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Ovarian, Fallopian Tube, and Peritoneal Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find basic information about this group of diseases and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to Ovarian, Fallopian Tube, and Peritoneal Cancer. Use the menu to see other pages. Think of that menu as a roadmap for the complete guide.

About the ovaries

The ovaries are part of a woman’s reproductive system. Every woman has two ovaries, with one located on each side of the uterus. They are almond-shaped and about 1.5 inches long. These glands contain germ cells, also called eggs. Ovaries are the primary source of estrogen and progesterone. These hormones influence breast growth, body shape, body hair, and regulate the menstrual cycle and pregnancy. During menopause, the ovaries stop releasing eggs and producing certain hormones.

About the fallopian tubes

The fallopian tubes are part of a woman’s reproductive system. They are small ducts that link a woman’s ovaries to her uterus. Typically, every woman has 2 fallopian tubes, with 1 located on each side of the uterus. During a woman’s monthly ovulation, usually an egg is released from one ovary and travels to the uterus through a fallopian tube.

About the peritoneum

The peritoneum is a tissue that lines the abdomen and most of the organs in the abdomen. The tissue covers the uterus, bladder, rectum, and the ovaries and fallopian tubes. A liquid called peritoneal fluid covers the tissue’s surface. This liquid helps the organs move within the abdomen and prevents them from sticking together.

About ovarian, fallopian tube, and peritoneal cancer

The term “ovarian cancer”' is often used to describe cancers that begin in the cells in the ovary,  fallopian tube, and peritoneum. The cancers are closely related and are treated the same way. These types of cancer begin when healthy cells in these areas change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Research studies suggest that high-grade serous cancer (HGSC), which accounts for most ovarian cancer, in most cases actually starts in the distal end (fimbria) of the fallopian tubes and spreads to the surface of the ovaries. Based on this understanding, some doctors recommend removal of the fallopian tubes rather than tying or banding the tubes, for when a woman is undergoing surgery for benign disease and does not want to get pregnant in the future.

Because the surfaces of the ovaries and the peritoneum are made up of the same types of cells, the two diseases look alike under a microscope. Peritoneal cancer can still develop after ovaries have been removed. Just as with ovarian cancer, some peritoneal cancers may begin in the fallopian tube.

There can also be noncancerous tumors and cysts in this area of the body. Removing the ovary or the part of the ovary where the tumor is located can successfully treat a noncancerous ovarian tumor. An ovarian cyst forms on the surface of the ovary and is different than a noncancerous tumor. A simple ovarian cyst can occur during a woman’s normal menstrual cycle and usually goes away without treatment. Simple ovarian cysts are not cancerous.

Types of ovarian cancer

  • Epithelial carcinoma. Epithelial carcinoma makes up 85% to 90% of ovarian cancers.

    The main histologic types of epithelial tumors include serous, endometrioid, clear cell, mucinous, mixed tumors, and several rare malignancies, including Brenner and transitional cell cancers.

    The vast majority of epithelial cancers are serous, and these cancers are either high-grade serous carcinoma (HGSC) or low-grade serous carcinoma (LGSC). 

    HGSCs are the most common histologic type of malignancy of the ovary, fallopian tube, and peritoneum, as noted above. LGSC is less common.

  • Germ cell malignancies. This uncommon type of ovarian cancer develops in the egg-producing cells of the ovaries. Germ cell malignancies typically occur in females aged 10 to 29 years.

    The types of germ cell tumors are dysgerminomas, immature teratoma, and endodermal sinus tumors (called EST and yolk sac tumors), which include embryonal carcinoma.

  • Stromal malignancies. This rare form of ovarian cancer develops in the connective tissue cells that hold the ovaries together. This tissue sometimes makes the female hormones estrogen and progesterone. Over 90% of these stromal tumors are granulosa cell tumors, either adult or childhood types.

    Granulosa cell tumors may secrete estrogen resulting in unusual vaginal bleeding at the time of diagnosis. Other types are theca cell malignancies, and mixtures of these two types.

Types of fallopian tube cancer

Fallopian tube cancer was once thought to be rare, but we now know that most cancers previously labeled “ovarian cancer” actually begin in a fallopian tube. Most cancers arising in the fallopian tube are epithelial and begin in the distal (outer) end of the tube, near the fimbria, which is where the opening of the tube is located and where eggs released from the ovary must enter in order to be fertilized. Virtually all of these are serous cancers, and most serous cancers are high-grade (HGSC).

Other very rare types of fallopian tube cancer include leiomyosarcoma, which arise from the smooth muscle of the fallopian tube, and transitional cell cancer that arise within other cells that line the fallopian tubes.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of women who are diagnosed with this disease and their survival rates. You may use the menu to choose a different section to continue reading in this guide.  

Ovarian, Fallopian Tube, and Peritoneal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find information about the number of women who are diagnosed with ovarian, fallopian tube, and peritoneal cancer each year. You will read information about surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 22,280 women in the United States will be diagnosed with ovarian cancer, and the vast majority of these are high-grade serous ovarian cancers (HGSC), which begins in a fallopian tube.

It is estimated that 14,240 deaths from this disease will occur this year. Combined, cancer of the ovaries, fallopian tubes, and peritoneum are the fifth most common cause of cancer-related death in women in the United States.

The 5-year survival rate tells you what percent of women live at least 5 years after cancer is found. Percent means how many out of 100. The 5-year survival rate for women with all types of ovarian and fallopian cancer is 46%. The 10-year survival rate is 35%. However, the rate varies widely depending on age of the woman, as well as the stage and grade of the cancer. Women under 65 have a 5-year survival rate of 58%. The survival rate of women 65 and older is 28%.

If ovarian and fallopian tube cancers are diagnosed and treated before they spread outside the ovaries and tubes, the general 5-year survival rate is about 90%. Approximately 15% of cases are diagnosed at this stage. If the cancer has spread to surrounding tissues or organs, the 5-year survival rate is 75%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 30%.

It is important to remember that statistics on the percent of women who survive ovarian, fallopian tube, and peritoneal cancer are an estimate. The estimate comes from data based on women with these cancers in the United States each year. Your own risk may be different. Doctors cannot say for sure how long any woman will live with ovarian, fallopian tube, or peritoneal cancer. Experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available since the previous 5 year analysis. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts & Figures 2016, the ACS website, and the National Cancer Institute.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. You may use the menu to choose a different section to continue reading in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of tumor. Use the menu to see other pages.

