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Ovarian Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Ovarian Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the ovaries

A woman’s ovaries are glands that contain the germ cells or eggs. Every woman has two ovaries as part of her reproductive system, one located on each side of the uterus. They are almond shaped and about one and a half inches long. Every month, during ovulation, an egg is released from an ovary and travels to the uterus through a structure called the fallopian tube.

Ovaries are the primary source of a woman’s sex hormones, estrogen and progesterone. These hormones influence breast growth, body shape, and body hair, and regulate the menstrual cycle and pregnancy. During menopause, the ovaries stop releasing eggs and producing sex hormones.

About ovarian cancer

Ovarian cancer begins when normal cells in an ovary change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Removing the ovary or the part of the ovary where the tumor is located can treat a noncancerous ovarian tumor. An ovarian cyst, which forms on the surface of the ovary, is different than a noncancerous tumor and usually goes away without treatment. An ovarian cyst is not cancerous.

Types of ovarian cancer include:

Epithelial carcinoma. Epithelial carcinoma makes up 85% to 90% of ovarian cancers. This type of cancer typically begins in cells on the outer surface of the ovary. Epithelial ovarian cancer is usually known for starting in the ovary. However, new evidence suggests at least some of ovarian cancer actually begins in special cells in the fallopian tube. These cells are near the ovary and may go to the surface of the ovary early in the cancer process. Therefore, the term 'ovarian cancer' is often used to describe epithelial cancers that begin in the ovary, in the fallopian tube, and from the lining of the abdominal cavity, call the peritoneum.

Germ cell tumor. This uncommon type of ovarian cancer develops in the egg-producing cells of the ovaries. This type of tumor is more common for women ages 10 to 29.

Stromal tumor. This rare form of ovarian cancer develops in the connective tissue cells that hold the ovaries together and make female hormones.

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Ovarian Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 21,980 women in the United States will be diagnosed with ovarian cancer. It is estimated that 14,270 deaths from this disease will occur this year.. It is the fifth most common cause of cancer-related death in women.

The overall one-year survival rate, which is the percentage of women who survive at least one year after the cancer is detected, excluding those who die from other diseases of women with ovarian cancer is 75%. The overall five-year survival rate is 44%, but this varies widely depending on the extent (stage) of the cancer. If the cancer is diagnosed and treated before it has spread outside the ovaries, the five-year survival rate is 92%. If the cancer has spread to the surrounding organs or tissue (regional spread), the five-year survival rate is 72%. If the cancer has spread to parts of the body far away from the ovary (distant spread), the five-year survival rate is 27%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of women with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with ovarian cancer. Because survival statistics are often measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2014.

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Ovarian Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will find out more about what factors increase the chance of this type of cancer. To see other pages, use the menu on the side of your screen.

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. However, 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 cancer:

Age. A woman’s risk of developing ovarian cancer increases with age. Women of all ages have a risk of ovarian cancer, but women over 50 are more likely to develop ovarian cancer. Sixty-eight percent (68%) of women with ovarian cancer are older than 55, and 32% are younger than 55.

Family history. Women with a first-degree relative (mother, daughter, or sister) with ovarian cancer have about a three times higher risk of developing the disease. This risk increases when two or more first-degree relatives have been diagnosed with ovarian cancer. If you are concerned ovarian cancer may run in your family, it is important to get an accurate family history and tell your doctor about what you discover. By understanding your family history, you and your doctor can take steps to reduce your risk and be proactive about your health (see below).

Genetics. About 10% to 15% of ovarian cancers occur because a genetic mutation (change) has been passed down within a family. A mutation in the BRCA1 or BRCA2 gene is associated with an increased risk of ovarian cancer; there is also an increased risk of fallopian tube cancer and primary peritoneal (the membrane lining the abdomen) cancer, which are similar to ovarian cancer. Read more about the BRCA1 and BRCA2 genes and hereditary breast and ovarian cancer.

