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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Ovarian epithelial cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the ovary?
STAGE EXPLANATION
Stages of cancer of the ovary
Stage I
Stage II
Stage III
Stage IV
Recurrent or refractory
TREATMENT OPTION OVERVIEW
How cancer of the ovary is treated
Treatment by stage
STAGE I OVARIAN EPITHELIAL CANCER
STAGE II OVARIAN EPITHELIAL CANCER
STAGE III OVARIAN EPITHELIAL CANCER
STAGE IV OVARIAN EPITHELIAL CANCER
RECURRENT OVARIAN EPITHELIAL CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


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 ovary. 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 recommended.

The chance of recovery (prognosis) and choice of treatment depend on the patient's age and general state of health, 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.


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:

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. Chemotherapy is 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 condition.

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.


STAGE I OVARIAN EPITHELIAL CANCER

All women who have ovarian cancer should have carefully performed surgical staging. Most women who have stage I ovarian cancer will have a total abdominal hysterectomy/bilateral salpingo-oophorectomy, omentectomy, and biopsy of lymph nodes and other tissues in the pelvis and abdomen. Depending on the pathologist's interpretation of the tumor cells, the specific cell type involved, and the grade of the tumor (how malignant it appears under a microscope), additional treatment may be recommended after surgery. Additional treatment may be one of the following:

1. Radiation therapy, chemotherapy, or careful observation without immediate treatment (watchful waiting).

2. Combination chemotherapy.

3. A clinical trial evaluating immediate versus delayed delivery of chemotherapy.


STAGE II OVARIAN EPITHELIAL CANCER

Treatment will include surgery to remove both ovaries, both fallopian tubes, the uterus, and as much of the cancer as possible (total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor debulking). During the surgery, samples of lymph nodes and other tissues in the pelvis and abdomen are cut out (biopsied) and checked for cancer. After the operation, treatment may be one of the following:

1. Combination chemotherapy with or without radiation therapy.

2. Combination chemotherapy.

3. A clinical trial evaluating new chemotherapy drugs or new combinations of drugs.


STAGE III OVARIAN EPITHELIAL CANCER

Treatment will include surgery to remove both ovaries, both fallopian tubes, the uterus, and as much of the cancer as possible (total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor debulking). During the surgery, samples of lymph nodes and other tissues in the pelvis and abdomen are cut out (biopsied) and checked for cancer. After the operation, treatment may be one of the following:

1. Combination chemotherapy.

2. Combination chemotherapy possibly followed by surgery to find and remove any additional cancer.


STAGE IV OVARIAN EPITHELIAL CANCER

Treatment will probably be surgery to remove as much of the cancer as possible (tumor debulking), followed by combination chemotherapy.


RECURRENT OVARIAN EPITHELIAL CANCER

There is no standard treatment for cancer that recurs (comes back). Clinical trials are currently evaluating several treatment options. Treatment for recurrent cancer may be one of the following:

1. A clinical trial evaluating chemotherapy possibly followed by surgery.

2. A clinical trial evaluating new chemotherapy drugs or new combinations of drugs.

3. A clinical trial of surgery to ease the symptoms caused by the cancer.

4. A clinical trial of combination chemotherapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the ovary, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about cancer of the ovary may be helpful:

What You Need To Know About Ovarian Cancer

The following general booklets on questions related to cancer may also be helpful:

Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
What You Need To Know About Cancer
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 07/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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