A risk factor is anything that increases a person's chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a woman's risk of developing ovarian, fallopian tube, or peritoneal cancer.

  • Family history. A strong family history of breast or ovarian cancer puts women at higher risk for ovarian, fallopian tube and peritoneal cancer. Doctors believe this is because many of these families have genetic mutations (harmful changes in the gene) that are passed from generation to generation (see Genetics, below). If you are concerned that ovarian cancer may run in your family, it is important to get an accurate family history, including breast cancers in the family. By understanding your family history, you and your doctor can take steps to reduce your risk and be proactive about your health.

  • Genetics. About 10% to 15% of ovarian, fallopian tube, and peritoneal cancers occur because a genetic mutation (harmful change) has been passed down within a family. A mutation in the BRCA1 or BRCA2 gene is associated with an increased risk of developing ovarian cancer. A woman with a BRCA1 mutation has approximately a 40% lifetime risk of breast cancer and a woman with a BRCA2 mutation has approximately a 10% to 20% lifetime risk of developing ovarian cancer. (A woman with an average risk has only a 1% to 2% lifetime risk of developing ovarian cancer). While less common, it is possible that BRCA-related ovarian cancer can occur in women who do not have a family history of either breast or ovarian cancer. It is recommended that all women with serous ovarian cancer under the age of 70 should consider genetic testing for BRCA1 and BRCA2, the genes related to Lynch Syndrome (see below), and other cancer risk genes even if they don’t have a family history. Read more about the BRCA1 and BRCA2 genes in this website’s section on hereditary breast and ovarian cancer.

  • Genetic conditions. There are several other genetic conditions that cause ovarian cancer. Some of the most common include:

    • Lynch syndrome. Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, increases a woman's risk of ovarian cancer and uterine cancer. It is caused by mutations in several different genes. Lynch syndrome increases the risk of colorectal cancer, as well as several other cancers.

    • Peutz-Jeghers syndrome (PJS). PJS is caused by a specific genetic mutation. The syndrome is associated with multiple polyps in the digestive tract that become noncancerous tumors and increased pigmentation (dark spots on the skin) on the face and hands. PJS raises the risk of ovarian cancer, breast cancer, colorectal cancer, and several other types of cancer.

    • Nevoid basal cell carcinoma syndrome (NBCCS). Women with NBCCS, also called Gorlin syndrome, have an increased risk of developing fibromas. These are benign fibrous tumors of the ovaries. There is a small risk that these fibromas could develop into a type of ovarian cancer called fibrosarcoma. People with NBCCS often have multiple basal cell carcinomas and jaw cysts and may develop medulloblastoma (a type of brain tumor) in childhood.

    • Li-Fraumeni and Ataxia-Telangiectasia. Women with Li-Fraumeni syndrome or ataxia-telangiectasia may have a slightly increased risk of developing ovarian cancer.

    There may be other hereditary syndromes linked to these types of cancer, and research in this area is ongoing. Only genetic testing can determine whether a woman has a genetic mutation. Most experts strongly recommend that women who are considering genetic testing first talk with a genetic counselor. This expert is trained to explain the risks and benefits of genetic testing.

  • Age. A woman’s risk of developing ovarian, fallopian tube and peritoneal cancer increases with age. Women of all ages have a risk of these cancers, but women over 50 are more likely to develop the malignancies. The average age of women diagnosed with these cancers is about 60 to 62 years.

  • Weight and height. Recent studies show that women who were obese in early adulthood are 50% more likely to develop ovarian cancer. Women who are obese are more likely to die from the disease.

  • Endometriosis. This is when the inside lining of a woman’s uterus grows outside of the uterus, affecting other nearby organs. This condition can cause several problems, but effective treatment is available. Researchers are continuing to study whether endometriosis is a risk factor for ovarian cancer. It may increase the risk of certain types of ovarian cancer, including clear cell and endometrioid ovarian cancers.

  • Ethnicity. Women of North American, Northern European, or Ashkenazi Jewish heritage have an increased risk of ovarian cancer.

  • Reproductive history. Women who have never had children, have unexplained infertility (the inability to bear a child), or have not taken birth control pills may have an increased risk of ovarian and fallopian tube cancer.

  • Hormone replacement therapy. Women who have taken estrogen-only hormone replacement therapy (HRT) after menopause may have a higher risk of ovarian cancer. The risk becomes higher the longer a woman uses the therapy. The risk decreases over time after the therapy ends.

  • Fertility drugs. Research studies have shown that use of fertility drugs do not increase the risk of ovarian cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to study what factors cause these types of cancer. Although there is no proven way to prevent these diseases completely, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

Research has shown that certain factors may reduce a woman's risk of developing ovarian and fallopian tube cancer:

  • Taking birth control pills. Women who took oral contraceptives for 3 or more years are 30% to 50% less likely to develop ovarian cancer. The decrease in risk may last for 30 years after a woman stops taking the pills.

  • Breastfeeding. The longer a woman breastfeeds, the lower her risk of ovarian and fallopian tube cancer.

  • Pregnancy. The more full-term pregnancies a woman has had, the lower her risk of ovarian and fallopian tube cancer.

  • Surgical procedures. Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian cancer. A hysterectomy is the removal of the uterus and, sometimes, the cervix. Tubal ligation is having the fallopian tubes “tied” or closed surgically to prevent pregnancy. Doctors recommend a bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes, for women with a high risk of ovarian and fallopian tube cancer.

For women with high-risk genetic mutations such as BRCA1, BRCA2, the genes related to Lynch Syndrome, and others, having the ovaries and fallopian tubes removed after childbearing is sometimes done to prevent breast and ovarian cancers. This can reduce ovarian cancer risk by 70% to 96%. If performed before natural menopause, it may there may be a 40% to 70% reduction in the risk of developing breast cancer.

It is very important for women considering preventive surgery to talk with their doctors and genetic counselors, in order to understand the risks and side effects of the surgery in the context of their personal risks of developing ovarian cancer.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to continue reading in this guide.  

Ovarian, Fallopian Tube, and Peritoneal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

Ovarian, fallopian tube, and peritoneal cancer can be hard to find in their earliest stages. That’s because the symptoms are often vague until these diseases are advanced. These diseases have the same symptoms.

It’s possible for women with ovarian, fallopian tube and peritoneal cancer to not show any symptoms. It’s also important to note that symptoms are non-specific and may be caused by a medical condition that is not cancer.

