About Ovarian Cancer

You are not alone.

Learning to cope with a new diagnosis begins with an understanding of the disease.

Understanding Ovarian Cancer

Ovarian cancer is a growth of abnormal malignant cells that begins in the ovaries. Cancer that spreads to the ovaries but originates at another site is not considered ovarian cancer.

Ovarian tumors can be benign (noncancerous) or malignant (cancerous). Although abnormal, cells of benign tumors do not metastasize (spread to other parts of the body). Malignant cancer cells in the ovaries can metastasize in two ways: directly to other organs in the pelvis and abdomen (the more common way), and also through the bloodstream or lymph nodes to other parts of the body.

Ovarian cancer accounts for approximately three percent of cancers in women. It is only the eleventh most common cancer among women, but ovarian cancer is the fifth leading cause of cancer-related death among women, and it is the deadliest of gynecologic cancers. Mortality rates are slightly higher for Caucasian women than for minority women.

Ovarian Cancer Risk by the Numbers

  • A woman’s lifetime risk of developing invasive ovarian cancer is 1 in 75.
  • A woman’s lifetime risk of dying from invasive ovarian cancer is 1 in 100.
  • Ovarian cancer primarily develops in women over 45. It does, however, occur in young women as well.
  • From 2007 to 2011, the median age at diagnosis was 63. From the same period, the median age at death from ovarian cancer was 71.

Ovarian Cancer Survival Rates

Ovarian cancer survival rates are much lower than other cancers that affect women.

  • Overall, the 10-year relative survival rate for ovarian cancer patients is 39 percent.
  • The overall five-year survival rate is 44.6 percent. Survival rates vary depending on the stage of diagnosis.
  • Women diagnosed at an early stage have a much higher five-year survival rate than those diagnosed at a later stage.
  • Approximately 15 percent of ovarian cancer patients are diagnosed early.
  • Survival rates for ovarian cancer continue to improve! Women diagnosed with ovarian cancer in 1975 experienced a five-year survival rate of 34.8 percent; today, the American Cancer Society estimates the rate to be 46 percent.

Types of Ovarian Cancer

Different types of ovarian cancer are classified according to the type of cell from which they arise.

Epithelial Ovarian Carcinoma

Epithelial ovarian carcinoma is the most common type of ovarian cancer, and arises from the cells covering the surface of the ovaries (epithelial cells). This type accounts for about 90% of ovarian cancer cases. Epithelial ovarian carcinomas include the following types:

  • Serous – The most common type of epithelial ovarian cancer. The term “serous” refers to serum, the clear liquid part of the blood.
  • Endometrioid – The second most common type of epithelial ovarian cancer. The term “endometrioid” refers to the lining of the uterus. In some cases, endometrioid carcinomas of the ovary appear together with an endometrial carcinoma (epithelial cancer of the uterus) and/or endometriosis (presence of endometrial tissue outside the uterus).
  • Undifferentiated – The cells of this type of tumor do not share characteristics with any specific type of ovarian tissue cells.
  • Borderline tumors – Cells have characteristics of both benign (non-cancerous) and malignant (cancerous) tissue.
  • Clear cell – This type of ovarian cancer gets its name because the center of the cells appear clear when viewed through a microscope.
  • Mucinous – Most commonly found in early stages, these tumors often present as large pelvic or abdominal masses.

Germ Cell Carcinoma Tumor

This type makes up about five percent of ovarian cancer cases and begins in the cells that form eggs. While germ cell carcinoma can occur in women of any age, it tends to be found most often in women in their early 20s. Six main kinds of germ cell carcinoma exist, but the three most common types are: teratomas, dysgerminomas, and endodermal sinus tumors. Many tumors that arise in the germ cells are benign.

Germ cell cancers usually grow rapidly. They can become very large and cause significant pain or abdominal distension. Some germ cell cancers may produce the pregnancy hormone HCG. This can lead to a false positive pregnancy test.

For more detailed information about germ cell ovarian cancer, visit the National Cancer Institute or the Foundation for Women’s Cancer websites.

Stromal Carcinoma Tumors

Ovarian stromal carcinoma accounts for about five percent of ovarian cancer cases. It develops in the connective tissue cells that hold the ovary together and those that produce the female hormones estrogen and progesterone. The two most common types are granulosa cell tumors and sertoli-leydig cell tumors. Unlike epithelial ovarian carcinoma, 70 percent of stromal carcinoma cases are diagnosed in Stage I.

