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Information from PDQ for Patients
Ovarian epithelial cancer
208/00950
** GENERAL INFORMATION ABOUT OVARIAN EPITHELIAL CANCER **
Ovarian epithelial cancer is a disease in which malignant (cancer) cells form
in the tissue covering the ovary. The ovaries are a pair of organs in the
female reproductive system. They are located in the pelvis, one on each side
of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary
is about the size and shape of an almond. The ovaries produce eggs and female
hormones (chemicals that control the way certain cells or organs function).
Ovarian epithelial cancer is one type of cancer that affects the ovary. (Refer
to the PDQ summaries on Ovarian Germ Cell Tumor Treatment and Ovarian Low
Malignant Potential Tumor Treatment for information about other types of
ovarian cancer.)
Women who have a family history of ovarian cancer are at an increased risk of
developing ovarian cancer. Women who have one first-degree relative (mother,
daughter, or sister) with ovarian cancer are at an increased risk of developing
ovarian cancer. This risk is higher in women who have one first-degree
relative and one second-degree relative (grandmother or aunt) with ovarian
cancer. This risk is even higher in women who have two or more first-degree
relatives with ovarian cancer.
Some ovarian cancers are caused by inherited gene mutations (changes). The
genes in cells carry the hereditary information that is received from a
person's parents. Hereditary ovarian cancer makes up approximately 5% to 10%
of all cases of ovarian cancer. Three hereditary patterns have been
identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and
colon cancers.
Tests that can detect altered genes have been developed. These genetic tests
are sometimes done for members of families with a high risk of cancer. (Refer
to the PDQ summaries on Screening for Ovarian Cancer, Prevention of Ovarian
Cancer, and Genetics of Breast and Ovarian Cancer for more information.)
Women with an increased risk of ovarian cancer may consider surgery to prevent
it. Some women who have an increased risk of ovarian cancer may choose to have
a prophylactic oophorectomy (the removal of healthy ovaries so that cancer
cannot grow in them). It is not known if this procedure prevents ovarian
cancer.
Ovarian cancer is hard to detect (find) early because usually there are no
symptoms. Some women who have early stage ovarian cancer may have symptoms
such as vague gastrointestinal (GI) discomfort, pressure in the pelvis, pain,
swelling of the abdomen, and shortness of breath. Most of the time, there are
no symptoms or they are very mild. By the time symptoms do appear, the cancer
is usually advanced.
When found in its early stages, ovarian epithelial cancer can be cured in many
patients. Women with any stage of ovarian epithelial cancer should consider
taking part in a clinical trial. Information about ongoing clinical trials is
available from the NCI cancer.gov Web site (http://cancer.gov).
Tests that examine the ovaries, pelvic area, blood, and ovarian tissue are used
to detect (find) and diagnose ovarian cancer. These following test and
procedures may be used:
- Pelvic exam: A procedure to check the uterus, vagina, ovaries, fallopian
tubes, bladder, and rectum to find any abnormality in their shape or size.
(A Pap test does not help diagnose ovarian cancer.)
- Ultrasound test: A procedure that bounces sound waves off the ovaries and
changes the echoes into sonograms (pictures).
- CA-125 assay: A blood test used to measure the level of CA-125, a substance
sometimes found in an increased amount in the blood, other body fluids, or
tissues and that may be a sign of ovarian cancer.
- Barium enema (lower GI series): A procedure used to show tumors or other
abnormal areas in the pelvis. A liquid containing barium is put into the
rectum by way of the anus. Barium is a sliver-white metallic compound that
helps to show the image of the lower gastrointestinal tract on an x-ray.
- Intravenous pyelogram: A series of x-rays of the kidneys, ureters, and
bladder to help determine if cancer has spread outside the ovaries. The
x-rays are taken after a dye is injected into a blood vessel. The dye is
concentrated in the urine, which outlines the kidneys, ureters, and bladder
on the x-rays.
- CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are created by a
computer linked to an x-ray machine. This test is also called computed
tomography, computerized tomography, or computerized axial tomography.
- Biopsy: Removal of tissue for examination under a microscope. The tissue is
removed in a procedure called a laparotomy (a surgical incision made in the
wall of the abdomen).
Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the
patient's age and general health, the type and size of the tumor, and the stage
of the cancer.
** STAGES OF OVARIAN EPITHELIAL CANCER **
After ovarian epithelial cancer has been diagnosed, tests are done to find out
if cancer cells have spread within the ovaries or to other parts of the body.
