Ovarian Cancer

Topic Overview

What is ovarian cancer?

Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries . This topic is about epithelial ovarian cancer, the most common type.

This cancer is often cured when it is caught early. But most of the time, the cancer has already spread by the time it is found.

It is frightening to hear that you or someone you love may have ovarian cancer. It may help to talk with your doctor or join a support group to deal with your feelings.

What causes ovarian cancer?

Experts do not know exactly what causes ovarian cancer. But they do know that DNA changes play a role in many cancers.

Some women are more likely than others to get this rare cancer. Women who are past menopause or who have never been pregnant are more likely to get ovarian cancer.

What are the symptoms?

In some cases, ovarian cancer may not cause early symptoms. But most women do have symptoms, even in early-stage ovarian cancer. These symptoms include recent, frequent bloating; pain in the belly or pelvis; difficulty eating or feeling full quickly; or urinary problems, such as an urgent need to urinate or urinating more often than usual.

Other symptoms that women with ovarian cancer may have include fatigue, indigestion, back pain, pain with intercourse, constipation, and changes in their menstrual cycles. But these symptoms are also common in women who don't have ovarian cancer.

How is ovarian cancer diagnosed?

Sometimes the doctor may feel a lump in or on an ovary during a routine pelvic exam . Often a lump may be seen during an ultrasound . Most lumps are not cancer.

The only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery. The doctor makes a cut (incision) in the belly so that he or she can look inside. The doctor will remove bits of any tumors that are found and send them to a lab to confirm that they contain cancer.

There is a blood test called CA-125 (cancer antigen 125) that is sometimes done to look for cancer in women at high risk. So far, there is not enough proof to show that this test works to find ovarian cancer early in most women. Too much CA-125 in the blood can be caused by many things, such as the menstrual cycle, endometriosis, and uterine fibroids, as well as many types of cancer.

How is it treated?

Surgery is the main treatment. The doctor will remove any tumors that he or she can see. This usually means taking out one or both ovaries. It may also mean taking out the fallopian tubes and uterus. After surgery, most women have several months of chemotherapy , which means taking drugs that kill cancer cells.

This cancer often comes back after treatment. So you will need regular checkups for the rest of your life. If your cancer does come back, treatment may help you feel better and live longer.

Ovarian cancer is very serious, but many women do survive it. It depends on your age and overall health, how far the cancer has spread, and how much cancer is left behind during surgery.

It may help to talk to other women who are going through the same thing. People who take part in support groups usually feel better, sleep better, and feel more like eating. Your doctor or your local branch of the American Cancer Society can help you find a support group. You can also look on the Internet to find support sites where women with this cancer can talk to each other.

What are your chances of getting ovarian cancer?

This cancer most often affects women who are past menopause. Women are more likely to get ovarian cancer if others in their family have had it. They are more likely to get it if they have had breast cancer.

You may also be more likely to get this cancer if:

You never had a baby.
You started your menstrual cycles before age 12 and went through menopause after age 50.
You are unable to become pregnant.
You have used hormone replacement therapy for menopause symptoms.

Frequently Asked Questions

Learning about ovarian cancer:	What is ovarian cancer? What causes it? What are the symptoms? What increases my chance of ovarian cancer? How common is it? How does family history affect my chances of getting ovarian cancer? Should I have a gene test for breast and ovarian cancer? Should I have my ovaries removed to prevent ovarian cancer?
Being diagnosed:	How is ovarian cancer found? What are the stages of ovarian cancer? What tests will I need? Do I need to see a specialist?
Getting treatment:	How is ovarian cancer treated? Will I need surgery? What medicines will I need to take? What other treatments are there?
Ongoing concerns:	What happens if my cancer comes back?
Living with ovarian cancer:	What can I do at home to relieve the side effects of treatment? Will I be able to have children?
Care at the end of life issues:	What is care at the end of life? What is hospice care?

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.


	Decision Points focus on key medical care decisions that are important to many health problems.
	Breast cancer risk: Should I have a BRCA gene test?
	Ovarian cancer: Should I have my ovaries removed to prevent ovarian cancer?

