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Ovarian, Fallopian Tube, and Peritoneal Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 04/2019

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

About the ovaries

The ovaries are part of a woman’s reproductive system. There are 2 ovaries, with 1 located on each side of the uterus. In premenopausal women, they are almond-shaped and about 1.5 inches long. These glands contain germ cells, also called eggs. Ovaries are the primary source of estrogen and progesterone. These hormones influence breast growth, body shape, body hair, and regulate the menstrual cycle and pregnancy. During and after menopause, the ovaries stop releasing eggs and producing certain hormones.

About the fallopian tubes

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

About the peritoneum

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

About ovarian, fallopian tube, and peritoneal cancers

In general, the term “ovarian cancer”' is often used to describe cancers that begin in the cells in the ovary, fallopian tube, or peritoneum. The cancers are closely related and are generally treated the same way. In this guide, this group of diseases is referred to as “ovarian/fallopian tube cancer” because peritoneal cancer is relatively rare. When the term “ovarian cancer” is used, it includes both fallopian tube and peritoneal cancers, because it may be unclear where the cancer started.

These types of cancer begin when healthy cells in these areas change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

An ovarian cyst is an abnormal growth of tissue that forms on the surface of the ovary. It can occur during a woman’s normal menstrual cycle and usually goes away without treatment. Simple ovarian cysts are not cancerous.

Recent research studies suggest that most ovarian/fallopian tube cancers are high-grade serous cancers (HGSC), and in most cases, the cancer actually starts in the distal, or outer, end of the fallopian tubes and then spreads to the surface of the ovaries and beyond. Based on this new knowledge, some doctors recommend removal of the fallopian tubes rather than tying or banding the tubes for the purposes of contraception, or when a women is undergoing surgery for benign disease and does not want to get pregnant in the future. This strategy could prevent the development of these cancers in the future.

Because the surfaces of the ovaries, the lining of the fallopian tubes, and the covering cells of the peritoneum are made up of the same types of cells, most of these diseases look alike under a microscope. Peritoneal cancer can still develop after ovaries and fallopian tubes have been removed. Just as with ovarian cancer, some peritoneal cancers may begin in the fallopian tube and spread from the end of the fallopian tubes into the peritoneal cavity.

Types of ovarian and fallopian tube cancer

  • Epithelial carcinoma. Epithelial carcinoma makes up 85% to 90% of ovarian/fallopian tube cancers. The main types of epithelial tumors include serous, endometrioid, clear cell, mucinous, mixed tumors, and several rare malignancies, including Brenner tumors. These types describe how these different ovarian/fallopian tube cancers are classified based on how they look under the microscope. There can be differences in how these cancers behave and which treatments will work best.

    The vast majority of epithelial cancers are serous, meaning they resemble the cells lining the fallopian tube. These cancers are either HGSC (see above) or low-grade serous carcinoma (LGSC). HGSCs make up the vast majority of ovarian/fallopian tube cancer, most of which arise from the fallopian tube. LGSC is less uncommon and may arise from the ovaries.

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

    Types of germ cell tumors include dysgerminomas, immature teratoma, endodermal sinus tumors (called EST and yolk sac tumors), and embryonal carcinomas.

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

    Granulosa cell tumors may secrete estrogen, resulting in unusual vaginal bleeding at the time of diagnosis. Other types are Sertoli-Leydig cell tumors and steroid cell tumors.

  • Fallopian tube cancer. This cancer was once thought to be rare, but we now know that most cancers previously labeled “ovarian cancer” actually begin in a fallopian tube. Most cancers arising in the fallopian tube begin in the outer end of the tube, near the fimbria, which is where the opening of the tube is located and where eggs released from the ovary must enter in order to be fertilized. Virtually all of these are serous cancers, and most are HGSC, although in rare cases, other types of cancer can start in the fallopian tube.

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The next section in this guide is Statistics. It helps explain the number of women who are diagnosed with ovarian, fallopian tube, and peritoneal cancer and the general survival rates. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 04/2019

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

This year, an estimated 22,530 women in the United States will be diagnosed with ovarian cancer, and the vast majority of these are high-grade serous ovarian cancers (HGSC), which begin in a fallopian tube. Ovarian cancer accounts for 2.5% of cancers in women and 5% of deaths from cancer. That is because many women are diagnosed when the disease is at an advanced, less curable stage.

Older women and white women have the highest risk of the disease. About half of women diagnosed with ovarian and fallopian tube cancer are 63 or older.

It is estimated that 13,980 deaths from these diseases will occur this year. Combined, cancer of the ovaries, fallopian tubes, and peritoneum are the fifth most common cause of cancer-related death in women in the United States. However, the death rate declined by 2% each year from 2007 to 2016.

The 5-year survival rate tells you what percent of women live at least 5 years after cancer is found. Percent means how many out of 100. The 5-year survival rate for women with all types of ovarian, fallopian tube, and peritoneal cancers is 47%.