Stromal cell cancers are usually slow growing. They can cause pain and discomfort in the early stages. These cancers are known to secrete hormones like estrogen or testosterone. The effects of these hormones include:

  • Abnormal uterine bleeding
  • New onset acne
  • Facial hair growth

For more detailed information about stromal carcinoma tumors, visit the Johns Hopkins Pathology or the Foundation for Women’s Cancer websites.

Small Cell Carcinoma of the Ovary 

Small cell carcinoma of the ovary (SCCO) is a rare, highly malignant tumor that affects mainly young women, with a median age at diagnosis of 24 years old. The subtypes of SCCO include pulmonary, neuro-endocrine and hypercalcemic. SCCO accounts for 0.1 percent of ovarian cancer cases. Approximately two-thirds of patients with SCCO have hypercalcemia. The symptoms are the same as other types of ovarian cancer.

Fallopian Tube and Primary Peritoneal Cancer

Because fallopian tube and primary peritoneal cancer are generally treated the same way as ovarian cancer, much of the information in this section can also apply to those two cancers. MOCA serves and welcomes women who are diagnosed with fallopian tube and primary peritoneal cancer.

For more specific information about the different types of ovarian cancer, see the American Cancer Society’s detailed guide here.

Assessing Your Risk

While most women with ovarian cancer do not have any known risk factors, some do exist. If a woman has one or more risk factors, she will not necessarily develop ovarian cancer; her risk, however, may be higher than that of the average woman.

Genetics: BRCA1, BRCA2 and Lynch Syndrome

About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 5 to 10 percent of all ovarian cancers.

Eastern European women and women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations.

Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer.

Another known genetic link to ovarian cancer is an inherited syndrome called hereditary nonpolyposis colorectal cancer (HNPCC or Lynch Syndrome). While HNPCC poses the greatest risk of colorectal cancer, women with HNPCC have about a 12 percent lifetime risk of developing ovarian and uterine cancer.

It is recommended by the Society of Gynecologic Oncologists that all women with an ovarian cancer diagnosis should meet with a genetic counselor. Here is a list of genetic counselors in Minnesota. The FORCE organization – Facing Our Risk of Cancer Empowered – also has helpful information.

Source: Ovarian Cancer Research Fund Alliance

Increasing Age

All women are at risk of developing ovarian cancer regardless of age. Ovarian cancer rates are highest in women aged 55 – 64 years. A woman’s risk, however, is highest during her 60s and increases with age through her late 70s.

  • From 2007 – 2011, the median age at which a woman was diagnosed is 63, meaning that half of women are younger than 63 when diagnosed with ovarian cancer and half are older. About 69 percent of women diagnosed with ovarian cancer in the United States from 2007 to 2011 were 55 or older.
  • The median age of diagnosis is 63.

Reproductive History and Infertility

Research suggests a relationship between the number of menstrual cycles in a woman’s lifetime and her risk of developing ovarian cancer. A woman is at an increased risk if she:

  • Started menstruating at an early age (before 12)
  • Has not given birth to any children
  • Had her first child after 30
  • Experienced menopause after 50
  • Has never taken oral contraceptives.

Infertility, regardless of whether or not a woman uses fertility drugs, also increases the risk of ovarian cancer.

Family History of Cancer

Women who have one first-degree relative with ovarian cancer but no known genetic mutation still have an increased risk of developing ovarian cancer. The lifetime risk of a woman who has a first degree relative with ovarian cancer is five percent (the average woman’s lifetime risk is 1.4 percent).

While it accounts for only a limited number of cases, heredity is a strong risk factor for ovarian cancer. Maternal and family history should be considered however, many women without a family history may still have a gene mutation associated with risk for ovarian cancer.

According to the most recent NCCN guidelines, all women diagnosed with ovarian cancer, primary peritoneal or fallopian tube cancer should be referred for genetic counseling and consideration of genetic testing.

Family history of any of the following cancers may indicate an increased risk: Breast cancer, Ovarian cancer, Colon cancer, Uterine cancer.

