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                   What is cancer of the ovary? 

                   Cancer of the ovary is a disease in which cancer
cells are found in the ovary. Approximately 25,000 women in the United
States are diagnosed with this disease each year. The ovary is a small
organ in the pelvis that makes female hormones and holds egg cells
which, when fertilized, can develop into a baby. There are two ovaries:
one located on the left side of the uterus (the hollow, pear-shaped
organ where a baby grows) and one located on the right. This PDQ summary
has information on cancer that occurs in the lining (epithelium) of the
Cancer that is found in the egg-making cells in the ovary is called a
germ cell tumor of the ovary, and is explained in a separate PDQ patient
information summary. 

                   Unfortunately, the vast majority of women with
ovarian cancer are diagnosed with advanced disease. Although sometimes
women with early ovarian cancer have symptoms, such as vague
gastrointestinal discomfort, pelvic pressure, and pain, more often women
with early ovarian cancer  have no symptoms or very mild and nonspecific
symptoms. By the time symptoms are present, women with ovarian cancer
usually have advanced disease. 

                   Because cancer of the ovary may spread to the
peritoneum, the sac inside the abdomen that holds the intestines,
uterus,and ovaries, many women with cancer of the ovary may have fluid
inside the peritoneum(called ascites), which causes swelling of the
abdomen. If the cancer has spread to the muscle under the lung that
controls breathing (the diaphragm), fluid may build up under the lungs
and cause shortness of breath. 

                   Some women are at higher risk of developing ovarian
cancer because of a family history of ovarian cancer. Women with two or
more close family members affected by ovarian cancer may be a part of a
cancer family syndrome and should be counseled by a qualified
specialist regarding their individual risk. A woman with one affected
close relative (mother, sister, or daughter) has a 5.0% lifetime risk of
ovarian cancer. This compares with a 1.5% lifetime risk of ovarian
cancer in a woman with no affected relatives. At the present time, with
current knowledge and technology, routine screening for ovarian cancer
for women with one or no close relatives with ovarian cancer cannot be

                   The chance of recovery (prognosis) and choice of
treatment depend on  the patient's age and general state of health,
(emotional and physical )the type and size of the tumor, and the stage
of the cancer. 

Stage explanation

                   Stages of cancer of the ovary 

                   Once cancer of the ovary has been found, more tests
will be done to find
                   out if the cancer has spread to other parts of the
body (staging). An operation called a laparotomy is done for almost all
patients to find out the stage of the disease. A doctor must cut into
the abdomen and carefully look at all the organs to see if they
contain cancer. During the operation the doctor will cut out small
pieces of tissue (biopsy) so they can be looked at under a microscope to
see whether they contain cancer.
                   Usually the doctor will remove the cancer and other
organs that contain cancer during the laparotomy (see section on How
Cancer of the Ovary is Treated). The doctor needs to know the stage of
the disease to plan further treatment. The following stages are used for
cancer of the ovary: 

                   --Stage I-- Cancer is found only in one or both of
the ovaries. 

                   --Stage II-- Cancer is found in one or both ovaries
and/or has spread to the uterus, and/or the fallopian tubes (the pathway
used by the egg to get from the ovary to the uterus), and/or other body
parts within the pelvis. 

                   --Stage III-- Cancer is found in one or both ovaries
and has spread to lymph nodes or to other body parts inside the
abdomen, such as the  surface of the liver or intestine. (Lymph nodes
are small bean-shaped  structures that are found throughout the body.
They produce and store infection-fighting cells.) 

                   --Stage IV-- Cancer is found in one or both ovaries
and has spread outside the abdomen or has spread to the inside of
the liver. 

                   --Recurrent or refractory-- Recurrent disease means
that the cancer has come back (recurred) after it has been treated.
Refractory disease means the cancer is no longer responding to

                   Treatment option overview

                   How cancer of the ovary is treated 

                   There are treatments for all patients with cancer of
the ovary. Three kinds of treatments are used:

                        - surgery (taking out the cancer in an
operation) - radiation therapy (using high-energy x-rays to kill cancer
cells) -chemotherapy (using drugs to kill cancer cells) 

                   Adequate and complete surgical intervention is
mandatory primary therapy for ovarian carcinoma, permitting precise
staging, accurate diagnosis, and optimal debulking of the tumor (taking
out as much of the cancer as possible). Such an operation generally
involves total hysterectomy, bilateral salpingo- oophorectomy
(removal of fallopian  tubes and ovaries), omentectomy (removal of fatty
tissue covering within the abdomen), and lymphadenectomy (sampling of
lymph nodes). An  aggressive approach to tumor debulking is important
in ovarian cancer,since removal of the maximum amount of tumor is
associated with improved survival. The procedure is best performed by
a qualified gynecologic oncologist, who is a gynecologic surgeon
with specialized training in pelvic cancers. 

                   Radiation therapy is the use of high-energy x-rays to
kill cancer cells and shrink tumors. Radiation may come from a machine
outside the body(external-beam radiation therapy) or it may be put
directly into the sac that lines the abdomen (peritoneum) in a liquid
that is radioactive(intraperitoneal radiation). 

                   Chemotherapy is the use of drugs to kill cancer
cells. It may be taken by pill or put into the body by inserting a
needle into a vein. Chemotherapyi s called a systemic treatment because
the drugs enter the bloodstream, travel through the body, and kill
cancer cells outside the ovaries.
                   Chemotherapy can also be given by a needle put
through the abdominal wall into the peritoneum (intraperitoneally). 

                   Treatment by stage 

                   Treatment of cancer of the ovary depends on the stage
of the disease, the type of disease, and the patient's age and overall

                   Treatment may be received as part of an ongoing
clinical trial for ovarian cancer. Clinical trials are designed to find
better ways to treat cancer patients and are based on the most
up-to-date information. Clinical trials are ongoing in most parts of the
country for most stages of cancer of the  ovary. If a clinical trial is
not available, or the patient chooses not to participate, treatments are
available that are considered standard based on their performance in
prior clinical trials. To learn more about clinical trials, call the
Cancer Information Service at 1-800-4-CANCER
                   (1-800-422-6237); TTY at 1-800-332-8615. 

God Bless
marty auslander
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