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Ovarian cancer happens
when cells that are not normal grow in one or both of your
ovaries. The ovaries are two small glands, located on either side of your uterus. They produce female sex hormones and store and release eggs (ova).
Treatments for ovarian cancer are more successful when the cancer is found early. But most of the time, cancer has already spread by the
time it is found.
This topic is about epithelial ovarian
cancer. This is cancer that grows in the tissue covering the ovaries. It is the most common type of ovarian cancer and usually occurs in women who are past menopause.
Experts don't know
exactly what causes ovarian cancer. But they do know that
DNA changes play a role in many cancers.
Symptoms of ovarian cancer may include:
These symptoms may be common in
women who don't have ovarian cancer. But if these symptoms are new for you, and they happen almost daily for 2 to 3 weeks, you should see a doctor.
doctor may feel a lump in or on an ovary during a routine
pelvic exam. Often a lump may be seen during an
ultrasound. Most lumps aren't cancer.
If your doctor thinks you may have ovarian cancer, you may have a blood test called CA-125 (cancer
antigen 125). Too much CA-125 in your blood can be a sign of ovarian cancer. But too much CA-125 in the blood can be caused by many
things, such as the menstrual cycle, endometriosis, and uterine fibroids.
The only way to know for sure that a woman has ovarian cancer is with
biopsies taken during surgery. Tissue samples will be sent to a lab to see if they contain cancer.
Surgery is the main treatment.
The doctor will remove any tumors that he or she can see. This usually means
taking out one or both ovaries. It may also mean taking out the fallopian tubes
and uterus. Chemotherapy is often part of treatment. It may be given before and after surgery.
Almost all women whose ovarian cancer is found early will live at least 5 more years.1 But how long a woman lives usually depends on how far the cancer has spread by the time it is found and treated.
When you find out that you have cancer, you may feel many emotions and may need some help coping. Talking
with other women who are going through the same thing may help. Your doctor or your local branch of the American
Cancer Society can help you find a support group.
For most women, the chances of getting this cancer are small. It most often affects women who are past menopause. You may be more likely to get it if other women in your family have had it. Also, some women inherit gene changes that increase their chances of getting it.
Learning about ovarian cancer:
Living with ovarian cancer:
Care at the end of life issues:
Health Tools help you make wise health decisions or take action to improve your health.
Experts don't know exactly what causes
ovarian cancer. Genetics, such as
DNA changes, are a risk factor for some women.
In general, about 1 out of 100 women will get ovarian cancer. That risk goes up to 5 out of 100 if one family member has had
ovarian cancer, and 7 out of 100 if two or three relatives have had it.2
About 10 out of 100 ovarian cancers are thought to be caused by gene mutations in the BRCA1 or BRCA2 genes.3 The risk for women who have these gene changes is much higher than for women without them.
In some cases,
ovarian cancer may cause early symptoms. The most common symptoms of
ovarian cancer include:4
If you have one or more of these symptoms, and it occurs
almost daily for more than 2 or 3 weeks, talk with your doctor.
These symptoms are common for some women. They may not mean that you
have ovarian cancer. But the early symptoms of ovarian cancer follow a pattern:
Other symptoms that affect some women with ovarian cancer
But these symptoms are also common in some women who don't
have ovarian cancer.
often spreads early. Because it grows in the tissues covering the ovaries, it can spread easily within the abdominal cavity to the bowels and bladder or the peritoneal lining. From there it may travel to other organs in the body, such as the liver or lungs.
A risk factor is anything that increases your chance of getting a disease such as cancer. The main risk factors for ovarian cancer include:
But most women who get ovarian cancer do not have these risk factors.
Ovarian cancer most often affects
postmenopausal women. You may also be more likely to get this cancer if:
Some things that lower a woman's risk for ovarian cancer include:
If you have a strong family history of ovarian or breast
cancer, you may want to talk with your doctor or a
genetic counselor about having a blood test to look
for BRCA1 and BRCA2 gene changes.
Ovarian cancer may cause early symptoms. Talk to your doctor if you have one or more of the following symptoms almost daily for more than 2 or 3 weeks:
These symptoms may be common for some women. They may
not mean that you have ovarian cancer. But the early symptoms of ovarian cancer
follow a pattern:
If you have been diagnosed with ovarian cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.
Health professionals who can evaluate your symptoms
and your risk for ovarian cancer include:
Doctors who can manage your cancer treatment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Some exams and
tests that are done to look for or diagnose ovarian cancer
The United States Preventive
Services Task Force (USPSTF) doesn't recommend routine screening for ovarian cancer.6 There is no proof that having regular tests helps women live longer by finding
ovarian cancer early.