Source: Ovarian Cancer Research Fund Alliance 

Hormone Replacement Therapy

Doctors may prescribe hormone replacement therapy to alleviate symptoms associated with menopause (hot flashes, night sweats, sleeplessness, vaginal dryness) that occur as the body adjusts to decreased levels of estrogen. Hormone replacement therapy usually involves treatment with either estrogen alone (for women who have had a hysterectomy) or a combination of estrogen with progesterone or progestin (for women who have not had a hysterectomy).

Women who use menopausal hormone therapy are at an increased risk for ovarian cancer. Recent studies indicate that using a combination of estrogen and progestin for five or more years significantly increases the risk of ovarian cancer in women who have not had a hysterectomy. Ten or more years of estrogen use increases the risk of ovarian cancer in women who have had a hysterectomy.

Research Article: Lacey JV, et al. (2006). Menopausal hormone therapy and ovarian cancer risk in the NIH-AARP Diet and Health Study Cohort. Journal of the National Cancer Institute, (98)19: 1397-1405.

Obesity

Various studies have found a link between obesity and ovarian cancer. A 2009 study found that obesity was associated with an almost 80 percent higher risk of ovarian cancer in women 50 to 71 who had not taken hormones after menopause.

Research Articles: Olsen, CM, et al. (2007).  Obesity and the risk of epithelial ovarian cancer: A systemic review and meta-analysis. Eur J Cancer, 43(4):690-709.  Pavleka, JC, et al. (2006). Effect of obesity on survival in epithelial ovarian cancer. Cancer, 107(7):1520-4.

Ways to Reduce Your Risk

Women can reduce the risk of developing ovarian cancer in several ways. There is, however, no prevention method for the disease. All women are at risk because ovarian cancer does not strike only one ethnic or age group. A healthcare professional can help a woman identify ways to reduce her risk as well as decide if consultation with a genetic counselor is appropriate.

Oral Contraceptives (Birth Control Pills)

The use of oral contraceptives decreases the risk of developing ovarian cancer, especially when used for several years. Women who use oral contraceptives for five or more years have about a 50 percent lower risk of developing ovarian cancer than women who have never used oral contraceptives.

Pregnancy and Breastfeeding

Pregnancy and breastfeeding are linked with a reduced risk of ovarian cancer, likely because women ovulate less frequently when pregnant or breastfeeding.

Removal of the Ovaries

Women can greatly reduce their risk of ovarian cancer by removing their ovarian and fallopian tubes, a procedure known as prophylactic bilateral salpingo oophorectomy. One recent study suggests that women with BRCA1 mutations gain the most benefit by removing their ovaries before age 35. There are risks associated with removing the ovaries and fallopian tubes; women should speak to their doctors about whether this procedure is appropriate for them.

Source: Ovarian Cancer Research Fund Alliance

For women interested in finding more information and support about hereditary breast and ovarian cancer, we recommend visiting the FORCE (Facing Our Risk of Cancer Empowered) website for more information.

Symptoms of Ovarian Cancer

For many years, ovarian cancer was called the “silent killer.”

Recent studies have shown that symptoms of ovarian cancer are not silent. The following symptoms are much more likely to occur in women with ovarian cancer than women in the general population: 

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating
  • Feeling full quickly
  • Urinary symptoms (urgency or frequency)

IF YOU HAVE ANY OF THESE SYMPTOMS ALMOST DAILY FOR THREE WEEKS OR MORE, TAKE ACTION BY SEEKING MEDICAL ATTENTION.

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of symptoms are a key factor in the diagnosis of ovarian cancer. Women who have these symptoms almost daily for three weeks or more should see their doctor, preferably a gynecologist. Several studies show that even early stage ovarian cancer can produce these symptoms. Prompt medical evaluation may lead to detection at the earliest possible stage.

Several other symptoms have been commonly reported by women with ovarian cancer, including:

  • Fatigue (feeling very tired all the time)
  • Indigestion (gas or nausea)
  • Back pain
  • Pain with intercourse
  • Constipation
  • Menstrual irregularities

These other symptoms, however, are not as useful in identifying ovarian cancer. That’s because they are also found in equal frequency in women in the general population who do not have ovarian cancer.

It is important to understand that symptoms associated with ovarian cancer are common. They are also often due to other causes. Nearly all women have these symptoms from time to time, and they don’t automatically mean that a woman has ovarian cancer — but they also shouldn’t be ignored.