	Actionsets are designed to help people take an active role in managing a health condition.
	Cancer: Controlling nausea and vomiting from chemotherapy

Cause

Experts do not know exactly what causes ovarian cancer . Genetics, such as DNA changes, are a risk factor for some women.

A family history of ovarian or breast cancer is found in 10% to 20% of women with ovarian cancer.¹ In general, fewer than 2 out of 100 women (less than 2%) will get ovarian cancer in their lifetime. That risk goes up to 4 or 5 out of 100 if one family member has had ovarian cancer, and 7 out of 100 if two relatives have had it. But if at least two first-degree relatives (meaning mother, sister, or daughter) have had ovarian cancer, the risk is 25 to 50 out of 100 (25% to 50%).²

Women who inherit changes ( genetic mutations) in the BRCA1 and BRCA2 genes have a higher chance of developing ovarian cancer and breast cancer. Women who inherit the gene change in BRCA1 have a lifetime chance of 20 to 60 out of 100 of getting ovarian cancer. For women who inherit the gene change in BRCA2, the lifetime chance is 10 to 35 out of 100.³

You have a higher chance of developing ovarian cancer if you:

Are unable to become pregnant ( infertility ).
Have never had a baby.
Have not used hormonal birth control methods. Hormonal methods change the normal cycle of the female hormones, estrogen and progesterone , so ovulation does not occur each month.

If you have a strong family history of ovarian or breast cancer, you may want to talk with your doctor or a genetic counselor about having a blood test to look for BRCA1 and BRCA2 gene changes. Women who inherit these changes in one or both of these genes have a higher chance of developing ovarian cancer, breast cancer, or both.

Symptoms

In some cases, ovarian cancer may not cause early symptoms. But most women do have symptoms, even in the early stages. The most common symptoms of ovarian cancer include:⁴

Recent, frequent bloating.
Pain in your belly or pelvis.
Difficulty eating or feeling full quickly.
Urinary problems, such as an urgent need to urinate or urinating more often than usual.

If you have one or more of these symptoms, and it occurs almost daily for more than 2 or 3 weeks, talk with your doctor.

These symptoms are common for some women, and they may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a specific pattern:

They start suddenly.
They feel different than your normal digestive or menstrual problems.
They happen almost every day and don't go away.

Other symptoms that affect some women with ovarian cancer include:

Fatigue.
Indigestion.
Back pain.
Pain with intercourse.
Constipation.
Menstrual cycle changes.

But these symptoms are also common in some women who don't have ovarian cancer.

What Happens

Ovarian cancer spreads when cancerous (malignant) cells enter the abdominal cavity . The cancer cells then grow on the peritoneal lining of the abdomen and other abdominal organs. In its advanced stage, ovarian cancer usually spreads to the lymph nodes and to other organs in the pelvis. This may cause kidney and bowel problems. Cancer may also spread to other organs in the body, such as the liver and lungs.

Cancer from other areas of the body can also spread to the ovaries. This most commonly occurs in cancers that involve the breast, stomach, colon, and the lining of the uterus (endometrium).⁵

Laparotomy is surgery that is done to confirm that cancer is present, to provide initial treatment, and to stage the cancer with biopsies of abdominal tissue, peritoneal fluid , and lymph nodes . The long-term outcome (prognosis) of ovarian cancer depends on the stage of your cancer when it is diagnosed.

What Increases Your Risk

Risk factors for ovarian cancer include:

A family history. Between 10% and 20% of women with ovarian cancer have a close female relative who had ovarian or breast cancer.¹ Women with a family history may develop ovarian cancer at an earlier age, such as in their 40s, rather than at the more typical age of postmenopausal women in their 50s. Women who have BRCA1 or BRCA2 gene mutations have between a 16% and 60% chance of developing ovarian cancer during their lifetimes.⁶
Increasing age. Ovarian cancer most often affects postmenopausal women.
Never having a baby.
Starting menstrual cycles before age 12 and going through menopause at an older age. The more menstrual cycles you have, the more risk you have for ovarian cancer.
Being unable to become pregnant ( infertility ). Women who do not use birth control and are sexually active but who are unable to become pregnant may have a higher chance for ovarian cancer.
Use of estrogen or hormone replacement therapy . Some studies have shown that some women who use these hormones have a slightly increased risk of developing ovarian cancer, and other studies have shown no increased risk.^7, ^8, ⁹ In general, experts advise women considering hormone replacement therapy for symptoms of menopause to take the smallest dose possible to control symptoms, and to take the medicine for the shortest time that they can.
Women who are of Ashkenazi Jewish ancestry (Jews whose ancestors came from Eastern Europe) may have an increased risk because of changes to the BRCA1 or BRCA2 genes. Women with this ancestry have higher rates of these gene changes.