Still, some experts recommend that women who have inherited a
BRCA gene change and have not had their ovaries removed have a transvaginal
ultrasound and a CA-125 blood test at least once a year, starting at age 35.
Women who have inherited a BRCA1 gene change (not a BRCA2 gene change) may want
to start having these tests as early as age 25.7
The choice of treatment and the
long-term outcome (prognosis) for women who have
ovarian cancer depends on the type and
stage of cancer. Your age, overall health, quality of
life, and desire to have children must also be
The main treatment choices are:
Women with more advanced ovarian cancer may have part of their chemotherapy before surgery and the rest of it after surgery. This can make the surgery safer for these women.
Radiation therapy may be used to destroy cancer cells using high-dose X-rays or other high-energy rays. For more information, see Other Treatment.
Additional information about ovarian cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/ovarian.
Most treatments for ovarian
cancer cause side effects. They may differ, depending on the type of
treatment and your age and overall health.
Radiation treatment also can cause side effects. For more information, see Other Treatment.
Home treatment may help you manage the side
advanced-stage ovarian cancer involves removing as much of the cancer as
possible. The uterus, the tissue lining the abdominal wall (omentum),
and any areas of visible cancer are removed. This may include surgery on the
intestines, urinary system, or spleen, or scraping of the diaphragm to remove
all the cancer. The long-term outcome is better if no cancer cells
Your doctor may talk to you about being in a
clinical trial of a treatment such as immunotherapy or targeted therapy.
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.
Your feelings about your body may change after treatment for cancer. Managing body image issues may involve talking
about your concerns with your partner and discussing your feelings with your
doctor. Your doctor may also be able to refer you to groups that can offer
support and information.
Sexual problems can be caused by the physical or emotional effects of cancer or its treatment. Some women may feel less sexual pleasure or lose their desire to be intimate. For more information, see the topic Sexual Problems in Women.
After treatment for
ovarian cancer, it's important to receive follow-up
care, because ovarian cancer may come back (recur). Your doctor will set up a schedule of checkups and tests.
If the cancer recurs or spreads (metastasizes), it's usually treated with chemotherapy. Surgery may also be done. Or your doctor may recommend that you join a clinical trial for treatment with surgery or immunotherapy.
long-term outcome for
recurrent ovarian cancer depends on whether the cancer has spread. Even with no sign of
cancer after treatment, 3 to 5 out of 10 women who are treated for
ovarian cancer have cancer return within 5 years. This also means that cancer doesn't recur within 5 years in 5 to 7 out of 10 women.8
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It also can help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief.
But this isn't the end of treatment. It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. You and your doctor can decide when you may be ready for hospice care.
For more information, see:
You cannot control some things that put you at risk for ovarian cancer, such as your family history or inheriting gene changes. But you can make some personal choices that lower your risk of cancer and other diseases.
If you are concerned about your risk for ovarian cancer, talk with your doctor. You may be a good candidate for taking birth control pills. Taking birth control pills for 5 years has been shown to reduce
ovarian cancer risk by 50%.9 The protection lasts for
many years after the pills are taken. But birth control pills have been linked
to a slight increase in breast cancer and may have other health risks, so talk
with your doctor about the risks and benefits before taking birth control
If you are at a very high risk because of your family history, you may want to have gene testing. Women at very high risk because of inherited genes may want to have surgery to remove their ovaries and fallopian tubes. This is usually done between the ages of 35 and 40, or when women are finished having children. Having this surgery greatly reduces a woman's risk for ovarian cancer, but it will cause a woman to start menopause early, which may have other risks.
The side effects of ovarian cancer treatment can be serious. Your doctor may give you medicines to help you with certain side effects. Healthy habits—such as eating a balanced diet and getting enough sleep and exercise—may help control your symptoms. You can try home treatments:
Other issues that can be treated at home include:
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
used to shrink
ovarian cancer and slow cancer growth. Chemotherapy is
recommended for most women after the initial surgery for ovarian cancer. But sometimes chemotherapy is given to shrink the cancer before surgery. The number of
cycles of treatment will depend on the stage of your disease.
Chemotherapy medicines for ovarian cancer may be taken by mouth, injected into a vein (IV), or given through a thin tube into the body (intraperitoneal, or IP). Sometimes treatments may be combined to give women both IV and IP chemotherapy.
Some of the chemotherapy medicines used for ovarian cancer include:
Other medicines that may be used include:
Treatment of ovarian cancer with chemotherapy can cause
nausea and vomiting. To help relieve nausea, your doctor will prescribe
medicines you can take with your treatments and when
you get home.