Our Source:

Foundation for Women’s Cancer

How Ovarian Cancer is Diagnosed

If you have concerning symptoms, schedule a pelvic exam preferably with a gynecologist.

Your exam should include a rectovaginal exam, along with a general physical exam.

  • If the exam is abnormal, ask for a transvaginal or pelvic ultrasound to evaluate the ovaries.
  • If the exam is normal, it is reasonable to wait 2 to 3 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 studies may be performed. These may include a CT scan or MRI and a blood test for the protein CA-125. CA-125 is elevated in approximately 80 percent of women with advanced stage epithelial ovarian cancer, although elevations can occur for reasons other than ovarian cancer, which means it is not an adequate screening test for the general public.

The Role of the Gynecologic Oncologist 

If your doctor suspects ovarian cancer, suggests surgery to determine if you have ovarian cancer, or if you have been diagnosed with ovarian cancer, it is important to see a gynecologic oncologist. This is a physician with special training in the care of women’s reproductive cancers.

Women can find the nearest gynecologic oncologist by visiting the “Find a Gynecologic Oncologist” page at the Foundation for Women’s Cancer website.

Click here for a full list of gynecologic oncologists in Minnesota.

Multiple studies have shown that an ovarian cancer patient’s chance of survival is significantly improved when her surgery is performed by a gynecologic oncologist. One analysis of multiple studies found that women whose surgeries were performed by gynecologic oncologists had a median survival time that was 50 percent greater than women whose surgeries were done by general gynecologists or other surgeons inexperienced in optimal debulking procedures.

Evaluating the Extent of Ovarian Cancer

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 if the cancer has spread. In addition, during surgery, certain additional steps should be performed to determine the extent of the disease, a process which is called staging. Staging helps to determine the exact extent of your cancer and what treatment plan is best for you.

It is important that your surgery be performed by a gynecologic oncologist. Following surgery your cancer will be categorized into one of the following stages:

  • Stage I: The 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.
  • Stage II: The cancer has spread from one or both ovaries to other tissues in the pelvis. For example, it may have spread to the fallopian tubes or to the uterus. Cancer cells may also be found in fluid collected from the abdomen.
  • Stage III: The cancer has spread outside the pelvis or nearby lymph nodes. Most commonly the cancer spreads to the omentum, diaphragm, intestine and the surface of the liver.
  • Stage IV: The cancer has spread to tissues outside the abdomen and pelvis. Most commonly the cancer has spread to the space around the lungs. If the cancer spreads inside the liver or spleen, it is considered stage IV.

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, high grade tumors (grades 3 or 4) have a greatly altered microscopic appearance.


More Resources

  • Ovarian Cancer Diagnosis (National Cancer Institute)
    Here are more details about the tests and procedures doctors may use to diagnose women with symptoms of ovarian cancer.

Our Sources

Ovarian Cancer National Alliance

Foundation for Women’s Cancer

How Ovarian Cancer is Treated

Ovarian cancer is most often treated with surgery and chemotherapy.

If ovarian cancer is suspected, it is absolutely critical to have a gynecologic oncologist perform surgery. A gynecologic oncologist’s involvement can have a direct and positive impact on a patient’s survival. In recent decades, research has shown that surgery by a gynecologic oncologist is one of the top factors in increasing ovarian cancer survival rates, as well as decreasing rates of recurrence.

Your specific treatment plan will depend on several factors, including:

  • Stage and grade of your cancer
  • Size and location of your cancer
  • Age and general health

Surgery 

Surgery is often the initial step in ovarian cancer and also provides the gynecologic oncologist with the definitive diagnosis. The cancer is removed during surgery. Additionally, specific organs, such as the ovaries, can be removed. Frequently, the gynecologic oncologist also removes the omentum (tissue covering the stomach and large intestine) and possibly lymph nodes. In some cases, the fallopian tubes, uterus and the cervix will also be removed.

It is critical to stage and grade the cancer appropriately, which determines the spread of the cancer and its differentiation. This procedure is typically known as “debulking” and may also involve tissue samples from various organs, the diaphragm as well as fluid (known as ascites). Tumor debulking reduces the amount of cancer substantially and allows the chemotherapy to treat the cancer which remains, such as microscopic cancer.

