Ovarian CancerLast Updated: January 21, 2009 This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/08 Overview
Ovarian cancer begins in a woman's ovaries. The ovaries are the glands containing the germ cells or eggs. They are part of a woman's reproductive system and every woman has two ovaries, 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 women'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. Ovarian cancer begins when normal cells in an ovary begin to change, grow without control, and no longer die, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it could 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. Ovarian cysts are not cancerous. There are three types of ovarian cancer: Epithelial carcinoma. Epithelial carcinoma makes up 85% to 90% of ovarian cancers. This type of cancer begins in cells on the outer surface of the ovary. Germ cell tumor. This uncommon type of ovarian cancer develops in the egg-producing cells of the ovaries. Stromal tumor. This rare form of ovarian cancer develops in the connective tissue cells that hold the ovaries together and produce female hormones. Statistics In 2009, an estimated 21,550 women in the United States will be diagnosed with ovarian cancer. It is estimated that 14,600 deaths from this disease will occur this year. Ovarian cancer accounts for nearly 3% of all cancers among women. It is the ninth most common cancer and fifth most common cause of cancer death in women. The one-year relative survival rate (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 five-year relative survival rate (percentage of women who survive at least five years after the cancer is detected, excluding those who die from other diseases) is 46%. If the cancer is diagnosed and treated before it has spread outside the ovaries, the five-year survival rate is 93%. If the cancer has spread to the surrounding organs or tissue (local spread), the five-year relative survival rate is 71%. If the cancer has spread to parts of the body far away from the ovary (distant spread), the five-year relative survival rate is 31%. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of 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. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2009. Find out more about basic cancer terms used in this section. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to 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. 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 (68% of women with ovarian cancer are older than 55 and 32% are younger than 55). Family history. Ovarian cancer risk increases for women who have a first-degree relative (mother, daughter, sister) who has had ovarian cancer. The risk increases when two or more first-degree relatives have had the disease. Genetics. A mutation in the BRCA1 or BRCA2 gene is associated with 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. For more information on BRCA1 and BRCA2, read Cancer.Net’s Guide to Hereditary Breast and Ovarian Cancer. Women with hereditary non-polyposis colorectal cancer (HNPCC) also have an increased risk of developing ovarian cancer. Learn more about The Genetics of Ovarian Cancer. 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. Fertility treatment drugs may also be associated with a higher risk of developing 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. Prevention Research has shown that certain factors may reduce a woman's risk of developing ovarian cancer:
Women who have had a hysterectomy (the removal of the uterus and, in some cases, 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 strong family histories 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 often, but not always, protects a woman from developing the disease. 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. Symptoms
Ovarian cancer was thought to cause no symptoms. However, recent studies have shown that woman with ovarian cancer are more likely to have the following symptoms, 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.
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 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:
However, these symptoms are equally as likely to be caused by another medical condition. If you are concerned about any of these symptoms, please talk with your doctor. Diagnosis
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 reproductive system). Doctors use many tests to diagnose cancer and determine 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. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
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 later stages of the disease. In fact, 70% of 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, cannot find or diagnose ovarian cancer. 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 evaluating whether this test can help with early detection of ovarian cancer. CA-125 assay. This blood test measures a substance called CA-125, a tumor marker, which is found in higher levels in women with ovarian cancer and other conditions, including endometriosis and pelvic inflammatory disease. This test is more accurate in postmenopausal women. Biopsy. 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, the patient will most likely receive surgery (see Treatment) to remove as much of the tumor as possible, 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). The doctor may recommend additional tests to see if the cancer has spread beyond the ovaries. Lower gastrointestinal (GI) series. This is a series of x-rays of the colon and rectum taken after the patient has a barium enema. The barium highlights the colon and rectum on the x-ray, making it easier to identify a tumor or abnormal area in those organs. 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. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein 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 and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can show if the cancer has spread to the lungs. To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed. Staging With Illustrations
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in 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. One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. 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. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of 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 present 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 present in areas outside the pelvis and/or the cancer has spread to the pelvic 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 pelvic 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 present in one or both ovaries with either a ruptured capsule or tumor spread to the ovarian surface or malignant cells in the abdominal fluid (T1c, N0, M0).
Larger image Stage IIA: The cancer has extended to 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 involves 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 extensions that are 2 cm or smaller (T3b, N0, M0).