The process used to find out if the cancer has spread within the ovary or to
other parts of the body is called staging. The information gathered from the
staging process determines the stage of the disease. It is important to know
the stage in order to plan the best treatment. An operation called a
laparotomy is usually done 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. The doctor will also perform a biopsy (cut out small pieces of
tissue 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 the Treatment Options by Stage
section).
The following stages are used for ovarian epithelial cancer:
-- Stage I --
In stage I, cancer is found in one or both of the ovaries. Stage I is divided
into:
- Stage IA: Cancer is found in a single ovary.
- Stage IB: Cancer is found in both ovaries.
- Stage IC: Cancer is found in one or both ovaries and one of the following is
true:
- Cancer is found on the outside surface of one or both ovaries.
- The tumor has ruptured the ovary wall.
- Cancer cells are found in fluid from the peritoneal cavity (the body cavity
that contains most of the organs in the abdomen). The fluid may already be
in the peritoneal cavity or it may be added by the doctor to wash the
peritoneum (tissue lining the peritoneal cavity).
-- Stage II --
In stage II, cancer is found in one or both ovaries and has spread into other
areas of the pelvis. Stage II is divided into:
- Stage IIA: Cancer has spread to the uterus and/or the fallopian tubes (the
long slender tubes through which eggs pass from the ovaries to the uterus).
- Stage IIB: Cancer has spread to other tissue within the pelvis.
- Stage IIC: Cancer has spread to the uterus and/or fallopian tubes and/or
other tissue within the pelvis and one of the following is true:
- Cancer is found on the outside surface of one or both ovaries.
- The tumor has ruptured the ovary wall.
- Cancer cells are found in fluid from the peritoneal cavity (the body cavity
that contains most of the organs in the abdomen). The fluid may already be
in the peritoneal cavity or it may be added by the doctor to wash the
peritoneum (tissue lining the peritoneal cavity).
-- Stage III --
In stage III, cancer is found in one or both ovaries and has spread to other
parts of the abdomen. Cancer has spread to the surface of the liver. Stage
III is divided into:
- Stage IIIA: The tumor is found only in the pelvis, but cancer cells have
spread to the surface of the peritoneum (tissue that lines the abdominal wall
and covers most of the organs in the abdomen).
- Stage IIIB: Cancer has spread to the peritoneum but is not larger than 2
centimeters (less than 1 inch) in diameter.
- Stage IIIC: Cancer has spread to the peritoneum and is larger than 2
centimeters in diameter and/or has spread to lymph nodes in the abdomen.
Lymph nodes are small bean-shaped structures found throughout the body. They
filter substances in a fluid called lymph and help fight infection and
disease.
-- Stage IV --
In stage IV, cancer is found in one or both ovaries and has metastasized
(spread) beyond the abdomen to other parts of the body. Cancer is found in the
tissues of the liver.
** RECURRENT OVARIAN EPITHELIAL CANCER **
Recurrent ovarian epithelial cancer is cancer that has recurred (come back)
after it has been treated.
** TREATMENT OPTION OVERVIEW **
There are treatments for all patients with ovarian epithelial cancer.
Different types of treatment are available for patients with ovarian epithelial
cancer. Some treatments are standard, and some are being tested in clinical
trials. Before starting treatment, patients may want to think about taking
part in a clinical trial. A treatment clinical trial is a research study meant
to help improve current treatments or obtain information on new treatments for
patients with cancer. 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.
Clinical trials are taking place in many parts of the country. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov). Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care team.
Three kinds of standard treatment are used. These include the following:
-- Surgery --
Most patients have surgery to remove as much of the tumor as possible.
Different types of surgery may include:
- Hysterectomy (removal of the ovaries, fallopian tubes, and uterus).
- Unilateral salpingo-oophorectomy (removal of one ovary and one fallopian
tube).
- Bilateral salpingo-oophorectomy (removal of both ovaries and both fallopian
tubes).
- Omentectomy (partial removal of the lining of the abdominal cavity).
- Lymph node biopsy (removal of lymph nodes for examination under a microscope
to check for cancer cells).
-- Radiation therapy --
Radiation therapy is the use of x-rays or other types of radiation to kill
cancer cells and shrink tumors. Radiation therapy may use external radiation
(using a machine outside the body) or internal radiation. Internal radiation
involves putting radioisotopes (materials that produce radiation) through thin
plastic tubes into the area where cancer cells are found.
Some women receive a treatment called intraperitoneal radiation therapy, in
which radioactive liquid is put directly in the abdomen through a catheter.