If a woman has not yet gone through menopause when the ovaries are removed, she will experience immediate surgical menopause due to the loss of hormones that are made by the ovaries. Soon after the surgery, the woman is likely to experience the following symptoms:

  • Hot flashes
  • Vaginal dryness
  • Sexual problems
  • Sleep disturbance
  • Increased risk of heart disease
  • Bone thinning (osteoporosis)

You should talk with your doctor about ways to cope with these side effects.

There are different types of surgery for ovarian cancer. The type of surgery you have depends mainly on these factors.

  • Type of ovarian cancer that you have
  • Whether the cancer is confined to your ovary or has spread
  • Whether you plan to become pregnant
  • Whether your general health is good

If your cancer was found at an early stage and has not spread, your surgeon may be able to leave your uterus and one ovary and fallopian tube intact, which may still allow you to have children. If both of your ovaries and your uterus are removed, you will no longer be able to have children. You will enter sudden menopause, if you have not already reached it. This means you will no longer have menstrual periods.

You may have more than one type of surgery. They may be done as one procedure or as separate procedures. Depending on the type and stage of the cancer, you may or may not have another type of treatment. For example, you could have chemotherapy, before or after surgery.

No matter what type of surgery you have, it is important for the cancer to be staged to see the extent of the disease. To do this, a pathologist checks the removed tissue samples (called biopsies) from your reproductive organs. In addition, the surgeon will usually remove specific lymph nodes. The surgeon will also usually take multiple biopsies in the abdomen and pelvis and remove the omentum.

These are the types of surgery used to treat ovarian cancer:

Total Abdominal Hysterectomy and Bilateral Salpingo-Oopherectomy (TAH/BSO)

This surgery is the most common in the treatment of ovarian cancer.  During this procedure, the surgeon removes the following:

  • Both ovaries
  • Both fallopian tubes
  • Uterus
  • Cervix, which is the narrow end of the uterus

Oophorectomy

This surgery removes an ovary. The surgeon may remove one or both of the ovaries. It depends on the likelihood of the cancer spreading. Another consideration may be whether or not you want to have children. If the cancer has not spread to more than one ovary, it may be possible for the surgeon to remove only one ovary and one fallopian tube. This is called salpingo-oopherectomy. This procedure would let you attempt pregnancy. If conservative surgery is performed, it is very important that staging be done to be sure that the cancer is in an early stage.

Lymph Node Biopsy/Omentectomy

Your doctor will usually remove lymph nodes and the omentum at the same time as an oophorectomy or hysterectomy. Lymph nodes are small glands that are part of your immune system. They help your body fight infections. The surgeon removes nodes and has the pathologist check them for signs of cancer. The omentum, which is a fatty structure that hangs off of your stomach, can also frequently be involved with cancer. It also should be removed as part of the staging process.

Cytoreduction or Debulking 

This surgery involves the removal of as much of the cancer as possible. Often this is a very extensive surgery and other organs such as a portion of the small intestine, colon, diaphragm, or spleen are removed. It is extremely important to have this surgery performed by a surgeon who can do cytoreduction, as ovarian cancer often spreads to multiple areas in the abdomen and pelvis at the time of diagnosis. Women in whom all of the cancer can be removed have cure rates that are twice as high as women in whom large amounts of tumor are left behind.

Chemotherapy 

Chemotherapy uses drugs to kill or reduce the number of cancer cells and help to keep the cancer from coming back. Used with surgery, it has been shown to extend the lives of women with ovarian cancer.

About 1 to 4 weeks after your surgery, you will likely begin chemotherapy. Typically a woman will have it for about 6 months. How often you receive treatment will depend on the type of chemotherapy you receive, which depends on the size of the tumor and whether it is likely to spread quickly. You may have chemotherapy every day, every week, every few weeks, or even once a month. You may be treated in the doctor’s office, or you may be treated in the outpatient part of a hospital.

Chemotherapy drugs travel through the bloodstream to reach all parts of the body. This is why chemotherapy can be effective in treating ovarian cancer that has spread beyond the ovaries. The same drugs that kill cancer cells, however, may also damage healthy cells.

Chemotherapy is usually given in cycles. Periods of chemotherapy treatment are alternated with rest periods when no chemotherapy is given.