Having both IV and IP chemotherapy often causes more serious side effects than having only IV or IP treatment. Side effects include belly pain, nerve pain (neuropathy), and kidney or liver problems. Your medical team will watch you closely. If your doctor
has given you instructions or medicines to treat your symptoms, be sure to
Surgery is the main treatment for ovarian cancer.
If you have very early-stage ovarian cancer and wish to
have children, discuss your choices with your
Having an experienced
gynecologic oncologist will help you get the best possible treatment and live longer than having a doctor who doesn't have as much experience treating ovarian cancer.5
Side effects from your surgery
can include trouble urinating or problems with your bowels, such as
constipation or diarrhea. Your ability to have or enjoy sexual intercourse may
also be affected.
If your ovaries are removed, you may have
menopause. Talk with your doctor about treatment to
manage these symptoms.
Radiation treatment for
ovarian cancer uses high-energy X-rays to kill cancer
cells and shrink tumors. It's not used very often to treat ovarian cancer.
Side effects of radiation may include
nausea, vomiting, diarrhea, pain or discomfort when urinating, and bladder
inflammation and scarring. You may also have an increased
risk of infection.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any of these therapies. They are not meant to take the place of standard medical treatment.
FORCE is an organization that provides educational and emotional support for women who are making decisions about surgery to prevent breast or ovarian cancer because they are at high risk. This website also has resources for women who have cancer and are concerned about their cancer coming back. There are online resources as well as a helpline, newsletters, and information on local groups and annual conferences.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
Cancer.Net is the information website of the American
Society of Clinical Oncology (ASCO) for people living with cancer and for those
who care for them. ASCO is the world's leading professional organization
representing physicians of all oncology subspecialties. Cancer.Net provides
current oncologist-approved information on living with cancer.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
The National Ovarian Cancer Coalition works to raise
awareness about ovarian cancer and to improve the survival rate and the quality
of life for women with ovarian cancer. This Web site offers information for
women who have just discovered that they have ovarian cancer. It also has
sections for survivors and caregivers; the section for caregivers includes
information on how to talk about having cancer to children and also how to do
your own research on the internet.
The Ovarian Cancer National Alliance was formed to link
individuals and organizations into a national movement to find a cure for
ovarian cancer. The alliance would like every woman to know the symptoms of
ovarian cancer and be diagnosed earlier, and every woman with ovarian cancer to
live a longer, better life. This website has information on what people can do
to advance ovarian cancer research and to help women learn about risk factors
and how to get good medical treatment.
The Foundation for Women's Cancer has a mission to increase awareness of cancers specific to women, to support research, and to provide information for women who are diagnosed with gynecologic cancers. Their website links to in-depth resources on reproductive cancer, prevention for cervical cancer, and updates on the National Race to End Women's Cancer.
American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010.
National Cancer Institute (2010). Ovarian Cancer Prevention PDQ–Health Professional Version. Available online: http://nci.nih.gov/cancertopics/pdq/prevention/ovarian/healthprofessional.
Fleming GF, et al. (2009). Epithelial ovarian cancer. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., pp. 763–835. Philadelphia: Lippincott Williams and Wilkins.
Rossing MA, et al. (2010). Predictive value of symptoms for early detection of ovarian cancer. Journal of the National Cancer Institute, 102(4): 222–229.
National Comprehensive Cancer Network (2011). Ovarian cancer, including fallopian tube cancer and primary peritoneal cancer. NCCN Clinical Practice Guidelines in Oncology, version 2. Available online: http://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf.
U.S. Preventive Services Task Force (2004). Screening for ovarian cancer. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsovar.htm.
National Cancer Institute (2011). Genetics of Breast and Ovarian Cancer (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.
Brennan K, et al. (2007). Premalignant and malignant disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971–884. New York: McGraw-Hill.
Cass II, Karlan BY (2008). Ovarian and tubal cancers. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 1022–1060. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
Cannistra SA (2007). Gynecologic cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 10. New York: WebMD.
Kehoe S, Morrison J (2009). Ovarian cancer (advanced), search date September 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
National Cancer Institute (2010). Ovarian Epithelial Cancer PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/HealthProfessional.
National Cancer Institute (2010). Ovarian Epithelial Cancer PDQ: Treatment – Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/patient.
Speroff L, Fritz MA (2011). The ovarian cancer section of Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 840–842. Philadelphia: Lippincott Williams and Wilkins.
Vergote I, et al. (2010). Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. New England Journal of Medicine, 363(10): 943–953.
July 6, 2011
Adam Husney, MD - Family Medicine & Ross Berkowitz, MD - Obstetrics and Gynecology
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