Cancer symptoms for ovarian, fallopian tube, and peritoneal cancer may include:

  • Abdominal bloating

  • Pelvic or abdominal pain

  • Difficulty eating or feeling full quickly

  • Urinary symptoms such as urgency or frequency

  • Fatigue

  • Upset stomach

  • Indigestion

  • Back pain

  • Pain with intercourse

  • Constipation

  • Menstrual irregularities

  • Pelvic mass or lump

Another symptom for fallopian tube cancer may be a watery vaginal discharge, which may be clear, white, or tinged with blood.

For many women, these symptoms occur often and are different from what is normal for their bodies. Women who have any of the symptoms listed in this section almost daily for more than a few weeks should see either a primary care doctor or a gynecologist. A gynecologist is a doctor who specializes in treating diseases of the female reproductive organs. Early medical evaluation may help find cancer at the earliest possible stage of the disease when it is easier to treat.

Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis. If the doctor diagnoses cancer, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care.

Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to continue reading in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

If your primary care doctor is suspicious that you might have ovarian, fallopian tube, or peritoneal cancer, you should see a gynecologic oncologist. A gynecologic oncologist is a doctor who specializes in treating cancers of the female reproductive system.

This section describes options for diagnosing ovarian, fallopian tube, and peritoneal cancer. Not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

Early detection and treatment is important. This is often not possible for ovarian, fallopian tube, or peritoneal cancer. There are no effective screening methods until cancer is suspected. Often, women don’t have any symptoms until the tumor is large or in later stages of the disease. About 70% of epithelial ovarian cancers are not found until the disease is in an advanced stage and has spread to other parts of the body, most commonly the abdomen.

The following tests may be used to diagnose ovarian, fallopian tube, and peritoneal cancer:

  • Abdominal-pelvic examination. Usually, the first exam is the abdominal-pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. Some early cancers are very small before they spread and cannot be reliably felt and detected by pelvic examination. A Pap test, usually done with a pelvic examination, is not likely to find or diagnose ovarian, fallopian tube, or peritoneal cancer. However, research advances in DNA testing may help find cells trapped in the cervix that could be studied for changes that indicate cancer elsewhere in a woman’s reproductive system. These findings are considered experimental but are a promising new method for earlier detection of these types of cancers.

  • Transvaginal ultrasound. An ultrasound wand is inserted in the vagina and aimed at the ovaries and uterus. An ultrasound uses sound waves to create a picture of the ovaries, including healthy tissues, cysts, and tumors. Researchers are studying whether this test can help with early detection of ovarian cancer.

  • Blood tests/CA-125 assay. There is a blood test that measures a substance called CA-125, a tumor marker. This marker is found in higher levels in women with ovarian cancer, fallopian tube cancer, or peritoneal cancer. Woman younger than 50 with conditions such as endometriosis, pelvic inflammatory disease, and uterine fibroids may also have an increased CA-125 level. This test is more accurate in women who have had menopause. Other tumor marker tests, such as HE4, are available, but neither of these markers have been shown to be effective for the early detection of these cancers.

  • Computed tomography (CT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. An x-ray is a way to create a picture of the structures inside the body using a small amount of radiation. A computer combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow. A CT scan can be used to measure the tumor’s size. While the technology of CT scanning has continued to evolve, tumors or abnormalities less than about 5 millimeters (1/5th of an inch) are difficult to see.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure as just a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to actively use energy, it absorbs more of the radioactive substance. A scanner detects this substance to produce images of the inside of the body.

  • Lower gastrointestinal (GI) series. This is a series of x-rays of the colon and rectum taken after the patient has a barium enema. This procedure delivers a special dye into the rectum and colon through the anus. The barium highlights the colon and rectum on the x-ray, making it easier to identify a tumor or abnormal area in those organs. This test may be used if the doctor is concerned that the cancer is blocking the large intestine, although a CT scan with contrast (see above) is more commonly used in these circumstances.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Paracentesis. This is a medical procedure that removes peritoneal fluid that has built up in a person’s abdomen. This fluid build-up may be called ascites. A sample of the fluid is examined under a microscope for signs of cancer (see below, under Biopsy).  

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definitive diagnosis. A pathologist analyzes the samples(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

Biopsies for ovarian, fallopian tube, and peritoneal cancer are often done during a first surgery. During the surgery, doctors may remove as much of the tumor as possible (see Treatment Options). A tumor sample will be analyzed by a pathologist after the surgery is over. A biopsy alone is sometimes used if the diagnosis is uncertain or if there is too much tumor to remove initially with surgery. This is usually done when chemotherapy is planned as the first treatment, with possible surgery afterward. (See Treatment Options.)

After diagnostic tests are done, your doctor will review all of the results with you. As noted above, surgery and an examination of the lymph nodes may be needed before results are complete. If the diagnosis is cancer, these test results help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. You may use the menu to choose a different section to continue reading in this guide.  

Ovarian, Fallopian Tube, and Peritoneal Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will learn how doctors describe the disease’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where a cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out a cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best. Knowing the stage can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

Cancer stage grouping for ovarian, fallopian tube, and peritoneal cancer

The stage of ovarian, fallopian tube, and peritoneal cancer is determined by the FIGO (International Federation of Obstetrics and Gynecology) staging system. There is a TNM (tumor-node-metastasis) system that correlates with the FIGO system, and this system is applied to the pathology report after a surgery.

FIGO cancer staging for ovarian, fallopian tube, and peritoneal cancer

It is important for the doctor to find out the histologic type of the cancer, and the presumptive site of origin (where the cancer began) — whether it appears to arise from the ovary, fallopian tube or peritoneum, or if it cannot be clearly determined.

Stage I: The cancer is only in the ovaries or fallopian tubes.

IA – The cancer is only inside one ovary or fallopian tube. No cancer is found on the ovarian or fallopian tube surface, or in the abdomen.

IB – The cancer is in both ovaries or fallopian tubes. No cancer is found on the surface of the ovary or fallopian tube, or in the peritoneal fluid or washings.

IC – The cancer is in one or both ovaries or fallopian tubes, with any of the following:

IC1 – Intraoperative surgical spill

IC2 – The tumor wall is ruptured before surgery or there is cancer on the surface of the ovary or fallopian tube

IC3 – Cancer cells found in ascites (peritoneal fluid) or in the washings of the peritoneum.

Stage II: The cancer involves one or both of the ovaries or fallopian tubes and has spread below the pelvis, or involves peritoneal cancer.