However, the rate varies widely depending on age and race/ethnicity of the woman, as well as the stage, cell type, and grade of the cancer. The 5-year survival rate for women younger than 65 is 60%, compared with 30% for those 65 and older. The survival rates for black women of the same ages are lower. Black women younger than 65 have a 51% survival rate, while those 65 and older have a 22% survival rate.

If ovarian and fallopian tube cancers are diagnosed and treated before they spread outside the ovaries and tubes, the general 5-year survival rate is about 92%. Approximately 15% of women with epithelial ovarian and fallopian tube cancer are diagnosed at this stage. If the cancer has spread to surrounding tissues or organs, the 5-year survival rate is 75%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 29%.

It is important to remember that statistics on the survival rates for women with ovarian, fallopian tube, and peritoneal cancer are an estimate. The estimate comes from annual data based on the number of women with these cancers in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publications, Cancer Facts & Figures 2019 and Cancer Facts & Figures 2018: Special Section—Ovarian Cancer, and the ACS website (January 2019).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by ovarian, fallopian tube, and peritoneal cancer. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 04/2019

ON THIS PAGE: You will find a drawing of the main body parts affected by ovarian, fallopian tube, and peritoneal cancer. Use the menu to see other pages.

Women's Cancers Anatomy

This illustration shows a frontal and sagittal (side) view of a woman’s reproductive system. The frontal section shows the fallopian tubes, 2 small ducts that link the 2 ovaries (1 on each side) to the hollow, pear-shaped uterus. The lower, narrow part of the uterus is called the cervix, which leads to the vagina. The uterus is located in the pelvis, between the bladder and rectum, and the vagina is located behind the urethra, which connects to the bladder. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and PreventionIt explains the factors that may increase the chance of developing ovarian, fallopian tube, and peritoneal cancer. Use the menu to choose another section to read in this guide.

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

Approved by the Cancer.Net Editorial Board, 04/2019

ON THIS PAGE: You will find out more about the factors that increase the chance of developing ovarian, fallopian tube, and peritoneal cancer. Use the menu to see other pages.

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

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

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

  • Genetics. About 10% to 15% of ovarian/fallopian tube cancers occur because a genetic mutation, or change, has been passed down within a family. All women with ovarian/fallopian tube cancer who are younger than 70 should receive genetic testing for the BRCA1 and BRCA2 mutation, regardless of whether there is a family history of ovarian or breast cancer. Women may also want to be tested for the genes related to Lynch syndrome (see below) and other cancer risk genes, based on their type of ovarian/fallopian tube cancer.

    A mutation in the BRCA1 or BRCA2 gene is associated with an increased risk of developing these cancers. A woman with an "average risk" has only a 1% to 2% lifetime risk of developing ovarian/fallopian tube cancer. A woman with a BRCA1 mutation has around a 40% lifetime risk, and a woman with a BRCA2 mutation has about a 10% to 20% lifetime risk. While less common, BRCA-related ovarian/fallopian tube cancers can occur in women who do not have a family history of either breast or ovarian/fallopian tube cancer. About 40% of women with ovarian/fallopian tube cancer who are found to have a BRCA mutation do not have a family history. Because of this, genetic testing for other family members may be recommended if a person has a BRCA mutation, because these cancers can be inherited. Read more about the BRCA1 and BRCA2 genes in this website’s section on hereditary breast and ovarian cancer.

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

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

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

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

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

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

  • Age. A woman’s risk of developing ovarian/fallopian tube cancer increases with age. Women of all ages have a risk of these cancers, but women over 50 are more likely to develop these cancers. About half of the women diagnosed with ovarian/fallopian tube cancer are 63 years or older.

  • Weight. Recent studies show that women who were obese in early adulthood may have an increased risk to develop ovarian/fallopian tube cancer. Women who are obese are more likely to die from any condition, including ovarian/fallopian tube cancer.

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

  • Ethnicity. Women of North American, Northern European, or Ashkenazi Jewish heritage have an increased risk of ovarian cancer. People of some of these ethnicities have higher risks of BRCA mutations.

  • Reproductive history. Women who started menstruating early in life, have never given birth to a child, have unexplained infertility (the inability to have a child), have not taken birth control pills, or who entered menopause later may have an increased risk of ovarian/fallopian tube cancer.

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

Fertility drugs were once thought to increase the risk of ovarian/fallopian tube cancer. It has been shown that they do not increase the risk.

Prevention

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

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

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

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

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

  • Surgical procedures. Women who have had a hysterectomy or a tubal ligation may have a lower risk of developing ovarian/fallopian tube cancer. A hysterectomy is the removal of the uterus and, sometimes, the cervix. Tubal ligation is having the fallopian tubes “tied” or closed surgically to prevent pregnancy. Doctors recommend a bilateral salpingo-oophorectomy, which is the removal of both ovaries and fallopian tubes, for women with a high risk of ovarian/fallopian tube cancer. After a woman has given birth to all of the children she intends to have, she may choose to have her fallopian tubes removed at the time of abdominal surgery for other purposes or during a caesarean section, also called a c-section.