Should I have a gene test for breast and ovarian cancer?
Polycystic ovary syndrome (PCOS) . Elevated levels of male hormones (androgens) commonly found in PCOS may increase your risk for ovarian cancer.¹⁰
A history of breast cancer . Women with a personal history of breast cancer or a family history of breast cancer have a higher risk for ovarian cancer.

When To Call a Doctor

In some cases, ovarian cancer may not cause early symptoms. But most women do have symptoms, even in the early stages. These symptoms may be caused by other problems. But if you have one or more of the following symptoms, and it occurs almost daily for more than 2 or 3 weeks, talk to your doctor:

Recent, frequent bloating.
Pain in your belly or pelvis.
Difficulty eating or feeling full quickly.
Urinary problems, such as feeling an urgent need to urinate or urinating more often than usual.

These symptoms may be common for some women, and they may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a specific pattern:

They start suddenly.
They feel different than your normal digestive or menstrual problems.
They happen almost every day and don't go away.

The symptoms may not seem bad enough for a woman to seek medical care. But getting medical care right away may help find ovarian cancer at an early stage. A woman has a better chance of successful treatment when ovarian cancer is found early.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your condition or symptoms without using medical treatment. Watchful waiting is not appropriate if you have symptoms that do not go away. If you are concerned about your symptoms and you have a higher risk for ovarian cancer, call and make an appointment with your doctor.

Who To See

Health professionals who can evaluate your symptoms and your risk for ovarian cancer include:

Doctors who can manage your cancer treatment include:

Gynecologic oncologist . Your long-term outcome (prognosis) is improved if you are under the care of an experienced gynecologic oncologist. His or her expertise can help determine the best treatment choices at the time of the initial surgery.⁴
Medical oncologist (often called an "oncologist").

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

There are no reliable screening tests for ovarian cancer .

Some initial exams and tests are done before surgery if ovarian cancer is suspected. These tests include:

Your medical history, to check what symptoms you have and what your chance of developing ovarian cancer is.
A physical exam, including a pelvic exam and Pap test . An ovarian lump may be felt during a pelvic exam. A rectovaginal exam may also be done to feel the pelvic organs.
A complete blood count (CBC), to check for anemia and other abnormal blood values.
A chemistry screen, to check for liver and kidney problems.
A human chorionic gonadotropin (hCG) level, which may be done to rule out pregnancy or an ectopic pregnancy .
A cancer antigen 125 (CA-125) level, to measure a protein found on the surface of many ovarian cancer cells.
A pelvic and transvaginal ultrasound, to look for an ovarian lump.

More tests may be done before surgery to determine if other areas of the body are involved. These tests include:

A pelvic or abdominal CT scan or MRI to check for the spread of cancer.
A chest X-ray to check for the spread of cancer.

Surgery, usually a laparotomy , is done to confirm that cancer is present, to provide initial treatment, and to stage the cancer.

Early Detection

For most women, the United States Preventive Services Task Force (USPSTF) does not recommend having a CA-125 blood test or a transvaginal ultrasound to find ovarian cancer early.¹¹ There is no proof that having regular tests helps women live longer by finding ovarian cancer early. Still, experts recommend that women who have inherited a BRCA gene change and have not had their ovaries removed have a transvaginal ultrasound and a CA-125 blood test at least once a year, starting at age 35. Women who have inherited a BRCA1 gene change (not a BRCA2 gene change) may want to start having these regular tests as early as age 25.¹²

Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children (preserve fertility) must also be considered.