IIA – The cancer has spread to the uterus and/or fallopian tubes and/or the ovaries.

IIB – The cancer has spread to other tissues within the pelvis.

Stage III: The cancer involves one or both of the ovaries or fallopian tubes, or peritoneal cancer. It has spread to the peritoneum outside the pelvis and/or to lymph nodes in the retroperitoneum (lymph nodes along the major blood vessels, such as the aorta) behind the abdomen.

IIIA – The cancer has spread to the retroperitoneal lymph nodes without spread to the peritoneal surfaces.

IIIA(i) –  Metastases are 10 millimeters (mm) or smaller

IIIA(ii) – Metastases are larger than 10 mm

IIIA2 – The cancer has spread microscopically from the pelvis to the abdomen, with or without lymph nodes with cancer in the back of the abdomen.

IIIB – The cancer has visibly spread past the pelvis to the abdomen and is 2 centimeters (cm) or smaller, with or without spread to the retroperitoneal lymph nodes.

IIIC – The cancer has visibly spread past the pelvis to the abdomen and is larger than 2 cm, with or without spread to the retroperitoneal lymph nodes.

Stage IV: The cancer has spread to organs outside of the abdominal area.

IVA – The cancer has spread to fluid around the lungs.  

IVB – The cancer has spread to organs beyond the abdomen, including lymph nodes in the groin and outside of the abdominal cavity.

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Grade of the cancer

Doctors also describe this type of cancer by its grade, which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. This helps the doctor predict how quickly the cancer may spread and can be a factor in making treatment plan decisions 

Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

Some tumors are borderline cancerous, and these are called tumors of low malignant potential (LMP).

Most epithelial ovarian cancers are the serous type, and they are they graded as:

LGSC -- low-grade serous carcinoma

HGSC -- high-grade serous carcinoma

Other histologic types, such as endometrioid cancers, may be graded as follows:

Grade 1: The tissue is well-differentiated (contains many healthy-looking cells).

Grade 2: The tissue is moderately differentiated (more cells appear abnormal than healthy).

Grade 3: The tissue is poorly differentiated (all or most cells appear abnormal).

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. You may use the menu to choose a different section to continue reading in this guide.  

Ovarian, Fallopian Tube, and Peritoneal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will learn about the different treatments doctors use for women with this type of cancer. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for these types of cancer. “Standard of care” means the best treatments known. Ovarian epithelial cancer, fallopian tube cancer, and peritoneal cancer are usually treated the same way.

When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for ovarian cancer, fallopian tube cancer, and peritoneal cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health or personal considerations, such as a woman’s age and if she is planning to have children in the future.

Your care plan may include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Women with ovarian cancer, fallopian tube cancer, or peritoneal cancer may have concerns about if or how their treatment may affect their sexual health and their ability to have children in the future. All patients are encouraged to talk with the health care team about these topics before treatment begins.

Surgery

Surgery is usually an important treatment for ovarian cancer, fallopian tube cancer, and peritoneal cancer. A gynecologic oncologist is a doctor who specializes in gynecological cancers, including surgery and chemotherapy.

As mentioned in Diagnosis, surgery is often needed to find out the complete extent of the disease. The goal is to provide an accurate stage. This is important because imaging tests aren’t always able to see the true extent of a disease. Up to 30% of women whose imaging tests seem to show early ovarian disease actually have disease that has spread to other organs.

To determine whether ovarian, fallopian tube, or peritoneal cancer has spread, the surgeon will remove lymph nodes, tissue samples, and fluid from the abdomen for testing. If it is clear during the surgery that the cancer has spread, the surgeon will remove as much of the cancer as possible. This has been shown to provide the best benefit when combined with chemotherapy (see below) after surgery.

There are several surgical options for ovarian, fallopian tube, and peritoneal cancer. The stage of the tumor determines the types of surgery. Sometimes doctors perform two or more procedures during the same surgery

  • Salpingo-oophorectomy. This surgery involves removal of the ovaries and fallopian tubes. If both ovaries and both fallopian tubes are removed, it is called a bilateral salpingo-oophorectomy. If the woman wants to become pregnant in the future and has early-stage cancer, it may be possible to remove only one ovary and one fallopian tube if the cancer is located in only one ovary. That surgery is called a unilateral salpingo-oophorectomy. For women with a germ cell type of ovarian tumor, surgery often needs to remove only the ovary with the tumor, which preserves the woman’s ability to become pregnant.

  • Hysterectomy. This surgery focuses on the removal of a woman’s uterus and, if necessary, surrounding tissue. If only the uterus is removed, it is called a partial hysterectomy. A total hysterectomy is when a woman’s uterus and cervix are removed.

  • Lymphadenectomy (lymph node dissection). The surgeon may remove lymph nodes in the pelvis and paraortic areas.

  • Omentectomy. This is surgery to remove the thin tissue that covers the stomach and large intestine.

  • Cytoreductive/debulking surgery. For women with metastatic cancer, the goal of this surgery is to remove as much tumor as is safely possible. This may include removing tissue from nearby organs, such as the spleen, gallbladder, stomach, bladder, or colon. This may involve removing part of each of these organs. This procedure can help reduce a person’s symptoms. It may help increase the effectiveness of other treatment, such as chemotherapy, given after surgery to control the disease that remains. If the disease has spread beyond ovaries, fallopian tubes, or peritoneum, doctors may use chemotherapy to shrink the tumor before cytoreductive or debulking surgery. This is called neoadjuvant chemotherapy.

    Debulking surgery should be performed by an experienced gynecologic oncologist. Talk with your doctor before surgery about the risks and benefits of this procedure. Ask about the surgeon’s experience with debulking surgery for this type of cancer.

    Side effects of surgery

    Surgery causes short-term pain and tenderness. If there is pain, the doctor will prescribe an appropriate medication. For several days after the operation, you may have difficulty emptying your bladder (urinating) and having bowel movements. Talk with your surgeon about what side effects to expect from your specific surgery and how they can be relieved.

    Studies have shown that women who have their surgeries performed by a gynecologic oncologist are more likely to be successfully treated with surgery and have fewer side effects.

    If the surgeon removes both ovaries, a woman can no longer become pregnant. The loss of both ovaries eliminates the body's source of sex hormones, resulting in premature menopause. Soon after surgery, a woman is likely to have menopausal symptoms, including hot flashes and vaginal dryness.

    Talk with your doctor about sexual and reproductive health concerns, including ways to address these concerns before and after cancer treatment.

    Learn more about the basics of cancer surgery.