    For women with high-risk genetic mutations such as BRCA1, BRCA2, and the genes related to Lynch syndrome, having the ovaries and fallopian tubes removed after having children is recommended to prevent ovarian/fallopian tube cancers as well as possibly reduce the risk of breast cancer. This can reduce ovarian/fallopian tube cancer risk by as much as 96%. If performed before menopause occurs naturally, there may be a 40% to 70% reduction in the risk of developing breast cancer, particularly in women with BRCA2 mutations.

    It is very important for women who are considering preventive surgery to talk with their doctors and genetic counselors so they can understand the risks and side effects of the surgery compared to their personal risk of developing ovarian/fallopian tube cancer.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems ovarian, fallopian tube, and peritoneal cancer can cause. Use the menu to choose a different section to read in this guide.

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

Approved by the Cancer.Net Editorial Board, 04/2019

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

Ovarian/fallopian tube cancer can be hard to find in its earliest stages. That’s because the symptoms are often vague until these diseases are advanced. They have the same symptoms.

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

Symptoms for ovarian/fallopian tube cancer may include:

  • Abdominal bloating

  • Pelvic or abdominal pain

  • Difficulty eating or feeling full quickly

  • Urinary symptoms, such as urgency or frequency

  • Fatigue

  • Upset stomach

  • Indigestion

  • Back pain

  • Pain with intercourse

  • Constipation

  • Menstrual irregularities

  • Swelling in the pelvis or abdomen

  • Vaginal discharge, which may be clear, white, or tinged with blood

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

Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If the doctor diagnoses cancer, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the symptoms you experience, including any new symptoms or a change in symptoms.

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

Ovarian, Fallopian Tube, and Peritoneal Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 04/2019

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

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

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

Doing laboratory testing of the ovarian and fallopian tube tissues is the only sure way for the doctor to know if an area of the body has cancer. In most cases, this requires surgical removal of these organs.

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

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

While early detection and treatment is important, this is often not possible for ovarian/fallopian tube cancer. There are no effective screening methods for ovarian/fallopian tube cancer. Often, women do not have any symptoms until the tumor is large or in later stages of the disease. About 70% of epithelial ovarian/fallopian tube cancers, particularly high-grade serous cancers, are not found until the disease is in an advanced stage and has spread to other parts of the body, most commonly the abdomen.

The following tests may be used to diagnose ovarian/fallopian tube cancer:

  • Abdominal-pelvic examination. Usually, the first exam is the abdominal-pelvic examination. The doctor feels the uterus, vagina, ovaries, bladder, and rectum to check for any unusual changes, such as a mass. Some cancers are very small before they spread and cannot be reliably felt and detected by pelvic examination. A Pap test, usually done with a pelvic examination, is not likely to find or diagnose these cancers because that test is used to find cervical cancer.

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

  • Blood tests/CA-125 assay. There is a blood test that measures a substance called CA-125, a tumor marker. This marker is found in higher levels in women with ovarian/fallopian tube cancer. Woman younger than 50 with conditions such as endometriosis, pelvic inflammatory disease, and uterine fibroids may also have an increased CA-125 level. This test is more accurate in women who have experienced menopause. Other tumor marker tests, such as HE4, are available, but none of these markers have been found to be effective for the early detection of these cancers.

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

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

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

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

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

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

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

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

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

Approved by the Cancer.Net Editorial Board, 04/2019

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

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

Doctors use diagnostic tests to find out a cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best. Knowing the stage can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. For ovarian/fallopian tube cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique or FIGO) is used.

FIGO stages for ovarian, fallopian tube, and peritoneal cancer

The stage provides a common way of describing the cancer, enabling doctors to work together to plan the best treatments. Doctors assign the stage of cancer using the FIGO system.

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

  • Stage IA: The cancer is only inside 1 ovary or fallopian tube. No cancer is found on the ovarian or fallopian tube surface or in the abdomen.

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

  • Stage IC: The cancer is in 1 or both ovaries or fallopian tubes, with any of the following:

    • Stage IC1: The tumor ruptures while it is being removed surgically, called intraoperative surgical spill.

    • Stage IC2: The tumor wall is ruptured before surgery, or there is cancer on the surface of the ovary or fallopian tube

    • Stage IC3: Cancer cells are found in fluid buildup in the abdominal cavity, called ascites, or in the samples of fluid from the peritoneal cavity taken during surgery.

Stage II: The cancer involves 1 or both of the ovaries or fallopian tubes and has spread below the pelvis, or it is peritoneal cancer.

  • Stage IIA: The cancer has spread to the uterus and/or fallopian tubes and/or the ovaries.

  • Stage IIB: The cancer has spread to other tissues within the pelvis.

Stage III: The cancer involves 1 or both of the ovaries or fallopian tubes, or it is peritoneal cancer. It has spread to the peritoneum outside the pelvis and/or to lymph nodes in the retroperitoneum (lymph nodes along the major blood vessels, such as the aorta) behind the abdomen.