-- Chemotherapy --
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be
taken by mouth or it may be put into the body by inserting a needle into a vein
or muscle. Either type of chemotherapy is called systemic treatment because
the drugs enter the bloodstream, travel through the body, and can kill cancer
cells throughout the body. Another way to give chemotherapy is intraperitoneal
chemotherapy (delivering the drug directly into the abdomen through a
catheter). With this method, most of the drug remains in the abdomen.
Other types of treatment are being tested in clinical trials:
- Biological therapy is treatment to stimulate the ability of the immune system
to fight cancer. Substances made by the body or made in a laboratory are
used to boost, direct, or restore the body's natural defenses against
disease. Biological therapy is sometimes called biological response modifier
(BRM) therapy or immunotherapy.
- High-dose chemotherapy with bone marrow transplantation or peripheral blood
stem cell transplantation. Chemotherapy can reduce the ability of bone
marrow to make blood cells. Bone marrow transplantation and peripheral
blood stem cell transplantation have been tested as ways to help the blood
recover so that higher than standard doses of chemotherapy can be given.
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE I OVARIAN EPITHELIAL CANCER **
Treatment of stage I ovarian epithelial cancer may include the following:
- Hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Lymph nodes
and other tissues in the pelvis and abdomen are removed and examined under
the microscope to look for cancer cells.
- Hysterectomy, unilateral salpingo-oophorectomy, and omentectomy. Lymph nodes
and other tissues in the pelvis and abdomen are removed and examined under
the microscope to look for cancer cells.
- Internal or external radiation therapy.
- Chemotherapy.
- Watchful waiting (careful observation without immediate treatment).
- A clinical trial.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site (http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE II OVARIAN EPITHELIAL CANCER **
Treatment of stage II ovarian epithelial cancer may be:
- Surgery to remove the tumor, hysterectomy, bilateral salpingo-oophorectomy,
and omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are
removed and examined under the microscope to look for cancer cells.
After surgery, treatment may include the following:
- Combination chemotherapy and internal or external radiation therapy.
- Combination chemotherapy alone.
- A clinical trial.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site (http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE III OVARIAN EPITHELIAL CANCER **
Treatment of stage III ovarian epithelial cancer may be:
- Surgery to remove the tumor, hysterectomy, bilateral salpingo-oophorectomy,
and omentectomy.
After surgery, treatment may include the following:
- Combination chemotherapy.
- Combination chemotherapy followed by second-look surgery (surgery performed
after the initial surgery to determine whether tumor cells remain).
- A clinical trial.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site (http://cancer.gov).
** TREATMENT OPTIONS FOR STAGE IV OVARIAN EPITHELIAL CANCER **
Treatment of stage IV ovarian epithelial cancer is combination chemotherapy
with or without surgery to reduce the size of the tumor.
** TREATMENT OPTIONS FOR RECURRENT OVARIAN EPITHELIAL CANCER **
Treatment of recurrent ovarian epithelial cancer may include the following:
- Chemotherapy with or without surgery.
- A clinical trial of chemotherapy or biological therapy (treatment to
stimulate or restore the ability of the immune system to fight cancer).
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site
(http://cancer.gov).
** TO LEARN MORE **
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and a
trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) provides online access to
information on cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and their families. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of cancer
treatment, coping with cancer, and clinical trials. Some publications provide
information on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on these and other
topics may be ordered online or printed directly from the NCI Publications
Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be
ordered by telephone from the Cancer Information Service toll-free at
1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m.
Eastern time, Monday through Friday. Information Specialists can help Internet
users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the NCI's Web site. PDQ is provided as a
service of the NCI. The NCI is part of the National Institutes of Health, the
federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on
cancer prevention, detection, genetics, treatment, supportive care, and
complementary and alternative medicine. Most summaries are available in two
versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in
easy-to-understand, non-technical language. Both versions provide current and
accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and
reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are
responsible for writing and maintaining the cancer information summaries. The
summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a
clinical trial. A clinical trial is a study to answer a scientific question,
such as whether one treatment is better than another. Trials are based on past
studies and what has been learned in the laboratory. Each trial answers
certain scientific questions in order to find new and better ways to help
cancer patients. During treatment clinical trials, information is collected
about new treatments, the risks involved, and how well they do or do not work.
If a clinical trial shows that a new treatment is better than one currently
being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are
available in health professional and patient versions. Many cancer doctors who
take part in clinical trials are also listed in PDQ. For more information,
call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at
1-800-332-8615.
Date Last Modified: 09/2002
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* If you want to know more about cancer and how it is treated, or if you *
* 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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