    Chemotherapy

    Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a gynecological oncologist or a medical oncologist, a doctor who specializes in treating cancer with medication.

    Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

    A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.
    Most of the chemotherapy options described below apply to epithelial ovarian cancer, as well as fallopian tube cancer and peritoneal cancer. The type of the chemotherapy used depends on several factors.

    • Adjuvant chemotherapy. This is done to destroy cancer remaining after surgery. This treatment typically consists of carboplatin (Paraplatin) given with paclitaxel (Taxol) or docetaxel (Docefrez, Taxotere) intravenously (IV), which is through the vein. Most of these drugs are given every 3 weeks.

      Another approach is called “dose-dense” chemotherapy. This is when the drugs are giving weekly instead of every 3 weeks. Some studies show that using dose-dense paclitaxel with carboplatin may improve survival rates compared to giving the drugs every 3 weeks. Talk with your doctor about which scheduling option is best for your situation.

      In addition, a third way to give adjuvant chemotherapy is to infuse it directly into the abdomen. This is called intraperitoneal or “IP” chemotherapy. This approach can be considered for women with stage III disease after a successful surgical debulking procedure. In previous studies, IP treatment was more effective when compared to intravenous treatment on the every 3-week schedule.

      Studies comparing dose-dense (weekly) IV chemotherapy with carboplatin and paclitaxel to IP chemotherapy with the same drugs show similar outcomes. Doctors are discussing whether the more intense IV approach can replace the use of IP chemotherapy.

      With each of these approaches, doctors consider a variety of factors, such as age, kidney function, and other existing health problems.

      Research studies are underway to see if additional medications, such as PARP inhibitors, should be used. Several studies have evaluated whether adding bevacizumab (Avastin), which is an anti-vascular or “blood vessel growth blocking” antibody, to standard chemotherapy following initial surgery is helpful. In general, bevacizumab used for ovarian cancer has prolonged the time in some patients before the cancer returns; see Latest Research.

    • Neoadjuvant chemotherapy. This is done to reduce the size of a tumor before surgery. It will usually follow a biopsy so the doctors can determine where the tumor began. This type of chemotherapy is usually given for 3 to 4 cycles before considering surgery, called interval surgery. Similar to adjuvant chemotherapy (see above), this treatment usually consists of carboplatin (Paraplatin) given with paclitaxel (Taxol) or docetaxel (Docefrez, Taxotere) intravenously, which is through the vein. Typically, the treatment cycle is to give these drugs every 3 weeks. Studies suggest a weekly schedule for the paclitaxel. Talk with your doctor about which scheduling option is best for your treatment plan.

      In August 2016, the American Society of Clinical Oncology (ASCO) and the Society of Gynecologic Oncology (SGO) released a joint clinical practice guideline on the use of neoadjuvant chemotherapy, which is chemotherapy given before surgery, for women with newly diagnosed, advanced ovarian cancer. Listen to a podcast about what this treatment guideline means for patients.

    • Maintenance chemotherapy. This is done to reduce the time to, or risk of, cancer recurrence. Bevacizumab (Avastin) can be used for maintenance chemotherapy for people with ovarian, fallopian tube, and peritoneal cancer. 

    • Recurrence chemotherapy. This is done to treat the cancer if it comes back, called a recurrence. A primary goal of the treatment of recurrent disease is to reduce or prevent symptoms of the disease while keeping the side effects of treatment to a minimum. Treatment for women with recurrent disease is generally categorized based on the time since her last treatment using a platinum chemotherapy drug. Platinum chemotherapy drugs include carboplatin and cisplatin. Researchers are working to see if surgery is an effective option for recurrent disease.

    • Platinum-sensitive disease: If the cancer returns more than 6 months after platinum chemotherapy, doctors call it “platinum-sensitive.” If it returns to one specific spot, additional surgery may be beneficial. You can discuss this with your doctor. Surgery is usually considered only if the time period following chemotherapy has been at least 12 months. If the cancer comes back to more than one place in the body, chemotherapy is the appropriate next step. For patients with platinum sensitive disease, clinical trials suggest there is benefit to using carboplatin again intravenously and combining it with liposomal doxorubicin (Doxil), paclitaxel (Taxol), or gemcitabine (Gemzar).

      A clinical trial evaluated adding bevacizumab to the gemcitabine and carboplatin combination. This extended the time before the disease came back but did not change the overall survival rate. You should discuss the risks and possible benefits of this approach with your doctor. 

    • Platinum-resistant disease: If the cancer returns in less than 6 months following platinum chemotherapy, doctors call it “platinum resistant.” In general, the choice of chemotherapy at this point is selected from a variety of medications that have all shown similar ability to shrink cancer. Doctors choose them based on possible side effects and preference based on schedule of dosing. These medications may include, but are not limited to:

      • Liposomal doxorubicin (Doxil)

      • Paclitaxel (Taxol)

      • Docetaxel (Taxotere)

      • Nab-paclitaxel (Abraxane)

      • Gemcitabine (Gemzar)

      • Etoposide (Toposar, VePesid)

      • Pemetrexed (Alimta)

      • Cyclophosphamide (Cytoxan)

      • Topotecan (Hycamtin)

      • Vinorelbine (Navelbine)

      • Irinotecan (Camptosar)

      For platinum-resistant cancer, most doctors recommend single and sequential use (1 drug after another) of these medications, but they are sometimes used in combination.

      Bevacizumab can be combined with liposomal doxorubicin, paclitaxel, or topotecan for platinum-resistant cancer. Doctors believe this is best used with patients who have received one or two treatments, have not previously received bevacizumab, and those do not have evidence of significant bowel involvement by a CT scan. By adding bevacizumab to the chemotherapy, the time to disease recurrence may be lengthened when compared to those patients receiving chemotherapy alone. You should discuss the risks and possible benefits of this approach with your doctor.

      Clinical trials are always reasonable to consider, if available. Talk with your doctor about available clinical trials open to you.

    Ovarian germ cell and stromal tumors

    For patients with ovarian germ cell tumors, the first treatment usually is surgery. In some cases, doctors can perform the surgery in a way that preserves fertility. Doctors generally recommend chemotherapy following surgery. The exception is stage IA dysgerminoma or stage I, grade 1 to 2 immature teratoma. Chemotherapy usually consists of a combination of intravenous (IV) bleomycin (Blenoxane), cisplatin (Platinol), and etoposide (Toposar, VePesid). The overall approach and medications given are similar to those used in male germ cell cancer, which is a type of testicular cancer. To learn more about this type of cancer, visit the Cancer.Net guides to testicular cancer and childhood germ cell tumors.    