  • Stage IIIA1: The cancer has spread to the retroperitoneal lymph nodes, which are found at the back of the abdomen, but not to the peritoneal surfaces.

    • Stage IIIA1(i): Metastases are 10 millimeters (mm) or smaller.

    • Stage IIIA1(ii): Metastases are larger than 10 mm.

  • Stage IIIA2: The cancer has spread microscopically from the pelvis to the abdomen. Cancer may or may not have spread to lymph nodes in the back of the abdomen.

  • Stage IIIB: The cancer has visibly spread past the pelvis to the abdomen and is 2 centimeters (cm) or smaller, with or without spread to the retroperitoneal lymph nodes. A centimeter is roughly equal to the width of a standard pen or pencil.

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

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

  • Stage IVA: The cancer has spread to fluid around the lungs.

  • Stage IVB: The cancer has spread to the liver or spleen or to organs beyond the abdomen, including lymph nodes in the groin outside of the abdominal cavity.

Grade

Doctors also describe these types of cancer by its grade. The grade describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. This helps the doctor predict how quickly the cancer may spread and may help the health care team make decisions about the treatment plan. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and has different cell groupings, it is called “differentiated” or a “low-grade tumor.” If the cancerous tissue looks very different from healthy tissue, it is called “poorly differentiated” or a “high-grade tumor.” In general, the lower the tumor’s grade, the better the prognosis.

Some tumors are called borderline tumors, which are tumors of low malignant potential (LMP). They are very different from high-grade cancers and represent about 10% to 15% of epithelial ovarian/fallopian tube cancers. Most epithelial ovarian/fallopian tube cancers are the serous type, and they are they graded as low-grade serous carcinoma (LGSC) or high-grade serous carcinoma (HGSC). These tumors have different genetic alterations and biology.

Other types of ovarian/fallopian tube cancer, such as endometrioid cancers, may be given these grades:

  • Grade 1: The tissue is well differentiated. This means the cells look and are organized within the tumor like normal cells. These tumors tend to grow slowly.

  • Grade 2: The tissue is moderately differentiated. It shares features between well and poorly differentiated. Grade 2 is not commonly used.

  • Grade 3: The tissue is poorly differentiated or undifferentiated. All or most cells appear very abnormal and do not have any normal tissue structure. These tumors tend to grow fast and can spread rapidly.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 04/2019

ON THIS PAGE: You will learn about the different types of treatment doctors use for women with ovarian, fallopian tube, and peritoneal cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for ovarian, fallopian tube, and peritoneal cancer. “Standard of care” means the best treatments known. Ovarian/fallopian tube epithelial cancers are treated the same way.

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

Treatment overview

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

Descriptions of the common types of treatments used for ovarian/fallopian tube cancers are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health or personal considerations, such as a woman’s age and if she is planning to have children in the future.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called "shared decision making." Share decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Share decision making is particularly important for ovarian, fallopian tube, and peritoneal cancer because there are different treatment options. Learn more about making treatment decisions.

Concerns about sexual health and having children

Women with ovarian, fallopian tube, or peritoneal cancer may have concerns about if or how their treatment may affect their sexual health and fertility. These topics should be discussed with the health care team before treatment begins. Premenopausal women who are still potentially able to get pregnant and want to preserve their fertility may want to talk with a reproductive endocrinologist (REI) before cancer treatment begins. It may be helpful to discuss what options for fertility preservation are covered by health insurance.

Surgery

Surgery is an important treatment for these types of cancer. A gynecologic oncologist is a doctor who specializes in the treatment of gynecologic cancers, including surgery and chemotherapy.

As mentioned in Diagnosis, surgery is often needed to find out the complete extent of the disease. The goal is to provide an accurate stage. This is important because imaging tests aren’t always able to see the full extent of a disease.

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

There are several surgical options for ovarian/fallopian tube cancer. The stage of the tumor determines the types of surgery. Sometimes doctors perform 2 or more procedures during the same surgery:

  • Salpingo-oophorectomy. This surgery involves removal of the ovaries and fallopian tubes. If both ovaries and both fallopian tubes are removed, it is called a bilateral salpingo-oophorectomy. If the woman wants to become pregnant in the future and has early-stage cancer, it may be possible to remove only 1 ovary and 1 fallopian tube if the cancer is located in only 1 ovary. That surgery is called a unilateral salpingo-oophorectomy. For women with a germ cell type of ovarian tumor, often only the ovary with the tumor needs to be removed, which preserves the woman’s ability to become pregnant.

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

  • Lymphadenectomy/lymph node dissection. During this procedure, 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 intestines.

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

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

Side effects of surgery

Surgery causes short-term pain and tenderness. If there is pain, the doctor will prescribe an appropriate medication. For several days after the operation, you may have difficulty emptying your bladder (urinating) and/or having bowel movements.

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

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

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a gynecologic oncologist or medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for ovarian, fallopian tube, and peritoneal cancer include:

  • Chemotherapy

  • Targeted therapy

  • Hormone therapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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. It is also important to let your doctor know if you are taking any other prescriptions or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. The type of the chemotherapy used depends on several factors.