There are several other genetic conditions linked to an increased risk of ovarian cancer. Some of the most common include:

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

Only genetic testing can determine whether a woman has a genetic mutation. Most experts strongly recommend that women considering genetic testing first talk with a genetic counselor (an expert trained to explain the risks and benefits of genetic testing).

Breast cancer. Having a diagnosis of breast cancer increases the risk for ovarian cancer, even when the BRCA genetic mutation test is negative (see above).

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 children), have not taken birth control pills, or had their first child after the age of 30 have an increased risk of ovarian cancer. Also, women who started menstruation before age 12 and/or go through menopause later in life have an increased risk of ovarian cancer.

Hormones. Women who have taken estrogen-only hormone replacement therapy (HRT) after menopause have a higher risk of ovarian cancer.

Obesity. Recent studies have shown that women who were obese in early adulthood are 50% more likely to develop ovarian cancer. Women who are obese are also more likely to die from the disease.

Behavioral and social factors.  Homosexual or bisexual women may have a higher risk of ovarian cancer than heterosexual women. This may be because lesbian women may be less likely to give birth, take oral contraceptives, or receive preventive screenings for fear of discrimination or insensitivity. Female-to-male transgendered and transsexual people may have a higher risk of ovarian cancer because of receiving hormones.

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.

Prevention

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

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

  • Taking birth control pills. Women who took oral contraceptives for three or more years are 30% to 50% less likely to develop ovarian cancer.
  • Breastfeeding
  • Pregnancy

Women who have had a hysterectomy (the removal of the uterus and, sometimes, the cervix) or a tubal ligation (having the fallopian tubes tied surgically to prevent pregnancy) may have a lower risk of developing ovarian cancer.

Some women with a strong family history of ovarian cancer may consider a risk-reducing salpingo-oophorectomy. This is a preventive surgery to remove the fallopian tubes and ovaries, even if cancer is not diagnosed. This operation will significantly reduce, but not eliminate, the risk that a woman will develop ovarian or fallopian tube cancer. Women considering this surgery should talk with their doctor and a genetic counselor to fully understand the risks and side effects of this surgery compared with the risk of developing ovarian cancer.

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Ovarian Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Ovarian cancer was once thought to cause no symptoms. However, recent studies have shown that women with ovarian cancer are more likely to have the following symptoms or signs, even if the cancer is in an early stage. Sometimes, women with ovarian cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Abdominal bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

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

Women with ovarian cancer may also have the following symptoms:

  • Fatigue
  • Indigestion
  • Back pain
  • Pain with intercourse
  • Constipation
  • Menstrual irregularities

However, these symptoms are equally as likely to be caused by another medical condition. If you are concerned about any of these symptoms or signs, please talk with your doctor.

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This will include how long you’ve been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects 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 helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

If your doctor suspects that you might have ovarian cancer, you should see a gynecologic oncologist (a doctor who specializes in treating cancer of the female reproductive system). Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. This is often done as part of surgery for ovarian cancer. The doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

As with all cancers, early detection and treatment is important. However, early detection of ovarian cancer is difficult. Often, women don’t have any symptoms until the tumor is large or in later stages of the disease. In fact, 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.

In addition to a physical exam, the following tests may be used to diagnose ovarian cancer:

Pelvic examination. The doctor feels the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to check for any unusual changes. A Pap test, usually done with a pelvic examination,

is not likely to find or diagnose ovarian cancer using traditional methods (as is used for detection of cervix precancer and cancer). However, advances in DNA testing has provided new evidence that one day cells trapped in the cervix could be studied for changes that reflect ovarian or uterine cancers. Currently, these findings are considered experimental but are promising as a new way to find these types of cancers earlier.

Transvaginal ultrasound. An ultrasound wand is inserted in the vagina and aimed at the ovaries. An ultrasound uses sound waves to create a picture of the ovaries, including healthy tissues, cysts, and tumors. Researchers are currently 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, which is found in higher levels in women with ovarian 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 postmenopausal women. Other tumor marker tests are available such as HE4 and OVA-1, as well, and may help. evaluate women with ovarian cysts who may have ovarian cancer.