    Stromal tumors are a rare form of ovarian cancer. They are found in the connective tissue that holds the ovaries together. For a stage I stromal tumor, treatment usually consists of surgery only. For high-risk, early stage tumors or stage III or stage IV disease, doctors often consider combination chemotherapy. You should discuss the risks and potential benefits with your doctor. For information about staging, visit the Staging section of this guide.

    Chemotherapy for a stromal tumor usually involves the combination of bleomycin (Blenoxane), cisplatin (Platinol) and etoposide (Toposar, VePesid). Chemotherapy can be used after surgery or for recurrent tumors. Researchers are looking at chemotherapy with carboplatin (Paraplatin) and paclitaxel (Taxol) as another alternative. For recurrent disease, doctors use the hormonal therapy leuprolide (Eligard, Lupron, Viadur). Clinical trials are evaluating the effectiveness of bevacizumab (Avastin) to block the growth of blood vessels. Studies are being done to test tumors molecularly to find other, more targeted drugs for this type of cancer. 

    Side effects of chemotherapy

    For ovarian, fallopian tube, and peritoneal cancer, the side effects of chemotherapy depend on the individual and the dose used. Side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

    Possible side effects of chemotherapy include difficulty with cognitive (brain) functions. For example, the patient may have issues with attention span or memory. Other possible side effects include stopping the ability to become pregnant and causing premature or early menopause. Rarely, certain drugs may cause some hearing loss or kidney damage. Patients may be given extra fluid intravenously for kidney protection. Before treatment begins, patients should talk with their health care team about possible short-term and long-term side effects of the specific drugs being given. It is important to note that many side effects can be reduced by adjusting the dose and/or schedule.  

    Learn more about the basics of chemotherapy and preparing for treatment. Researchers are continually evaluating the medications that treat cancer. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases. 

    Radiation therapy

    Radiation therapy is not used as a first treatment for ovarian, fallopian tube, or peritoneal cancer. Occasionally, it can be an option for treating small, localized recurrent cancer. See the section below for more about treatment options for recurrent ovarian, fallopian tube, and peritoneal cancer.

    Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external beam radiation therapy. This type of radiation is given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen usually consists of a specific number of treatments given over a set period of time.

    Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy

    For more information on radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers (PDF).

    Getting care for symptoms and side effects

    Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care. Palliative care includes supporting the patient with her physical, emotional, and social needs.

    Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. Palliative care works best when it is started as early as needed in the cancer treatment process.

    People often receive treatment for the cancer and treatment to ease side effects at the same time. Patients who receive both, often have less severe symptoms and better quality of life, and report they are more satisfied with treatment.

    Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy or surgery. Talk with your doctor about the goals of each treatment in the treatment plan.

    Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you experience a problem so it can be addressed as quickly as possible. Learn more about palliative care

    Metastatic ovarian, fallopian tube, and peritoneal cancer

    If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

    New treatments for these types of cancer include experimental combinations of chemotherapy, targeted therapy and immunotherapy, also called biologic therapy. These combinations are designed to boost the body’s natural defenses to fight the cancer (see Latest Research). Because the benefits of these options remain unproven, their risks must be weighed against possible improvements in symptoms and survival. Palliative care will be important to help relieve symptoms and side effects.

    For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may be helpful to talk with other patients, including through a support group.

    Remission and the chance of recurrence

    A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

    A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. It’s important to talk with your doctor about the possibility of the cancer returning. This is particularly important after treatment for ovarian, fallopian tube and peritoneal cancer, as many women experience at least one recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

    If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

    When this occurs, a new cycle of testing will begin to discover as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as surgery and chemotherapy. However, they may be used in a different combination or given at a different pace. Radiation therapy may be used in some situations. Your doctor may suggest clinical trials that are studying new ways to treat your type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects

    The symptoms of recurrent ovarian, fallopian tube, and peritoneal cancer are similar to those experienced when the disease was first diagnosed. The four most common symptoms are bloating; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary symptoms (urgency or frequency). However, other symptoms may include persistent indigestion, gas, nausea, diarrhea, or constipation; unexplained weight loss or gain, especially in the abdominal area; abnormal bleeding from the vagina; pain during sexual intercourse; fatigue; and lower back pain.

    In addition to monitoring symptoms, doctors may be able to diagnose a recurrence by measuring the level of CA-125 in the blood in women whose levels were elevated prior to treatment. As outlined in Diagnosis, CA-125 is a cancer antigen, or a substance that is found in higher levels in women with ovarian, fallopian tube, and peritoneal cancer. In 95% of women, a rise in CA-125 indicates a recurrence. However, sometimes a recurrence can happen without an elevation of this marker depending on the tumor type.

    Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

    People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

    If treatment fails

    Recovery from ovarian, fallopian tube, or peritoneal cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

    This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help. Many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

    Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

    After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

    The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to continue reading in this guide.  

    Ovarian, Fallopian Tube, and Peritoneal Cancer - About Clinical Trials

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    ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

    What are clinical trials?

    Doctors and scientists are always looking for better ways to care for patients with ovarian cancer, fallopian tube cancer, or peritoneal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. Every drug that is now approved by the FDA was tested in clinical trials.

    Many clinical trials focus on new treatments. Researchers want to learn whether a new treatment is safe, effective, and possibly better than standard treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than standard treatment.

    Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late side effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

    Deciding to join a clinical trial

    Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are an excellent way to contribute to progress in treating ovarian cancer, fallopian tube cancer, and peritoneal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with these cancers.

    Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

    Patient safety and informed consent

    To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

    Because some of these specific types of cancer of the fallopian tubes are quite rare, specific studies for these diseases are uncommon. However, many clinical trials on ovarian cancer are open to women with these diseases because these diseases often respond to the same treatment.

    Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

    Finding a clinical trial

    Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for ovarian cancer, fallopian tube cancer, and peritoneal cancer, learn more in the Latest Research section.

    Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

    This website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

    The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. You may use the menu to choose a different section to continue reading in this guide.    

    Ovarian, Fallopian Tube, and Peritoneal Cancer - Latest Research

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    ON THIS PAGE: You will read about the scientific research being done to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

    Doctors are working to learn more about ovarian, fallopian tube, and peritoneal cancer. They are looking for ways to prevent them, as well as looking for the best ways to treat them and provide care to people diagnosed with these diseases.