If the chemotherapy stops or slows the cancer, then maintenance therapy with targeted treatments may be used for certain patients (see "Targeted therapy," below).

Neoadjuvant chemotherapy

Neoadjuvant chemotherapy is a medical term to describe chemotherapy that is given before surgery. It is done to reduce the size of a tumor before surgery. It is usually started after a biopsy, so the doctors can determine where the tumor began. Neoadjuvant chemotherapy is usually given for 3 to 4 cycles before considering surgery, called interval surgery. This treatment usually consists of carboplatin (available as a generic drug) given intravenously with paclitaxel (Taxol) or docetaxel (Taxotere). The typical treatment cycle is to give these drugs every 3 weeks. Talk with your doctor about which scheduling option is best for your treatment plan.

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

Adjuvant chemotherapy

Adjuvant chemotherapy is a medical term to describe chemotherapy that is given after surgery to destroy any remaining cancer. For these types of cancer, the specific drugs typically are carboplatin given with paclitaxel or docetaxel intravenously (IV). Most of these drugs are given every 3 weeks.

Another approach is called “dose-dense” chemotherapy. This is when paclitaxel is given weekly instead of every 3 weeks. Research studies have shown conflicting results on the effectiveness of this approach. Some studies show better outcomes with dose-dense chemotherapy, and others show that the outcomes are the same.

Adjuvant chemotherapy can also be infused directly into the abdomen. This is called intraperitoneal or “IP” chemotherapy. This approach may be considered for women with stage III disease after a debulking surgery that removes all visible disease. However, the effectiveness of IP chemotherapy is not clear. While some research studies have shown that IP treatment may offer more benefit than IV treatment in some patients, more recent research has shown no difference between IV and IP chemotherapy, especially when bevacizumab (Avastin) is added to the treatment.

A treatment plan that adds bevacizumab to adjuvant chemotherapy with carboplatin and paclitaxel, followed by a course of bevacizumab alone, was approved by the U.S. Food and Drug Administration (FDA) in 2018. Bevacizumab is a targeted therapy that stops blood vessel growth (see "Targeted therapy," below). This adjuvant treatment is approved for women with stage III or stage IV ovarian/fallopian tube/peritoneal cancer. In general, bevacizumab used for ovarian/fallopian tube cancer has prolonged the time before the cancer returns in some patients.

Talk with your doctor about which scheduling option is best for your situation.

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

Side effects of chemotherapy

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

Possible side effects of chemotherapy include difficulty with concentration and memory. For example, the patient may have issues with attention span or memory, sometimes called “chemobrain.” Other possible side effects include losing the ability to become pregnant, called infertility, and causing early menopause. Rarely, certain drugs may cause some hearing loss or kidney damage. Patients may be given extra fluid intravenously to protect their kidneys. Before treatment begins, patients should talk with their health care team about possible short-term and long-term side effects of the specific drugs they will receive. It is important to note that many side effects can be reduced by adjusting the dose and/or schedule.

Learn more about the basics of chemotherapy.

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. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

For ovarian/fallopian tube cancer, some targeted therapy drugs are directed at specific genes that might be found with abnormalities in certain types of epithelial ovarian/fallopian tube cancer. Standard chemotherapy has been effective in treating most ovarian/fallopian tube cancer. Typically, about 20% of high-grade tumors have mutations in the BRCA genes. These are usually diagnosed at later stages. Other tumor mutations are less common.

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

Other types of less common ovarian/fallopian tube cancer include low-grade serous, endometrioid, clear cell, and mucinous cancers. These tumors have a variety of mutations, including BRAF, PI3KCA, and PTEN, which may mean targeted treatment may be available.

  • PARP inhibitors. PARP inhibitors block an enzyme involved in repairing damaged DNA. By blocking this enzyme, DNA inside cancer cells may be less likely to be repaired, leading to cell death and possibly slowing down or stopping tumor growth. The BRCA genes (BRCA1 and BRCA2) are normally involved in DNA repair, and a mutation in these genes interferes with this pathway function. PARP inhibitors make it difficult for cells that otherwise have a BRCA mutation to grow and divide. PARP inhibitors do not work in a cases where a BRCA mutation is present, but this is an active area of research.

    Studies are underway with other PARP inhibitors that do not all require the inherited BRCA mutation. Researchers are further testing to see if PARP inhibitors can keep the cancer from coming back after chemotherapy. Talk with your doctor about the potential benefits and risks of PARP inhibitors.

  • Anti-angiogenesis inhibitors. Drugs called anti-angiogenesis inhibitors block the action of a protein called vascular endothelial growth factor (VEGF). These drugs have been shown to increase the cancer’s response to treatment and delay the time it takes for the cancer to return. VEGF promotes angiogenesis, which is the formation of new blood vessels. Because a tumor needs nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor.