X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. While the technology of CT scanning has continued to evolve, tumors or abnormalities under about 5 mm (1/5th an inch) are difficult to see. To help, a contrast medium (a special dye) is injected into a patient’s vein or given orally (by mouth) or rectally to provide better detail.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then 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 (a procedure that 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 is used occasionally for ovarian cancer.

Biopsy. For many types of cancer, a biopsy is the removal of a small amount of tissue for examination under a microscope. A biopsy for ovarian cancer is rarely done as a separate procedure. If the doctor suspects ovarian cancer, surgery is usually recommended to remove as much of the tumor as possible (see Treatment), and a tumor sample will be analyzed afterwards. Other tests can suggest that cancer is present, but only an analysis of the tumor can make a definite diagnosis. The sample removed during surgery or biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). If the test results indicate cancer, the doctor may recommend additional tests (above) to see if the cancer has spread beyond the ovaries.

After the 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 results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. In addition, this section covers grading which describes the difference between cancerous tissue and healthy tissue. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to determine the 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 and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer and treatment recommendations may vary among these cancers despite them being of the same stage.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are four stages: stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for ovarian cancer:

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no tumor in the ovary.

T1: The tumor is limited to one or both ovaries.

T1a: The tumor is contained within one ovary. No part of the tumor has spread to the surface of the ovary, and no cancer cells are found in the abdominal fluid.

T1b: There are encapsulated (self-contained) tumors in both ovaries, but no tumor is touching an ovarian surface. No cancer cells are found in the abdominal fluid.

T1c: The tumor is in one or both ovaries, but the capsule has ruptured (burst), or the tumor has spread to the ovarian surface, or cancer cells are found in the abdominal fluid.

T2: The tumor involves one or both ovaries and has spread into the pelvis.

T2a: The tumor has grown into the uterus and/or fallopian tubes, but no cancer cells are found in the abdominal fluid.

T2b: There is cancer in other pelvic tissue, but no cancer cells are found in the abdominal fluid.

T2c: The tumor has grown into the pelvic area, such as in T2a or T2b, but cancer cells also are detected in the abdominal fluid.

T3: The tumor involves one or both ovaries and has spread microscopically (cancerous cells can be seen when tissue or fluid sample is viewed under a microscope) into the abdominal area outside the pelvis or has spread to pelvic lymph nodes.

T3a: Microscopic metastasis is in the peritoneal area (the tissue that lines the abdominal wall and covers most of the organs in the abdomen) beyond the pelvis.

T3b: Metastasis measuring 2 centimeters (cm) (a little less than one inch), or smaller is discovered outside the pelvis.

T3c: Metastasis larger than 2 cm is in areas outside the pelvis and/or the cancer has spread to the regional nodes (pelvic or paraortic) lymph nodes.

Node. The "N" in the TNM staging system stands for the lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes in the pelvis are called regional nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): No cancer was found in the regional lymph nodes.

N1: The cancer has spread to the regional nodes (pelvic or paraortic) lymph nodes. T3, T3a, and N1 are sometimes used interchangeably.

Distant metastasis. The "M" in TNM system indicates whether the cancer has spread to other parts of the body.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): There is no cancer beyond the peritoneal area.

M1: The cancer has spread beyond the peritoneal area.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage I: This stage describes cancer that is located only in the ovaries (T1, N0, M0).

Stage IA: The cancer is encapsulated and is located in only one ovary with no spread to pelvic lymph nodes or other parts of the body (T1a, N0, M0).

Stage IB: The cancer is encapsulated and is located in both ovaries with no spread to pelvic lymph nodes or other parts of the body (T1b, N0, M0).

Stage IC: The cancer is in one or both ovaries with either a ruptured capsule or tumor spread to the ovarian surface or cancerous cells in the abdominal fluid (T1c, N0, M0).

Stage II: The cancer is in one or both ovaries and has grown into the pelvis (T2, N0, M0).

Stage IIA: The cancer has grown into the uterus or fallopian tubes, but not to the pelvic lymph nodes or distant organs (T2a, N0, M0).