Chemotherapy can be delivered by two routes: intravenous (IV) or  intraperitoneal (IP) chemotherapy. With IP chemotherapy, the medications are injected directly into the abdominal cavity. The goal is to deliver a large dose directly to the tumor location. The National Cancer Institute recommends that, for select ovarian cancer patients, chemotherapy can be given by both IV and IP. This combination has been found to increase survival for women with advanced stage ovarian cancer.

IP chemotherapy has more short term toxicity, but recent studies have shown that it is associated with a longer survival rate. It is important for you to talk with your team about the pros and cons of this approach.

Neoadjuvant Chemotherapy

Some cancers will be advanced at initial diagnosis or your doctor may think immediate surgery will be too difficult for you to tolerate. If that’s the case, your gynecologic oncologist may feel that surgery is unlikely to have the desired effect and may prescribe chemotherapy treatments first to shrink the tumor. Once the tumor has shrunk and your physical condition improves, surgery will be performed. Usually this surgery is followed by more chemotherapy.

Chemotherapy Drugs for Ovarian Cancer

There are several chemotherapy drugs used to treat ovarian cancer. Your doctor may recommend more than one at the same time. This is called combination chemotherapy. The following drugs are typically used to treat ovarian cancer. They may be used alone or in combination.

  • Platinum agents such as Paraplatin (carboplatin and cisplatin). These are the drugs doctors most often use to treat ovarian cancer. They work by creating breaks in the genetic material—DNA—inside each cell. This leads to cell death.
  • Taxanes such as Taxol (paclitaxel) and Taxotere (docetaxel). These keep cells from dividing. This class of drugs is used in combination with cisplatin or carboplatin.
  • Anthracyclines such as Adriamycin (doxorubicin) and Doxil (liposomal doxorubicin). These drugs are often used if cancer comes back. When cancer comes back, it is called recurrence.
  • Additional drugs. Other drugs often used at the time of recurrence are gemcitabine and topotecan.

Side Effects of Chemotherapy 

The side effects of chemotherapy are different for everyone. They depend on the following:

  • The type of drug you’re taking
  • How often you take it
  • How long your treatment lasts

Your gynecologic or medical oncologist, healthcare provider, or chemotherapy nurse will talk with you about possible side effects. Here are some typical side effects for the most commonly used chemotherapy drugs for ovarian cancer. Ask your treatment team members about which ones you are most likely to experience.

  • Allergic reactions
  • Anemia from reduced red blood cells, as noticed from a blood test
  • Bleeding after normal cuts, from reduced platelet counts
  • Bruising
  • Constipation
  • Diarrhea
  • Dry skin
  • Fatigue
  • Fluid retention
  • Hair loss
  • Infections, from reduced white blood cells
  • Joint pain
  • Mouth sores
  • Muscle aches
  • Nausea and vomiting
  • Rashes on the hands or feet
  • Tingling or numbness in hands and feet

These side effects usually go away during rest periods between treatments. They also usually go away after your treatment ends. Ask your doctor for ways to ease these side effects. For instance, you may take certain drugs to ease nausea and vomiting. If these side effects do not go away, it is important to bring this to your health care team’s attention. Some side effects, like cognitive issues, neuropathy and lymphedema, can be long-term. Be sure to talk with your heath care team if you are experiencing any of these.

Ask Your Doctor: Common Treatment Questions

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

You may find it helpful to make a list of your questions before seeing your doctor. Use the list of questions below as a starting place.

  • Which treatments do you think are best for me, and why?
  • Which treatments are not for me, and why?
  • What is the success rate of this particular treatment for my type and stage of ovarian cancer?
  • Can I take my other medicines during the treatment period?
  • How long is the treatment period?
  • How long will each treatment take?
  • Where do I have to go for the treatment?
  • Who is involved in giving me the treatment?
  • Does someone need to go with me during treatments?
  • How will I feel after the treatment?
  • What side effects can I expect to have?
  • Will this treatment make me unable to bear children?
  • Will this treatment put me into menopause?
  • How long will side effects last?
  • Are there symptoms or side effects that I need to call you about?
  • What can I do to ease the side effects?
  • Will I be able to go to work and be around my family?
  • Should I change my diet? What foods can’t I eat?
  • Are there any clinical trials I should look into?
  • Are there support groups nearby that I can join?

