slow cancer growth. Chemotherapy is
recommended for most women after the initial surgery for ovarian cancer.
Medication Choices
Different chemotherapy drugs are given in different ways.
Some are taken by mouth (oral), some are injected into a vein (intravenous, or IV), and others are injected through a
thin tube into the belly (intraperitoneal). Oral and IV chemotherapy is called
a systemic treatment because the medicines enter the bloodstream, travel
through the body, and kill cancer cells both inside and outside the ovaries. In
intraperitoneal (IP) chemotherapy, the drug is put into the body in the same
area as the cancer. It is not a systemic treatment, but a little of the
medicine still gets into the bloodstream.
Extensive research and
clinical trials have studied the different chemotherapy medicines used to treat
ovarian cancer. There are several drugs to treat ovarian cancer. Some are used
alone, and some are combined with other drugs. Your doctor will recommend
chemotherapy treatment that is specifically tailored to you.
Chemotherapy is recommended after surgery for most women with ovarian cancer.
The current standard of treatment is 6 cycles of paclitaxel and carboplatin or
cisplatin. These medicines are injected into a vein (intravenously, or IV).
Each chemotherapy cycle is scheduled every 3 to 4 weeks, so chemotherapy may
last 4 to 6 months. Carboplatin is used more often than cisplatin because it
has milder side effects. The use of carboplatin or cisplatin with paclitaxel is
considered the most effective treatment for ovarian cancer.3, 22
Treatment of ovarian cancer with chemotherapy can cause
nausea and vomiting. Your doctor will prescribe
medicinesyou can take with your treatments and when
you get home, to help relieve any nausea that you may have.
What To Think About
Most chemotherapy causes some
side effects. Home treatment may help manage your symptoms. If your doctor
has given you instructions or medicines to treat your symptoms, be sure to
follow them. In general, healthy habits such as eating a balanced diet and
getting enough sleep and exercise can help control your symptoms.
Surgery
Surgery for ovarian cancer
Your doctor confirms
that you have
ovarian cancer and determines its extent (or
stage) by taking
biopsies during
laparotomy surgery. Your long-term outcome (prognosis)
is improved under the care of an experienced
gynecologic oncologist whose expertise can help
determine the best treatment choices at the time of surgery.12 Your surgery may include:
A hysterectomy, which removes your uterus,
and salpingo-oophorectomies, which remove your ovaries and
fallopian tubes.
Taking a sample of
peritoneal fluid (peritoneal washings) from the
abdominal cavity to look for cancer cells.
Removing and checking
the pelvic and aortic
lymph nodes, to see if the cancer has
spread.
Checking the abdominal organs and tissues for cancer cells.
Biopsies may be done.
Removing and checking the fatty tissue (omentum) attached to
some of the abdominal organs, to see if the cancer has spread.
An
appendectomy, which removes your appendix.
Surgery to lower the chance of developing ovarian cancer
Having surgery to close or tie off your fallopian tubes (bilateral
tubal ligation) will lower your chances of developing
ovarian cancer.2 But, you will not be able to become
pregnant after having this surgery. Talk to your doctor about whether this
choice is right for you.
A small number of women with ovarian
cancer have a first-degree female relative-such as a sister, mother, or
daughter-or a second-degree female relative-such as an aunt or grandmother-who
has had ovarian cancer. Changes (mutations) in two major genes, BRCA1 and
BRCA2, are most closely related to a higher lifetime chance for ovarian cancer
in these families.5 You may consider a
BRCA gene test if you have
a family history of ovarian cancer. Most experts recommend that women with
known BRCA mutations have their uterus, ovaries, and fallopian tubes removed
while these organs are still healthy, to reduce their lifetime chance of
developing ovarian cancer. You will not be able to become pregnant, but studies
have shown that this surgery lowers your chance of getting ovarian cancer by
about 95%.1, 21 There is still a
small chance of getting ovarian cancer, even after the ovaries are removed.
This is because there can already be a tiny cancer growing before the ovaries
are removed. Those cancer cells can remain in the body after the surgery and
continue to grow.22
If you have very early-stage ovarian cancer and wish to
have children (preserve fertility), discuss your choices with your
doctor.
Ovarian cancer does not cause many symptoms in its early
stages, which is why about 70% of cases are not found until the cancer has
spread.17 Most women who have advanced-stage cancer
have a
hysterectomy to remove the
uterus and an
oophorectomy to remove both ovaries. The
fallopian tubes are usually removed also.
In advanced-stage surgery, your surgeon will take a sample of peritoneal
fluid, remove lymph nodes and fatty tissue (omentum), and remove any abdominal
tissue that is thought to have cancer.
What To Think About
Side effects from your surgery
can include difficulty urinating or problems with bowel functioning, such as
constipation or diarrhea. Your ability to have or enjoy sexual intercourse may
also be affected.