Stage IIB: The cancer has spread to other pelvic tissue, but not to lymph nodes or distant organs (T2b, N0, M0).

Stage IIC: The cancer has spread into the pelvic area and is shedding cancer cells into the abdominal fluid (T2c, N0, M0).

Stage III: The cancer is located in one or both ovaries and the pelvis and has spread into the peritoneum (T3, N0, M0).

Stage IIIA: The cancer has spread microscopically throughout the pelvis (T3, N0, M0).

Stage IIIB: The cancer has spread into the peritoneal area with areas of tumor growth that are 2 cm or smaller (T3b, N0, M0).

Stage IIIC: This stage describes any cancer that has spread into the peritoneal area with areas of tumor growth larger than 2 cm (T3c, N0, M0). Or, the cancer has spread to the lymph nodes in the retroperitoneal or inguinal areas (any T, N1, M0).

Stage IV: This stage describes any cancer that has spread to distant organs (any T, any N, M1).

Recurrent cancer and retreatment staging. Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer will be revaluated (see Diagnosis) and there may be more biopsies. Ovarian cancer reassessments usually include diagnostic imaging (such as CT scan, PET/CT scan, MRI, or ultrasound) and blood work (such as CA-125). Occasionally, it may include surgery, such as laparoscopy, in which a doctor inserts a thin, lighted, scope to look inside the peritoneal area to check for recurrent disease. The goal of these procedures is to establish a diagnosis and to start treatment planning for recurrent disease care. See the Treatment Options section for more about the treatment of recurrent ovarian cancer.

Grade

In addition to the TNM system, an ovarian tumor can also be described by grade (G), which is how similar the tumor tissue is to normal tissue. Tumor grade is determined by examining the tumor tissue under a microscope. Cells that appear healthy are called well-differentiated. In general, the more differentiated the ovarian tumor, the better the prognosis.

However, a specific type of epithelial ovarian cancer called serous ovarian cancer is not graded this way and only considers a Low-grade and a High-grade classification, which is not necessarily the same as G1 and G2-3. They are specific histologies that also have a different biology and natural history.

GX: The grade cannot be evaluated.

GB: The tissue is considered borderline cancerous. This is commonly called low malignant potential (LMP).

G1: The tissue is well-differentiated (contains many healthy-looking cells).

G2: The tissue is moderately differentiated (more cells appear abnormal than healthy).

G3 to G4: The tissue is poorly differentiated or undifferentiated (all or most cells appear abnormal).

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the 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.

Ovarian cancer is treated with one or a combination of treatments, most commonly surgery and chemotherapy. Each treatment option is described below, followed by an outline of the treatments based on the stage of the disease. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, the patient’s preferences and overall health, and personal considerations, such as the woman's age and if she is planning to have children. Women with ovarian cancer may have concerns about if or how their treatment may affect their sexual function and fertility, and these topics should be discussed with the health care team before treatment begins.

Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, 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.

Surgery

Surgery is usually the main treatment for ovarian cancer. A gynecologic oncologist is a doctor that specializes in gynecological cancer surgery (including ovarian cancer) and chemotherapy.

As mentioned in Diagnosis, surgery is often needed to find out the complete extent of disease. The goal is to provide an accurate stage, because in up to 30% of women with apparently early disease (after imaging tests) there is actually spread to other organs.

To determine whether the cancer has spread, the surgeon will remove lymph nodes, tissue samples, and fluid from the abdomen for testing. If, during the surgery, it is clear that the cancer has spread, the surgeon removes as much of the cancer as possible in order to reduce the amount of cancer that will need more treatment with chemotherapy or radiation therapy.

There are several surgical options for ovarian cancer, sometimes done 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 tumor, surgery often only needs to remove only the ovary with the tumor, which preserves the woman’s ability to bear children.

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.