    Bevacizumab, an antibody that binds VEGF and prevents it from being active, has been shown to be effective in ovarian/fallopian tube cancer. It may be combined with chemotherapy to treat stage III or stage IV disease (see "Chemotherapy," above).

Maintenance therapy using targeted therapy

Maintenance therapy is a medical term to describe treatment used to reduce the risk of cancer coming back, called a recurrence, or to delay the time to recurrence. The drugs are used to “maintain” a clinical remission, which is when there is no evidence of disease after the course of chemotherapy treatment has been completed.

Targeted therapy is used to maintain remission in women whose ovarian/fallopian tube/peritoneal cancer has completely responded to their initial chemotherapy and the disease is in a “clinical remission.”

Niraparib (Zejula), olaparib (Lynparza), and rucaparib (Rubraca) are PARP inhibitors approved by FDA for use in maintenance therapy for ovarian/fallopian tube cancer. They are effective in women who carry a BRCA mutation and those who do not carry the mutation. These PARP inhibitors can be taken by mouth daily. Common side effects are nausea and fatigue.

Bevacizumab, an anti-angiogenesis inhibitor that is given by vein, is also approved for maintenance therapy of ovarian/fallopian tube cancer.

Hormone therapy

Hormone therapy may be used to treat some low-grade tumors if they come back, or recur. These include tamoxifen (Soltamox) and aromatase inhibitors, such as letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin). Hormone therapy is more often used to treat stromal tumors, such as recurrent granulosa cell tumors.

Radiation therapy

Radiation therapy is not used as a first treatment for ovarian/fallopian tube cancer. It may be used to treat some people with clear cell ovarian cancer after chemotherapy. Occasionally, it can be an option for treating small, localized recurrent cancer. See “Remission and the chance of recurrence” below for more information about treatment options for recurrent ovarian/fallopian tube cancer.

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

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

For more information on radiation therapy for gynecologic cancers, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers (PDF; please note that this link takes you to a separate, external website).

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer 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, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

How epithelial ovarian/fallopian tube cancer is treated

As discussed in the Introduction, most cases of ovarian/fallopian tube cancer are epithelial carcinoma. Of those, a great majority are high-grade serous cancer (HGSC). Treatment for early stage, HGSC ovarian/fallopian tube cancer often involves surgery and adjuvant chemotherapy. Treatment for more advanced HGSC includes surgery with adjuvant chemotherapy and/or targeted therapy, neoadjuvant chemotherapy followed by surgery, or chemotherapy alone if surgery is not possible.

How ovarian germ cell tumors are treated

The first treatment for ovarian germ cell tumors is usually surgery. In some cases, doctors can perform the surgery in a way that preserves fertility. Doctors may recommend adjuvant chemotherapy after surgery, depending on the stage and subtype of germ cell cancer. Chemotherapy usually consists of a combination of IV bleomycin (available as a generic drug), cisplatin (available as a generic drug), and etoposide (available as a generic drug). The overall approach and medications given are similar to those used in male germ cell cancer, which is a type of testicular cancer. To learn more about this type of cancer, visit the Cancer.Net guides to testicular cancer and childhood germ cell tumors.

How stromal tumors are treated

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

Chemotherapy for a stromal tumor usually involves the combination of bleomycin, cisplatin, and etoposide. Chemotherapy can be used after surgery or for tumors that have come back after treatment, called recurrent disease. Researchers are looking at chemotherapy with carboplatin (available as a generic drug) and paclitaxel (Taxol) as alternatives. For recurrent disease, doctors may use hormonal therapy. Studies are being done to test tumors to find other targeted drugs to treat ovarian stromal tumors.

How metastatic cancer is treated

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

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

For most people, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

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

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. It is important to talk with your doctor about the possibility of the cancer returning. This is particularly important after treatment for ovarian/fallopian tube cancer, as many women experience at least 1 recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

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

When this occurs, a new cycle of testing will begin to discover as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options.

How recurrent cancer is treated

Chemotherapy is normally used to treat a recurrence of ovarian, fallopian tube, and peritoneal cancer. A primary goal of the treatment of recurrent disease is to reduce or prevent symptoms of the disease while keeping the side effects of treatment to a minimum. Treatment for women with recurrent disease is generally based on the time since her last treatment using a platinum chemotherapy drug. Platinum chemotherapy drugs include carboplatin and cisplatin. There is also evidence that surgery may be an effective option for certain patients with recurrent disease, and this should be discussed with your gynecologic oncologist.

If the cancer comes back more than 6 months after platinum chemotherapy, doctors call it "platinum-sensitive disease." If the cancer returns in less than 6 months after platinum chemotherapy, doctors call it “platinum-resistant disease.” However, doctors are now starting to consider other factors than just the cancer's previous response to platinum chemotherapy when deciding which treatment to use for recurrent ovarian, fallopian tube, and peritoneal cancers.