If your ovaries are removed, you may have
symptoms of
menopause. Talk with your doctor about medicines to
manage these symptoms.
Ovarian cancer may grow and spread to the
point that it
blocks the bowel. Or, the first surgery to remove the
cancer may cause problems, such as a blocked bowel. For more information, see
the topic
Bowel Obstruction.
Other Treatment
Complementary therapies alone
are not a substitute for the standard treatment recommended for
ovarian cancer. Before you try any of these therapies,
discuss their possible benefits and side effects with your doctor. Let him or
her know if you are already using any such therapies.
The combination of conventional
medical treatment and complementary medicine is an approach that is sometimes
called integrative medicine, in which both conventional and complementary
therapies are used together for the best outcome. Complementary therapies alone
are not a substitute for the standard treatment recommended for ovarian
cancer.
Other Places To Get Help
Organizations
American Cancer Society
Phone:
1-800-ACS-2345 (1-800-227-2345)
TDD:
1-866-228-4327 (toll-free)
Web Address:
www.cancer.org
The American Cancer Society conducts educational programs and
offers many services to people with cancer and to their families. Staff at the
toll-free numbers have information about services and activities in local areas
and can provide referrals to local ACS divisions.
American Society of Clinical Oncology
(ASCO)
1900 Duke Street
Suite 200
Alexandria, VA 22314
Phone:
(703) 299-0150
Fax:
(703) 299-1044
TDD:
1-888-651-3038
E-mail:
asco@asco.org
Web Address:
http://www.asco.org
This organization offers information and educational programs on
cancer.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:
1-800-332-8615
E-mail:
cancergovstaff@mail.nih.gov
Web Address:
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online)
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
Wooster R, Weber BL (2003). Breast and ovarian cancer.
New England Journal of Medicine, 348(23):
2339-2347.
Ozols RF, et al. (2005). Epithelial ovarian cancer. In
WJ Hoskins et al., eds., Principles and Practice of Gynecologic Oncology, 4th ed., chap. 25, pp. 895-987. Philadelphia: Lippincott
Williams and Wilkins.
Karlan BY, et al. (2005). Ovarian cancer, peritoneal
carcinoma, and fallopian tube carcinoma. In VT DeVita Jr et al., eds.,
Cancer: Principles and Practice of Oncology, 7th ed.,
vol. 1, pp. 1364-1397. Philadelphia: Lippincott Williams and Wilkins.
Brennan K, et al. (2007). Premalignant and malignant
disorders of the ovaries and oviducts. In AH DeCherney et al., eds.,
Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971-884. New York: McGraw-Hill.
National Cancer Institute (2002). Genetic testing for BRCA1 and BRCA2: It's your choice. Available online: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA.
Zografos GC, et al. (2004). Common risk factors of
breast and ovarian cancer: recent view. International Journal of Gynecological Cancer, 14: 721-740.
Speroff L, Fritz MA (2005). Postmenopausal hormone
therapy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 689-777. Philadelphia: Lippincott Williams and
Wilkins.
Beral V, et al. (2007). Ovarian cancer and hormone
replacement therapy in the Million Women Study. Lancet,
369(9574): 1703-1710.
Edmondson RJ, Monaghan JM (2001). The epidemiology of
ovarian cancer. International Journal of Gynecological Cancer, 11: 423-429.
Modugno F, et al. (2004). Oral contraceptive use,
reproductive history, and risk of epithelial ovarian cancer in women with and
without endometriosis. American Journal of Obstetricians and Gynecologists, 191: 733-740.
Fairfield KM, et al. (2004). A prospective study of
dietary lactose and ovarian cancer. International Journal of Cancer, 110: 271-277.
National Comprehensive Cancer Network (2007). Ovarian
cancer. Clinical Practice Guidelines in Oncology, version 1. Available online:
http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf.
U.S. Preventive Services Task Force (2004). Screening for ovarian cancer. Available online: http://www.ahrq.gov/clinic/uspstf/uspovar.htm.
National Cancer Institute (2007). Genetics of Breast and Ovarian Cancer (PDQ)-Health
Professional Version. Available online:
http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.
Trimbos JB, Timmers P (2004). Chemotherapy for early
ovarian cancer. Current Opinion in Obstetrics and Gynecology, 16(1): 43-48.
Armstrong DK, et al. (2006). Intraperitoneal cisplatin
and paclitaxel in ovarian cancer. New England Journal of Medicine, 354(1): 34-43.
Cannistra SA (2007). Gynecologic cancer. In DC Dale,
DD Federman, eds., ACP Medicine, section 12, chap. 10.
New York: WebMD.
Lurie G, et al. (2007). Association of estrogen and
progestin potency of oral contraceptives with ovarian carcinoma risk.