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 later-stage ovarian 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. It is felt such a procedure can reduce a person’s symptoms and can help increase the effectiveness of treatment, such as chemotherapy, given after surgery to control the disease that remains. Debulking surgery should be performed by an experienced gynecologic oncologist. Talk with your doctor before surgery about the risks and benefits of this procedure and ask about the surgeon’s experience with debulking surgery for ovarian cancer.

Side effects of ovarian cancer surgery

Surgery causes short-term pain and tenderness. If a patient is experiencing pain, the doctor will prescribe an appropriate medication. For several days after the operation, the patient may have difficulty emptying her 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. Learn more about the basics of cancer surgery

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 both ovaries are removed, a woman can no longer bear children. The loss of both ovaries also eliminates the body's source of sex hormones, resulting in premature menopause. Soon after surgery, the patient is likely to have menopausal symptoms, including hot flashes and vaginal dryness. Women are encouraged to talk with their doctors about sexual and reproductive health concerns and coping with gynecologic surgery, including ways to address these concerns before and after cancer treatment

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a gynecological oncologist or a medical oncologist. 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.

For ovarian cancer, chemotherapy depends on the goal of treatment:

Neoadjuvant chemotherapy: to reduce the size of the tumor before surgery. It will usually follow a biopsy so the doctors can determine the tumor’s site of origin. This type of chemotherapy is usually given for 3 to 4 cycles before considering surgery (called interval surgery).

Adjuvant chemotherapy: to destroy cancer remaining after surgery.

Maintenance chemotherapy: to slow a tumor’s growth and/or reduce the risk of its recurrence.

Recurrence chemotherapy: to treat the cancer if it comes back

Palliative chemotherapy: to reduce side effects from the disease, improving the patient’s comfort and quality of life. (see below, Getting care for symptoms.)

There are different ways to give chemotherapy to a patient. Although chemotherapy can be given orally (by mouth), most drugs used to treat ovarian cancer are given intravenously (IV) or intraperitoneally (IP). IV chemotherapy is either injected directly into a vein or through a catheter, a thin tube temporarily put into a large vein to make injections easier. IP chemotherapy is when a catheter is placed in the abdomen to deliver chemotherapy directly into the pelvic area. IP chemotherapy is used as a treatment for women with later-stage cancer and women with cancer remaining after surgery.

Several clinical trials have shown a significant benefit for combining IP and IV chemotherapy for patients with later-stage ovarian cancer. The National Cancer Institute recommends that women with later-stage ovarian cancer be offered this treatment option.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. In addition, possible side effects of chemotherapy include difficulty with cognitive (brain) functions (such as issues with attention span or memory) or neuropathy (a disorder where nerves are damaged causing numbness or pain). Other possible side effects include both the inability to become pregnant and premature menopause. Rarely, certain drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection. Before treatment begins, patients are encouraged to talk with their oncologist about possible short-term and long-term side effects of the specific drugs being given.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. 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 uncommon as a first treatment for ovarian cancer, but it can an option for treating recurrent ovarian cancer, especially when confined to a small area.

Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy is given either by delivering a small amount of radioactive material directly to the tumor or by injecting radioactive liquid directly into the abdomen through a catheter (called intraperitoneal or IP radiation therapy). External-beam radiation therapy is radiation given from a machine outside the body. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy depend on the dose and the area of the body being treated, but may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away soon after treatment is finished.

Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.

Learn more about 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. See more about treatment options for recurrent ovarian cancer, below.

Treatment options by stage

Stage I

  • Surgery
  • Surgery and chemotherapy

Stage II

  • Surgery
  • Chemotherapy

Stages III & IV

  • Surgery and chemotherapy (either IV or IP or both combined)
  • Chemotherapy

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, and it includes supporting the patient with her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

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

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

Recurrent ovarian cancer

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

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious 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 cancer, as many women experience at least one recurrence. Understanding the 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 cycle of testing will begin again to learn 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 therapies described above (such as surgery and chemotherapy) but they may be used in a different combination or given at a different pace. In addition, radiation therapy is used more commonly when there is a recurrence of ovarian cancer. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

The symptoms of recurrent ovarian 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 intercourse; fatigue; and lower back pain.

