Ovarian – Foundation for Women's Cancer
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Ovarian Cancer

This section will take you through the basics of what you need to know about ovarian cancer. It will introduce you to the people who may be part of your treatment team. Also, it will identify the different types of treatments for ovarian cancer. Hopefully, this information will help prepare you to talk with your treatment team and to feel more confident about your treatment plan.

Download a printable version of the information in this section with our brochure, Ovarian Cancer: Your Guide.

Ovarian Cancer Overview

Cancer occurs when cells in an area of the body grow abnormally. Ovarian cancer is the seventh most common cancer among women.

Medical Evaluation and Diagnosis

When a woman experiences concerning symptoms, a pelvic exam, including a rectovaginal exam, and a general physical exam should be performed. If the exam is abnormal, women should undergo a transvaginal or pelvic ultrasound to evaluate the ovaries, or a CT scan to look for distant disease.

If the exam is adequate and normal, it is reasonable to wait two to three weeks to see if the symptoms resolve. If they do not, then a transvaginal or pelvic ultrasound should be performed. If an abnormality of the ovaries is found, additional radiographic studies, such as a CT scan or an MRI, and a blood test for CA 125 may be performed. CA 125 is elevated in approximately 80 percent of women with advanced-stage epithelial ovarian cancer, but elevations can occur for reasons other than ovarian cancer. You can read more about CA 125 with our brochure, CA 125 Levels: Your Guide.

If ovarian cancer is suspected or diagnosed, it is important to seek care first from a gynecologic oncologist—medical doctors with specialized training in treating gynecologic cancers who can manage your care from diagnosis to completion of treatment. Use our Seek a Specialist tool to find a gynecologic oncologist in your area.

Seek a Specialist

During your treatment, you will come in contact with many health care professionals—these people make up your treatment team. They will work with each other and you to provide the special care you need. Learn more about your treatment team.

Working with your treatment team

Surgical Staging

When ovarian cancer is diagnosed, it is vital to determine if the cancer has spread beyond the ovaries. Your treatment team may do more tests to determine this. In addition, during surgery, certain additional

steps should be performed to determine the extent of the disease. This process is called staging. Staging helps to determine the exact extent of your cancer and what treatment plan is best for you.

Following surgery, your cancer will be categorized into Stage I, II, III, or IV, illustrated on the following page. The cancer will also be assigned a grade. Grade refers to how abnormal the cells appear under a microscope. Low grade tumors, also called grade 1, have features that resemble normal ovarian cells. In contrast, in high grade tumors (grade 3) the microscopic appearance is greatly altered from normal.

It is important that your surgery be performed by a gynecologic oncologist, a physician with special training in the care of women’s reproductive cancers. Studies show that patients treated by gynecologic oncologists at high-volume centers have improved outcomes.

Ovarian cancer stages

Ovarian Cancer Stage 1 IllustrationThe cancer is found in one or both ovaries. Cancer cells also may be found on the surface of the ovaries or in fluid collected from the abdomen.

Ovarian Cancer Stage 2 Illustration

The cancer has spread from one or both ovaries to other tissues in the pelvis, such as the fallopian tubes or uterus. Cancer cells may also be found in fluid collected from the abdomen.

Ovarian Cancer Stage 3 IllustrationThe cancer has spread outside the pelvis or nearbylymph nodes. Most commonly the cancer spreads to the omentum (an apron of fatty tissue that hangs down from the colon and stomach), diaphragm, intestine, and the outside (surface) of the liver.

Ovarian Cancer Stage 4 IllustrationThe cancer has spread to tissues outside the abdomen and pelvis. The most common place for the cancer to spread is in the space around the lungs. Additionally, if the cancer spreads inside the liver or spleen, it is considered stage IV.

Treatment Types and Side Effects

Ovarian cancer is most often treated with surgery and chemotherapy. Whether surgery or chemotherapy is used first will depend on several factors specific to your disease. Only rarely is radiation therapy used. It is important to distinguish between early-stage ovarian cancer and advanced disease because the treatment approaches are different.

All treatments for ovarian cancer have side effects. Most side effects can be managed or avoided. Treatments may affect unexpected parts of your life, including your function at work, home, intimate relationships, and deeply personal thoughts and feelings.

Before beginning treatment, it is important to learn about the possible side effects, and talk with your treatment team members about your feelings or concerns. They can prepare you for what to expect and tell you which side effects should be reported to them immediately. They can also help you find ways to manage the side effects that you experience.

Understanding the goals of treatment

As you begin your treatment, make sure that you understand what to expect. Is this for cure? What are the chances of cure? If there is no cure, will the treatment make me live better or longer? It is very important to understand the truth about what to expect from the treatmentand what are the potential costs of side effects, expenses, etc.so that you can make the best decisions for yourself and the life you want to lead.

Importance of participation in clinical trials

There are many ongoing clinical trials studying new and better ways to treat ovarian cancer. Many treatment options are available today because women diagnosed with ovarian cancer were willing to participate in prior clinical trials.

Clinical trials are designed to test some of the newest and most promising treatments for ovarian cancer. The Foundation for Women’s Cancer partners with NRG Oncology (formerly Gynecologic Oncology Group), part of the National Cancer Institute cooperative group working only on gynecologic cancer clinical trials, and others to make information about current clinical trials available. For more information about clinical trials available for enrollment, visit ClinicalTrials.gov.

Ovarian cancer treatment types

Follow up after treatment

In general, women are followed up with exams (including a pelvic exam) every 3 to 4 months for 3 years, and then every 6 months. In addition, CA 125 and imaging studies such as x-rays, CT scans, or MRIs may be periodically performed, especially if you have any new pains or symptoms.

Recurrent disease

Recurrences are often diagnosed when the CA 125 level begins to rise, or new masses are found on imaging studies or by examination. A biopsy may be required to be certain a lesion is a recurrent tumor.

If ovarian cancer recurs, there are several options for treatment. These include repeat surgery, re-treatment with the same chemotherapy given initially, treatment with a different type of agent (chemotherapy, hormonal or targeted therapy), and sometimes radiation. As each recurrence will be different, it is important to discuss your individual situation with your team. It is also important to investigate whether there is a clinical trial that is appropriate for you. Don’t be afraid to seek a second opinion.

A recent advance in ovarian cancer treatment is the successful use of poly ADP ribose polymerase (PARP) inhibitors. This category of drugs is especially effective in patients with BRCA1 and BRCA2 mutations. Currently only one PARP inhibitor has received FDA approval for ovarian cancer patients who are BRCA1/2 positive. Several other PARP inhibitors are undergoing clinical trials. This advance underscores the strong recommendation that all women with ovarian cancer be tested for the BRCA1/2 mutations. This is important information for family members and can guide treatment options for patients.

As you go through cancer treatment, be patient with yourself.