Platinum-sensitive disease. If the cancer is localized, additional surgery may be beneficial. Talk about this with your doctor. Surgery is usually considered only if the time following chemotherapy has been 1 year or longer. If the cancer comes back to more than 1 place in the body, chemotherapy is the appropriate next step. For women with platinum-sensitive disease, clinical trials suggest using IV carboplatin and combining it with liposomal doxorubicin (Doxil), paclitaxel, or gemcitabine (Gemzar) may be beneficial.

A clinical trial studied adding bevacizumab to the gemcitabine and carboplatin combination. This extended the time before the disease came back but did not change how long patients lived. You should discuss the risks and possible benefits of this approach with your doctor.

The following PARP inhibitors are approved for the treatment of recurrent ovarian, fallopian tube, and peritoneal cancer:

  • Olaparib (Lynparza). Olaparib is approved for the treatment of persistent or recurrent ovarian/fallopian tube/peritoneal cancer in women who have the inherited BRCA mutation and who have received 3 or more lines of chemotherapy. The Solo2 clinical trial is investigating the use of olaparib for maintenance therapy (note that this link takes you to a different, independent website).

  • Rucaparib (Rubraca). Rucaparib is approved for the treatment of BRCA-positive advanced ovarian/fallopian tube/peritoneal cancer in women who have received 2 or more lines of chemotherapy. The Ariel3 clinical trial is investigating the use of rucaparib for maintenance therapy (note that this link takes you to a different, independent website).

  • Niraparib (Zejula). Niraparib is approved for maintenance therapy in adults with recurrent ovarian/fallopian tube/peritoneal cancer and can be used after treatment for recurrent disease (see “Maintenance therapy using targeted therapy” above).

Platinum-resistant disease. In general, if the cancer returns in less than 6 months after platinum chemotherapy, the next chemotherapy is chosen from a list of medications that have all shown similar ability to shrink cancer. Doctors choose them based on possible side effects and preference based on schedule of dosing. These medications may include, but are not limited to:

  • Liposomal doxorubicin

  • Paclitaxel

  • Docetaxel (Taxotere)

  • Nab-paclitaxel (Abraxane)

  • Gemcitabine

  • Etoposide

  • Pemetrexed (Alimta)

  • Cyclophosphamide (available as a generic drug)

  • Topotecan (Hycamtin)

  • Vinorelbine (Navelbine)

  • Irinotecan (Camptosar)

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

Bevacizumab can be combined with liposomal doxorubicin, paclitaxel, or topotecan to treat platinum-resistant cancer. Doctors believe this is best used for patients who have received 1 or 2 treatments of chemotherapy and who do not have evidence of a bowel obstruction, verified by a CT scan. By adding bevacizumab to the chemotherapy, the time before the disease recurs may be lengthened. You should discuss the risks and possible benefits of this approach with your doctor.

Your doctor may suggest clinical trials that are studying new ways to treat your type of recurrent cancer.

Symptoms of recurrent ovarian, fallopian tube, and peritoneal cancer

The symptoms of recurrent ovarian/fallopian tube cancer are similar to those experienced when the disease was first diagnosed. The 4 most common symptoms are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urinary symptoms (urgency or frequency). However, other symptoms may include persistent indigestion, gas, nausea, diarrhea, or constipation; unexplained weight loss or gain, especially in the abdominal area; abnormal bleeding from the vagina; pain during sexual intercourse; fatigue; and lower back pain.

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

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

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

If treatment does not work

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

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

People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

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

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

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

Approved by the Cancer.Net Editorial Board, 04/2019

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

What are clinical trials?

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

Clinical trials are used for all types and stages of ovarian, fallopian tube, and peritoneal cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

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

Deciding to join a clinical trial

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

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

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

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

Because some of these specific subtypes of ovarian/fallopian tube cancer are quite rare, studies focusing only on a subtype are uncommon. However, many clinical trials on ovarian/fallopian tube cancer are open to women with different subtypes because such diseases often respond to the same treatment.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. This may include that the new treatment is not working or there are serious side effects. Clinical trials are closely monitored by experts who watch for any problems with each study. It is important that people 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 they choose to leave the clinical trial before it ends.

Finding a clinical trial

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

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

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for ovarian, fallopian tube, and peritoneal cancer. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 04/2019

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

Doctors are working to learn more about ovarian/fallopian tube cancer. They are looking for ways to prevent them, as well as looking for the best ways to treat them and provide care to people diagnosed with these diseases. The following areas of research may include new options for patients through clinical trials. Most ovarian cancer trials now include patients with fallopian tube and peritoneal cancers. Always talk with your doctor about the best diagnostic and treatment options for you.

  • Screening. Screening is used to look for cancer before a person has any signs or symptoms. There are no effective screening methods for these diseases suitable for the general symptom-free population. A screening method study that uses serial CA-125 blood tests and pelvic ultrasonography for finding early-stage ovarian/fallopian tube cancer has been completed, and it is not clear whether this approach will help people live longer. As noted in Diagnosis and Types of Treatment, CA-125 is a substance called a tumor marker that is found in higher levels in women with ovarian/fallopian tube cancer and in women with many benign conditions.

