Ovarian CancerLast Updated: October 04, 2011 This section has been reviewed and approved by the Cancer.Net Editorial Board, 01/11 Overview
About the ovaries 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. 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. 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. 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. Find out more about basic cancer terms used in this section. Looking for More of an Overview? If you would like additional introductory information, explore these related items on Cancer.Net:
Or, choose “Next” (below, right) to continue reading this detailed section. To select a specific topic within this section, use the icon panel located on the right side of your screen. Statistics
This year, an estimated 21,990 women in the United States will be diagnosed with ovarian cancer. It is estimated that 15,460 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-related death in women. The one-year 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 survival rate is 46%. If the cancer is diagnosed and treated before it has spread outside the ovaries, the five-year survival rate is 94%. If the cancer has spread to the surrounding organs or tissue (regional spread), the five-year survival rate is 73%. If the cancer has spread to parts of the body far away from the ovary (distant spread), the five-year survival rate is 28%. 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 2011. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person's chance of developing cancer. 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 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 (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 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 BRCA1 and BRCA2 and hereditary breast and ovarian cancer. Women with Lynch syndrome 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. 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, 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 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 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. Symptoms and Signs
Ovarian cancer was once thought to cause no symptoms. However, recent studies have shown that woman 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.
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 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. 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 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. 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. Woman younger than 50 with conditions such as endometriosis, pelvic inflammatory disease, and uterine fibroids may have an increased CA-125 level. 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. 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. 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. 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. Learn more about what to expect when having common tests, procedures, and scans. After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging. Learn more about the first steps to take after a diagnosis of cancer. Staging With Illustrations
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether 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 judges three factors: 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:
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 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 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 comes back after treatment. If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above. 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 (see Diagnosis). Grade In addition to the TNM system, 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, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net. Treatment
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 standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current 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, 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. 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. Learn more about making treatment decisions. Surgery Surgery is the removal of the tumor and surrounding tissue during an operation. Surgery is often the first treatment used for ovarian cancer. A gynecologic oncologist is a doctor who specializes in using surgery to treat cancer in a woman’s reproductive organs. 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. For women with a germ cell tumor, surgery is most often needed to remove only the ovary with the tumor, which preserves the woman’s ability to bear children. 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 need more 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 have menopausal symptoms, including hot flashes and vaginal dryness. Women are encouraged to talk with their doctors about sexual and reproductive health concerns and ways to address them before and after cancer treatment. Learn more about cancer surgery. 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 medical oncologist, a doctor who specializes in treating cancer with medication. 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. 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. IP chemotherapy is used as a treatment for women with advanced 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 advanced 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, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. 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. 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. 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 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. 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 or IP radiation therapy). A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. 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. 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. Treatment options by stage Stage I
Stage II
Stages III & IV
Recurrent ovarian cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. 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, chemotherapy, and radiation therapy) but may be used in a different combination or given at a different pace. 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 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 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. Doctors can also monitor ovarian cancer recurrence by measuring the level of CA-125 in the blood. CA-125 is a cancer antigen, or a substance that is found in higher levels on the surface of ovarian cancer cells. 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. Since the benefits of these options remain unproven, their risks must be carefully weighed against possible improvements in symptoms and survival. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. 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. Learn more about advanced cancer care planning. Find out more about common terms used during cancer treatment. About Clinical Trials
Doctors and scientists are always looking for better ways to treat women with ovarian cancer. To make scientific advances, doctors create research studies involving people, 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. 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. For specific topics being studied for ovarian cancer, learn more in the Current 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. 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 trials ends, and/or if the patient chooses to leave the clinical trial before it ends. 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 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 your overall health. Common side effects for each treatment option are described in detail within the Treatment section. 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. Also, be sure to communicate with your doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor 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. For many patients, a diagnosis of ovarian cancer is stressful and can bring difficult emotions. 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 medical care. A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking 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 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, 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 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. Find out more about common terms used after cancer treatment is complete. Current Research
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. CA-125 is a substance called a tumor marker that is found in higher levels in women with ovarian cancer. 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 the cancer’s 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. Learn more about immunotherapy. 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 patients’ comfort and quality of life. Learn more about common statistical terms used in cancer research. Looking for More about Current Research? If you would like additional information about the latest areas of research regarding ovarian cancer, explore these related items:
Or, choose “Next” (below, right) to continue reading this detailed section. Questions to Ask the Doctor
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.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