In addition to monitoring symptoms, doctors can also watch for ovarian cancer recurrence by measuring the level of CA-125 in the blood. As outlined in Diagnosis, CA-125 is a cancer antigen, or a substance that is found in higher levels on the surface of ovarian cancer cells. Most (95%) women who have a rise in CA-125 show a recurrence.

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.

Metastatic ovarian cancer

If ovarian cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

New treatments for ovarian cancer include experimental combinations of chemotherapy and new biologic agents, also called immunotherapy, which are designed to boost the body’s natural defenses to fight the cancer (see Latest Research). Since the benefits of these options remain unproven, their risks must be carefully weighed against possible improvements in symptoms and survival. Supportive care will also 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 also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from ovarian cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this 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, and 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 six 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 bereavement.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Ovarian Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

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. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat women with ovarian cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.  

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (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 are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

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 the only way to make progress in treating ovarian cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with ovarian cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. 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.

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 also list all of the risks of the new treatment, which may or may not be different than 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.

For specific topics being studied for ovarian cancer, learn more in the Latest Research section.

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 also 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.

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.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about ovarian cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Screening. A screening method that estimates a woman’s risk of ovarian cancer by using her age and the results of a yearly CA-125 blood test holds promise for detecting early-stage ovarian cancer. As explained in Diagnosis, CA-125 is a substance called a tumor marker that is found in higher levels in women with ovarian cancer.

In September 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. However, women at high risk for ovarian cancer due to family history or BRCA mutation carriers (see Risk Factors) are recommended to have screening with CA-125 blood tests and transvaginal ultrasound.  

Risk reduction. Doctors are studying whether vitamins A and D and drugs that stop inflammation, such as COX-2 inhibitors, may reduce a woman's risk of developing ovarian cancer.

Preventive surgery. Current clinical trials are looking at surgery to remove the fallopian tubes and/or ovaries before disease starts (called prophylatic surgery) as a way to reduce a woman’s risk of ovarian cancer.

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. Although no targeted therapies are approved by the U.S. Food and Drug Administration (FDA) for ovarian cancer, there are several including bevacizumab (Avastin) and olaparib (AZD-2281) that have some documented significant clinical activity, alone or in combination with other drugs. Many new targeted treatments are also 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 targeted therapy.

Immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the 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 immunotherapy drugs, such as interferon, may boost the immune system's ability to kill cancer cells. Cancer vaccines are another type of immunotherapy currently being tested for ovarian cancer. Other immunotherapies are being developed to target specific immune cells that may

be helping cancer cells survive. Learn more about immunotherapy.

Hormone therapy. Research is underway about the role of estrogen and other hormones in ovarian cancer treatment, including the use of tamoxifen and aromatase inhibitors in the treatment of recurrent or later-stage ovarian cancer.

Gene therapy. One promising 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.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current ovarian cancer treatments, in order to improve a woman’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, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for ovarian cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with ovarian cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Ovarian Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for ovarian cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical and pelvic examinations and/or medical tests to monitor your recovery for the coming months and years. Although there are no specific guidelines for follow-up care for women treated for ovarian cancer, many doctors recommend a pelvic examination every two to four months for the first two years after treatment, and every six months for the following three years. Other tests may include a chest x-ray, CT scan, urine tests, 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, and 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, or 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.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

Women recovering from ovarian cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended screening tests for other cancers. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

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. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make 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 also 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.

  • What type of ovarian cancer do I have?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage and grade of my cancer? What does this mean?
  • What are my treatment options?
  • What clinical trials are open to me?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • 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 goals of each treatment?
  • What type of surgery will be performed?
  • What are the possible side effects of treatment, both in the short term and the long term?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What are the chances the cancer will recur?
  • What does it mean to say ovarian cancer is a “chronic disease”?
  • How can I keep myself as healthy as possible during treatment?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Should other women in my family be tested regularly for ovarian cancer?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Ovarian Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2013

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. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and 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. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Ovarian Cancer. Use the menu on the side of your screen to select another section, to continue reading this guide.