    The U.S. Preventive Services Task Force has issued a statement that says that, for the general population of women with no symptoms, screening for ovarian/fallopian tube cancer is not helpful and may lead to harm.

    Some have recommended that women at high risk of developing ovarian/fallopian tube cancer because of their family history or presence of BRCA1 or BRCA2 or other high-risk gene mutation(s) (see Risk Factors) should be screened with CA-125 blood tests and transvaginal ultrasound. As stated above, this approach has not been shown to help women live longer or find cancers at an earlier and more curable stage. Therefore, if a high-risk gene mutation exists, the recommendation is to remove both fallopian tubes and ovaries after a woman finishes giving birth to children or around the time she turns 40.

  • Other targeted therapies. As described in Types of Treatment, clinical trials are ongoing on many treatments that target different mutations, including KRAS, BRAF, PI3KCA, and PTEN. Many other new, targeted treatments are now being studied in clinical trials. Increasingly, doctors are learning about each patient’s individual tumor's biology through molecular testing. This information may be useful in matching patients with a clinical trial for a specific targeted therapy. Learn more about the basics of targeted therapy.

  • Immunotherapy. Immunotherapy is designed to boost the body’s natural defenses to fight a cancer. It uses materials made either by the body or in a laboratory to bolster, target, or restore immune system function. Researchers are examining whether drugs called checkpoint inhibitors may boost the immune system's ability to destroy cancer cells. Drugs in this category target PD-1, PD-L1, and CTLA4. They have been shown to shrink tumors in other types of cancer, such as melanoma and some lung cancers, and have had some effectiveness in women with ovarian/fallopian tube cancer.

    Cancer vaccines are another type of immunotherapy researchers are testing to use for ovarian/fallopian tube cancer. Some approaches, called “adoptive cell therapy,” use cells called killer T cells from the immune system in an individual patient. Researchers take these cells and grow them in the laboratory, training them to attack certain targets, such as MUC 16 (CA-125), that are found on ovarian/fallopian tube cancer cells. Doctors then put the T cells back into the patient via an IV. This approach, also called chimeric antigen receptor (CAR) T-cell therapy, has been used with some success in people with some blood cancers. Clinical trials are opening for ovarian/fallopian tube cancer. Learn more about the basics of immunotherapy.

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

  • Gene therapy. A new area of research is discovering how damaged genes in ovarian/fallopian tube 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 functional ones.

  • Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of standard cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

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

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

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

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

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

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

Coping with physical side effects

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

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

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

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

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

Caring for a loved one with cancer

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

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

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

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

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

Ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print out.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on diarrhea and rash that provide a tracking sheet to record the timing and severity of the side effect. These free fact sheets are available as a PDF, so they are easy to print out.

The next section in this guide is Follow-up Care. It explains the importance of checkups after you finish cancer treatment. Use the menu to choose a different section to read in this guide.

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

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

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

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

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

For all 3 cancers, other tests may include x-rays, CT scans, MRI scans, ultrasound studies, and blood tests, such as a CA-125 test.

Women treated for ovarian/fallopian tube cancer may have an increased risk of breast cancer, colon cancer, or Lynch syndrome (for certain types of ovarian/fallopian tube cancer). Talk with your doctor about screening tests for these cancers.

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

Learn more about the importance of follow-up care.

Watching for recurrence

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

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

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

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

Keeping personal health records

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

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

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

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Survivorship

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

What is survivorship?

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

  • Having no signs of cancer after finishing treatment.

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

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

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

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

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

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

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

Changing role of caregivers

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

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

A new perspective on your health

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

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

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

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

Looking for More Survivorship Resources?

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

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

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

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

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 04/2019

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

Talking often with the health care team is important for making informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

  • What type of ovarian/fallopian tube cancer do I have?

  • Where did this cancer start?

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

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

  • Should I have genetic testing to see if I have any mutations, such as BRCA mutation?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

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

  • What treatment plan do you recommend? Why?

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

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

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

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

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

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

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

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

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

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

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

  • How long will the operation take?

  • How long will I be in the hospital?

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

  • Will I need to have a stoma?

  • Who should I contact about any side effects? And how soon?

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

  • Will I have chemotherapy after the surgery?

Questions to ask about having systemic therapy using medication

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects? And how soon?

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

  • What can be done to relieve the side effects?

Questions to ask about having radiation therapy

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • Where will the radiation be directed?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects? And how soon?

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

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

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

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

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

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

  • Who will be leading my follow-up care?

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

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

  • Why are ovarian/fallopian tube cancers called “chronic diseases”?

  • Should other women in my family be tested regularly for these types of cancer?

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

The next section in this guide is Additional Resources. It offers more website resources that may be helpful to you. Use the menu to choose a different section to read in this guide.

Ovarian, Fallopian Tube, and Peritoneal Cancer - Additional Resources

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

Cancer.Net includes many other sections about the medical and emotional aspects of cancer 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 links to help you explore other parts of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Ovarian, Fallopian Tube, and Peritoneal Cancer. Use the menu to choose a different section to read in this guide.