Obstetrics and Gynecology, 109(3): 597-607.
Deligeoroglou E, et al. (2003). Oral contraceptives
and reproductive system cancer. Annals of the New York Academy of Sciences, 997: 199-208.
American Cancer Society (2006). American Cancer Society's Detailed Guide: Ovarian Cancer.
Available online:
http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?rnav=criov&dt=33.
Kauff ND, et al. (2002). Risk-reducing
salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. New England Journal of Medicine, 346(21):
1609-1615.
Berek JS (2002). Ovarian cancer. In JS Berek, ed.,
Novak's Gynecology, 13th ed., pp. 1245-1319.
Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
Chu CS, Rubin SC (2001). Second-look laparotomy for
epithelial ovarian cancer: A reappraisal. Current Oncology Reports, 3(1): 11-18.
National Cancer Institute (2006). Ovarian Epithelial Cancer (PDQ): Treatment-Health Professional Version. Available online:
http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/healthprofessional.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Wooster R, Weber BL (2003). Breast and ovarian cancer.
New England Journal of Medicine, 348(23):
2339-2347.
Ozols RF, et al. (2005). Epithelial ovarian cancer. In
WJ Hoskins et al., eds., Principles and Practice of Gynecologic Oncology, 4th ed., chap. 25, pp. 895-987. Philadelphia: Lippincott
Williams and Wilkins.
Karlan BY, et al. (2005). Ovarian cancer, peritoneal
carcinoma, and fallopian tube carcinoma. In VT DeVita Jr et al., eds.,
Cancer: Principles and Practice of Oncology, 7th ed.,
vol. 1, pp. 1364-1397. Philadelphia: Lippincott Williams and Wilkins.
Brennan K, et al. (2007). Premalignant and malignant
disorders of the ovaries and oviducts. In AH DeCherney et al., eds.,
Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971-884. New York: McGraw-Hill.
National Cancer Institute (2002). Genetic testing for BRCA1 and BRCA2: It's your choice. Available online: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA.
Zografos GC, et al. (2004). Common risk factors of
breast and ovarian cancer: recent view. International Journal of Gynecological Cancer, 14: 721-740.
Speroff L, Fritz MA (2005). Postmenopausal hormone
therapy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 689-777. Philadelphia: Lippincott Williams and
Wilkins.
Beral V, et al. (2007). Ovarian cancer and hormone
replacement therapy in the Million Women Study. Lancet,
369(9574): 1703-1710.
Edmondson RJ, Monaghan JM (2001). The epidemiology of
ovarian cancer. International Journal of Gynecological Cancer, 11: 423-429.
Modugno F, et al. (2004). Oral contraceptive use,
reproductive history, and risk of epithelial ovarian cancer in women with and
without endometriosis. American Journal of Obstetricians and Gynecologists, 191: 733-740.
Fairfield KM, et al. (2004). A prospective study of
dietary lactose and ovarian cancer. International Journal of Cancer, 110: 271-277.
National Comprehensive Cancer Network (2007). Ovarian
cancer. Clinical Practice Guidelines in Oncology, version 1. Available online:
http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf.
U.S. Preventive Services Task Force (2004). Screening for ovarian cancer. Available online: http://www.ahrq.gov/clinic/uspstf/uspovar.htm.
National Cancer Institute (2007). Genetics of Breast and Ovarian Cancer (PDQ)-Health
Professional Version. Available online:
http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.
Trimbos JB, Timmers P (2004). Chemotherapy for early
ovarian cancer. Current Opinion in Obstetrics and Gynecology, 16(1): 43-48.
Armstrong DK, et al. (2006). Intraperitoneal cisplatin
and paclitaxel in ovarian cancer. New England Journal of Medicine, 354(1): 34-43.
Cannistra SA (2007). Gynecologic cancer. In DC Dale,
DD Federman, eds., ACP Medicine, section 12, chap. 10.
New York: WebMD.
Lurie G, et al. (2007). Association of estrogen and
progestin potency of oral contraceptives with ovarian carcinoma risk.
Obstetrics and Gynecology, 109(3): 597-607.
Deligeoroglou E, et al. (2003). Oral contraceptives
and reproductive system cancer. Annals of the New York Academy of Sciences, 997: 199-208.
American Cancer Society (2006). American Cancer Society's Detailed Guide: Ovarian Cancer.
Available online:
http://www.cancer.org/docroot/CRI/CRI_2_1x.asp?rnav=criov&dt=33.
Kauff ND, et al. (2002). Risk-reducing
salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. New England Journal of Medicine, 346(21):
1609-1615.
Berek JS (2002). Ovarian cancer. In JS Berek, ed.,
Novak's Gynecology, 13th ed., pp. 1245-1319.
Philadelphia: Lippincott Williams and Wilkins.