    The following areas of research may include new options for patients through clinical trials. As mentioned in the Clinical Trials section, most ovarian cancer trials now include patients with fallopian tube and peritoneal cancers.

    Always talk with your doctor about the diagnostic and treatment options best for you.

    • Screening. Screening is used to look for cancer before a person has any signs or symptoms. There are no effective screening methods for these diseases suitable for the general symptom-free population. A screening method that uses serial CA-125 blood tests and pelvic ultrasonography for detecting early-stage ovarian cancer has been completed, and it is not clear whether this approach will produce an improved survival rate. As explained in Diagnosis, CA-125 is a substance called a tumor marker that is found in higher levels in women with ovarian, fallopian tube, and peritoneal cancer, and in many benign conditions.

      In 2012, the U.S Preventative Services Task Force released a statement saying that for the general population of women with no symptoms, screening for ovarian cancer is not helpful and may lead to harm.

      Although some have recommended that women at high risk for ovarian cancer because of their family history or presence of BRCA1 or BRCA2 or other high-risk gene mutation(s) (see Risk Factors) should be screened with CA-125 blood tests and transvaginal ultrasound, this approach has not been shown to improve survival or detect cancers at an earlier and more curable stage.  Therefore, if a high-risk gene mutation exists, the recommendation is to remove both fallopian tubes and ovaries preventively (prophylactically) after the completion of child-bearing, in most women by age 40.

    • Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Some targeted therapy drugs are directed at specific genes that might be found with abnormalities in certain types of epithelial ovarian cancer. For this purpose, serous ovarian cancers are divided into two groups: high-grade serous cancer (HGSC) and low-grade seous cancer (LGSC). Standard chemotherapy has been most effective in HGSC. Typically, these tumors have mutations in TP53 and BRCA genes and are diagnosed at later stages. Other tumor mutations are rarely seen.

      The BRCA mutation, even if found only in the tumor and not in the blood, may increase the effectiveness of certain classes of drugs, such as PARP inhibitors (see below).

      Other types of ovarian cancer are much less common, and include LGSC, endometrioid, clear cell, and mucinous cancers. These tumors have a variety of mutations including KRAS, BRAF, PI3KCA and PTEN, which may mean there is an available targeted treatment. Clinical trials in these groups are ongoing.    

    • Anti-angiogenesis inhibitors. Drugs called anti-angiogenesis inhibitors block the action of a protein called vascular endothelial growth factor (VEGF). These drugs have been shown to increase the cancer’s response to treatment and delay the time it takes for the cancer to return. VEGF promotes angiogenesis, which is the formation of new blood vessels. Because a tumor needs nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Bevacizumab (Avastin), an antibody that binds VEGF and prevents it from being active, has been shown to be effective in ovarian cancer.  FDA approval was given in the United States for its use in combination with selected chemotherapy for patients with platinum resistant recurrence (see Treatment Options).

    • PARP inhibitors. Researchers are evaluating another class of drugs, called PARP inhibitors, for ovarian cancer. These drugs act on DNA repair in cancer cells, making it difficult for them to replicate. The BRCA genes (BRCA1 and BRCA2) are normally involved in DNA repair, and a mutation in these genes interferes with this pathway function. PARP inhibitors make it particularly difficult for cells that otherwise have a BRCA mutation to grow and divide.  

      The FDA approved the PARP inhibitor olaparib (Lynparza) for recurrent disease in patients who have the inherited BRCA mutation and who have received 3 or more lines of chemotherapy. In the supporting study of 137 patients with a BRCA mutation, 34% of patients experienced shrinkage in tumor for an average of 7.9 months. A very small number of patients developed secondary, hematologic (blood) cancers after use of these drugs. Studies are underway with other PARP inhibitors that do not all require the inherited BRCA mutation. Researchers are testing these to see if these inhibitors can keep the cancer from coming back after chemotherapy. You should discuss the potential benefits and risks of PARP therapy with your doctor.

      Many other new targeted treatments are now in clinical trials. Increasingly, doctors are learning about each patient’s individual tumor's biology through direct molecular testing. This information may be useful in matching patients with a clinical trial for a specific targeted therapy. Learn more about the basics of targeted therapy.

    • Immunotherapy. Immunotherapy is usually designed to boost the body’s natural defenses to fight a cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function.

      Researchers are examining whether drugs called checkpoint inhibitors may boost the immune system's ability to destroy cancer cells. Examples of these drugs target PD-1, PD-L1, and CTLA4 and they have been shown to cause shrinkage in other cancer types such as melanoma and some lung cancers, as well as having some activity in patients with ovarian cancer.

      Cancer vaccines are another type of immunotherapy researchers are testing for use against ovarian cancer. Some approaches called “adoptive cell therapy” use killer T cells found as part of the immune system in an individual patient. Researchers grow them in the laboratory and train them to attack certain targets, such as MUC 16 (CA125), that are found on ovarian cancer cells. Doctors then give the T cells back intravenously to the patient. This approach has been tried in patients with blood cancers with some early success. Clinical trials are opening for ovarian cancer.  Learn more about the basics of immunotherapy.

    • Hormone therapy.  For treatment of recurrent or later-stage ovarian cancer, tamoxifen (Nolvadex, Soltamax), aromatase inhibitors, and enzalutamide (Xtandi), a blocker of the androgen receptor, are being used.

    • Gene therapy. A new area of research is discovering how damaged genes in ovarian cancer cells can be corrected or replaced. Researchers are studying the use of specially designed viruses that carry normal genes into the core of cancer cells and then replace the defective genes with the functional ones.

    • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of standard cancer treatments, to improve a patient’s comfort and quality of life.

    Looking for More About the Latest Research?

    If you would like additional information about the latest areas of research regarding ovarian cancer, fallopian tube cancer, and peritoneal cancer, explore these related items that take you outside of this guide:

    The next section in this guide is Coping with Treatment.  It offers guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. You may use the menu to choose a different section to continue reading in this guide.  

    Ovarian, Fallopian Tube, and Peritoneal Cancer - Coping with Treatment

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    ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

    Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

    As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

    Coping with physical side effects

    Common physical side effects from each treatment option for ovarian cancer, fallopian tube cancer, and peritoneal cancer are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

    Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

    Coping with emotional and social effects

    You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

    Patients and their families are encouraged to share their feelings with a member of their health care team. You can find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

    Coping with financial effects

    Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations in a separate part of this website.