To make it easier to remember what your doctor says, take notes during meetings, or ask if you can use a tape recorder. It may also help to have a family member or friend with you to take part in the discussion, take notes, or just listen.

What Happens After Treatment

In general, women treated for ovarian cancer have follow-up exams (including a pelvic exam) every 3 to 4 months for 3 years. Then the exams go to every 6 months. In addition, imaging studies such as x-rays, CT scans or MRIs are periodically performed.

If the CA-125 was elevated before treatment, it is important to have it checked at each visit. Recurrences are often diagnosed when the CA-125 begins to rise. They may also be diagnosed when new masses are found on imaging studies or by examination.

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)
  • Radiation (sometimes)

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.


More Resources

For a comprehensive overview of treatment options for ovarian cancer, the Foundation for Women’s Cancer also provides in-depth resources on many topics, including surgery, side effects, chemotherapy, radiation therapy and targeted therapies.


Our Source:

Foundation for Women’s Cancer

Ovarian Cancer Research

Clinical research trials study new ways to prevent, diagnose, and treat ovarian cancer.

The more women who participate in clinical trials, the faster we will find early detection tools, better treatment, and, ultimately, a cure.

A women can begin exploring the options of clinical trials at any point during her experience with ovarian cancer. MOCA encourages women to find out more about clinical trials by visiting the Ovarian Cancer Research Fund Alliance Clinical Trials Matching Service online or by calling (800) 535-1682.

The U.S. National Institutes of Health also offers a website matching tool which also includes a tool to find clinical trials in Minnesota.

Types of Ovarian Cancer Clinical Research Trials

A woman may be eligible to participate in a clinical trial at any point in her experience with ovarian cancer. Many women think of clinical trials as an option only after other treatments have failed. Clinical trials do exist for women in this situation, but many equally important trials are available for women earlier in their fight against ovarian cancer.

  • Prevention trials test ways to reduce the risk of ovarian cancer. They typically enroll healthy women at high risk for developing ovarian cancer or survivors who want to prevent its return or reduce the chance of developing a new type of cancer.
  • Screening trials look for ways to detect ovarian cancer at an early stage in healthy women.
  • Diagnostic trials seek to develop better ways to diagnose and care for women with ovarian cancer. They usually enroll women who have already had ovarian cancer or who have signs and symptoms of it.
  • Treatment trials determine what new treatments or combinations of existing treatments can help women who have ovarian cancer. They evaluate the effectiveness of new treatments or new ways to use existing treatments. (A “treatment” may be a drug, therapy, vaccine, surgery or any combination of these.) Various treatment trials exist for women with ovarian cancer, most of which explore the effectiveness of different combinations of surgery and drug therapies in fighting ovarian cancer.

 

  • Quality-of-life/supportive care trials aim to improve the quality of life for ovarian cancer patients, survivors, and their families. These may include issues like side effects from chemotherapy like neuropathy or nausea, or need for pain medication.
  • Genetic trials, which are usually part of another clinical trial, attempt to determine how a woman’s genetic makeup can influence the detection, diagnosis, prognosis, and treatment of ovarian cancer. Family-based genetic research studies are different than cancer clinical trials: in these family-based genetic research studies, multiple high-risk family members may give blood and tissue and agree to be evaluated on an annual basis.

The goal of many clinical trials is to gain approval for the drug in use against ovarian cancer by the Food and Drug Administration. This can be a lengthy process with three phases of research.

  • Phase 1 trials evaluate the safety of a treatment. These studies typically enroll fewer than 50 people who have different types of cancer and determine the safe dosage and delivery method of a drug. These trials also evaluate the side effects of the drug.
  • Phase 2 trials test to see if the treatment works against ovarian cancer. These studies typically enroll about 100 women with ovarian cancer.
  • Phase 3 trials test the new treatment against the best existing treatment, also called the “standard of care” or “standard care.” These studies typically enroll hundreds to thousands of women to determine if the treatment is safe and effective against ovarian cancer. Phase 3 data is used to apply for FDA approval.

More Resources

  • National Cancer Institute
    More information about ovarian cancer clinical trials for prevention, screening, and treatment from the U.S. National Institutes of Health.

Sources:

Ovarian Cancer Research Fund Alliance > Clinical Trials, Types of Clinical TrialsThe Clinical Trial Process