Stage IIIC: This stage describes any cancer that has spread into the peritoneal area in extensions larger than 2 cm (T3c, N0, M0). Or, the cancer has spread to the lymph nodes and/or pelvis but not to other parts of the body (any T, N1, M0).
Stage IV: This stage describes any cancer that has spread to distant organs (any T, any N, M1).
Recurrent: Recurrent cancer is cancer that comes back after treatment. Retreatment staging. Ovarian cancer treatment may include second-look surgeries, in which a doctor either performs another surgery to check for recurrent cancer or uses a laparoscope (a thin, lighted, flexible tube that can be inserted into an incision in the body) to look inside the peritoneal area to check for recurrent disease. Other procedures used for retreatment staging include imaging techniques, such as an ultrasound and CT scan. Grade An ovarian tumor can also be described by grade (G), which is how similar the tumor 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. GX: The grade cannot be evaluated. GB: The tissue is considered borderline cancerous. 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, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com. Treatment
The treatment of ovarian cancer depends on the size and location of the tumor, whether the cancer has spread, the woman's overall health, and personal considerations, such as the woman's age and if she is planning to have children. In many cases, a team of doctors will work with the woman to determine the best treatment plan. 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. This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section. Ovarian cancer is treated with one or a combination of treatments, including surgery, chemotherapy, and radiation therapy. Each treatment option is described below, followed by an outline of the treatments based on the stage of the disease. Surgery Surgery is often the first treatment used for ovarian cancer. Usually, a bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes) and hysterectomy are performed. The surgeon may also remove the omentum, the thin tissue covering the stomach and large intestine. To determine whether the cancer has spread, the surgeon will often also remove lymph nodes, tissue samples, and fluid from the abdomen. 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 fallopian tube if the cancer is located in only one ovary. If, during the surgery, it is clear that the cancer has spread, the surgeon removes as much of the cancer as possible. This may reduce the amount of cancer that will require further treatment with chemotherapy or radiation therapy. 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. Studies have shown that women who have their surgeries performed by gynecologic oncologists 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 experience menopausal symptoms, including hot flashes and vaginal dryness. Women should talk with their doctors before and after surgery about ways to cope with these side effects. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects. 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. Several clinical trials have shown a significant benefit for combining IP and IV chemotherapy for patients with advanced ovarian cancer. The National Cancer Institute recommends that women with later-stage ovarian cancer be offered this option of treatment. The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. Other potential 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. After chemotherapy is completed, a second surgery may be performed to examine the abdomen and remove fluid and tissue samples to determine if any cancer cells remain. 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 through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. 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 radiation therapy). Radiation treatment is not usually used to treat ovarian cancer, but it may be used to relieve side effects. 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. For more information about radiation therapy, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers. Treatment options by stage Stage I
Stage II
Stage III & IV
Recurrent ovarian cancer If ovarian cancer recurs, the symptoms are similar to those experienced when the disease was first diagnosed. The four of the most common symptoms are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, urinary symptoms (urgency or frequency). However, other symptoms may include:
Treatment for advanced cancer and recurrent disease If standard treatment is not effective, the doctor may recommend options including "second-line" chemotherapy drugs and radiation therapy to help relieve side effects. New therapies for ovarian cancer include experimental combinations of chemotherapy and new biologic agents, which are designed to boost the body’s natural defenses to fight the cancer. Since the benefits of these options remain unproven, their risks must be carefully weighed against possible improvements in symptoms and survival. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment. Clinical Trials Resources Doctors and scientists are always looking for better ways to treat patients with ovarian cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are 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. 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 finding new drugs and other therapies is 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. To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so 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. Learn more about Clinical Trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. Clinical Trials Resources
Doctors and scientists are always looking for better ways to treat patients with ovarian cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are 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. 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 finding new drugs and other therapies is 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. To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with your doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’ s section on Managing Side Effects. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient. For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor. After Treatment
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, urinalysis, and blood tests, such as a CA-125 test. Women treated for ovarian cancer may be at increased risk for breast 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, blurred vision, dizziness, coughing, hoarseness, headaches, backaches, 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 other medical conditions. 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 Healthy Living After Cancer. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: After Treatment. Current Research
Research for ovarian cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor. 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. Targeted therapy. Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development. Learn more about targeted therapy. 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. Immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made 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. Questions to Ask the Doctor
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
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