    Caring for a loved one with cancer

    Family members and friends often play an important role in taking care of a person with ovarian cancer, fallopian tube cancer, or peritoneal cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

    Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

    • Providing support and encouragement

    • Giving medications

    • Helping manage symptoms and side effects

    • Coordinating medical appointments

    • Providing a ride to appointments

    • Assisting with meals

    • Helping with household chores

    • Handling insurance and billing issues

    Learn more about caregiving.

    Talking with your health care team about side effects

    Before starting treatment, talk with your doctor about possible side effects. Ask:

    • Which side effects are most likely?

    • When are they are likely to happen?

    • What can we do to prevent or relieve them?

    Be sure to tell your health care team about any side effects that happen during and after treatment. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

    Ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

    The next section in this guide is Follow-up Care. It explains the importance of check-ups after you finish cancer treatment. You may use the menu to choose a different section to continue reading in this guide.  

    Ovarian, Fallopian Tube, and Peritoneal Cancer - Follow-Up Care

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

    ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. Use the menu to see other pages.

    Care for women diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

    Follow-up care for ovarian cancer, fallopian tube cancer, and peritoneal cancer may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

    Although there are no specific guidelines for follow-up care for women treated for ovarian cancer, many doctors recommend a pelvic examination every 2 to 4 months for the first 4 years after treatment, and every 6 months for the following 3 years.

    For all three cancers, other tests may include x-rays, CT scans, MRI scans, ultrasound studies, and blood tests, such as a CA-125 test.

    Women treated for ovarian cancer may have an increased risk of breast cancer or colon cancer (Lynch Syndrome with certain types of ovarian cancer). They should talk with their doctors about screening tests for these cancers.

    Any new problem should be reported to your doctor, including, pain, loss of appetite or weight, changes in your menstrual cycle, unusual vaginal bleeding, urinary problems, blurred vision, dizziness, coughing, hoarseness, headaches, backaches or abdominal pain, bloating, difficulty eating, or digestive problems that seem unusual or don’t go away. These symptoms may be signs that the cancer has come back or signs of another medical condition.

    Learn more about the importance of follow-up care.

    Watching for recurrence

    One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

    Managing long-term and late side effects

    Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

    Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

    Keeping personal health records

    You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan after treatment is completed.

    This is a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

    If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

    The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. You may use the menu to choose a different section to continue reading in this guide.  

    Ovarian, Fallopian Tube, and Peritoneal Cancer - Survivorship

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

    ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

    What is survivorship?

    The word “survivorship” means different things to different people. Common definitions include:

    • Having no signs of cancer after finishing treatment.

    • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

    Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

    Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

    Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

    Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

    • Understanding the challenge you are facing,

    • Thinking through solutions,

    • Asking for and allowing the support of others, and

    • Feeling comfortable with the course of action you choose.

    Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

    Changing role of caregivers

    Family members and friends may go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

    As treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

    A new perspective on your health

    For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

    People recovering from ovarian cancer, fallopian tube cancer, or peritoneal cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

    It is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

    Talk with your doctor to develop a survivorship care plan that is best for your needs.

    Looking for More Survivorship Resources?

    For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

    • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank forms for treatment summaries and survivorship care plans. This booklet is available as a PDF, so it is easy to print out.

    • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

    • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

    The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. You may use the menu to choose a different section to continue reading in this guide.  

    Ovarian, Fallopian Tube, and Peritoneal Cancer - Questions to Ask the Doctor

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

    ON THIS PAGE: You will find some questions to ask your doctor, or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

    Talking often with the doctor is important for making informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

    Questions to ask after getting a diagnosis

    • What type of ovarian cancer, fallopian tube cancer, or peritoneal cancer do I have?

    • Where did this cancer start?

    • Can you explain my pathology report (laboratory test results) to me?

    • What is the stage and grade of my cancer? What does this mean?

    Questions to ask about choosing a treatment and managing side effects

    • What are my treatment options?

    • What clinical trials are available to me? Where are they located, and how do I find out more about them?

    • What treatment plan do you recommend? Why?

    • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

    • What are the possible side effects of each treatment, in the short term and the long term?

    • Who will be part of my health care team, and what does each member do?

    • Who will coordinate my overall treatment and follow-up care?

    • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

    • Could this treatment affect my sex life? If so, how and for how long?

    • Could this treatment affect my ability to become pregnant or bear a child in the future? If so, should I talk with a fertility specialist before cancer treatment begins?

    • If I’m worried about managing the costs of cancer care, who can help me?

    • What support services are available to me? To my family?

    • Whom should I call for questions or problems?

    • Is there anything else I should be asking?

    Questions to ask about having surgery

    • What type of surgery will I have? Will lymph nodes be removed?

    • How long will the operation take?

    • How long will I be in the hospital?

    • Can you describe what my recovery from surgery will be like?

    • What are the possible long-term effects of having this surgery?

    • Will I have chemotherapy after the surgery?

    Questions to ask about having chemotherapy or radiation therapy

    • What type of treatment is recommended?

    • What is the goal of this treatment?

    • How long will it take to give this treatment?

    • What side effects can I expect during treatment?

    • What are the possible long-term effects of having this treatment?

    • What can be done to relieve the side effects?

    Questions to ask about planning follow-up care

    • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

    • What long-term side effects or late effects are possible based on the cancer treatment I received?

    • What follow-up tests will I need, and how often will I need them?

    • How do I get a treatment summary and survivorship care plan to keep in my personal records?

    • Who will coordinate my follow-up care?

    • What survivorship support services are available to me? To my family?

    • How can I keep myself as healthy as possible during treatment?

    • Why are ovarian cancer, fallopian tube cancer, and peritoneal cancer called “chronic diseases”?

    • Should other women in my family be tested regularly for this type of cancer?

    • Should other women in my family be tested for the BRCA1 or BRCA2 gene?

    The next section in this guide is Additional Resources.  It offers more website resources beyond this guide that may be helpful to you. You may use the menu to choose a different section to continue reading in this guide.  

    Ovarian, Fallopian Tube, and Peritoneal Cancer - Additional Resources

    This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

    ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Ovarian Cancer, Fallopian Tube Cancer, and Peritoneal Cancer. Use the menu to go back and review other pages.

    Cancer.Net includes many other sections about the medical and emotional aspects of cancer, for the person diagnosed, their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

    Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

    This is the end of the Cancer.Net’s Guide to Ovarian, Fallopian Tube, and Peritoneal Cancer. Use the menu to select another section, to continue reading this guide.