Surgery is done to confirm and treat cancer. Removal of all cancerous tissue and taking biopsies to check for the spread of cancer (surgical staging) is important for diagnosis and treatment, because the amount of cancer remaining (residual cancer) after the initial surgery may affect your outcome.
Chemotherapy , which uses medicines to kill cancer cells, is recommended after surgery for most stages of ovarian cancer. Chemotherapy that is given after a surgery is called adjuvant therapy .

Initial treatment

The goal of the initial surgery is to remove all visible cancer. The type of surgery you will need depends on the stage of your cancer and if you want to be able to have children after having the surgery.

If you have early-stage (stage I and low-grade [grade 1]) cancer and you wish to have children, your surgery may include:

Removal of your cancerous ovary and fallopian tube .
A biopsy of your other ovary.
Removal of fatty tissue (omentum) that is attached to some of the abdominal organs.
Removal of lymph nodes in the pelvis and near the large blood vessel (aorta) in the belly.
Biopsies of other tissues and peritoneal fluids (peritoneal washings) from the belly to look for cancer cells.

Your uterus and the healthy ovary will remain, so it may be possible for you to become pregnant.

If you have a more advanced stage (stage II, III, or IV) of cancer, or you have stage I and do not want to have children, your surgery may include:

A hysterectomy, which removes your uterus, and a salpingo-oophorectomy, which removes your ovaries and fallopian tubes.
Collection of peritoneal fluid.
Removal of pelvic and aortic lymph nodes (lymph node dissection).
Removal of fatty tissue (omentum).
Removal of as much cancerous tissue as possible.
Biopsies of any tissue that may be cancerous.

Because this surgery removes all the reproductive organs, you will not be able to become pregnant after having it.

Chemotherapy is recommended after surgery for most women. Paclitaxel (Taxol) and carboplatin or cisplatin are commonly used medicines. The number of treatment cycles you have will depend on the stage of your disease. Chemotherapy may be given into a vein ( intravenous, or IV ). Or it may be given into your belly (intraperitoneal, or IP). Studies show that women who have IP treatment live longer than women who have IV treatment. But the side effects are worse with IP treatment.

Home treatment measures may help relieve some of the common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.

If you have not yet gone through menopause and both of your ovaries are removed, you will develop symptoms of menopause. Talk with your doctor about medicines to manage these symptoms.

If you have recently been diagnosed with ovarian cancer , you may experience a wide variety of emotions in reaction to having cancer. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to having cancer. You can take steps to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their cancer.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after being diagnosed with cancer such as yours can help you accept and deal with your cancer.

What to think about during initial treatment

In about 70% of women with ovarian cancer, the cancer has already spread (metastasized) outside the pelvis by the time it is diagnosed.¹³ Advanced-stage cancer spreads most commonly to the lining of the abdominal cavity , the pelvic lymph nodes , and the fatty tissue around some of the abdominal organs.

Your long-term outcome depends on your age, the stage and grade of your cancer, and the amount of cancer remaining after your initial surgery.

The side effects of chemotherapy will depend on the medicines that are used and how the medicines are given. Both intravenous (IV) and intraperitoneal (IP) chemotherapy may cause side effects, such as fever, a weakened immune system , and hearing loss. But IP causes more infections, belly pain, nausea and vomiting, and nerve damage.¹⁴ Your quality of life becomes a critical issue when considering your treatment choices. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

You may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of ovarian cancer.

For more information about specific ovarian cancer treatments, see the topics:

Ovarian Cancer – Health Professional Information [NCI PDQ].

Ovarian Cancer – Patient Information [NCI PDQ].

Ongoing treatment

After initial treatment for ovarian cancer , it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment, depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your gynecologic oncologist or oncologist will schedule regular checkups, usually every 3 months for the first 2 years after treatment. Your doctor may then recommend checkups every 6 to 12 months depending on your stage of cancer. These checkups will include:

A physical exam of your neck, lungs, and abdomen, and a pelvic exam to check for recurring cancer or swollen lymph nodes .
A CA-125 blood test to see if the cancer has returned.
An abdominal and pelvic CT scan or MRI to check to see if cancer has spread, especially when new symptoms, such as belly pain, are present or if CA-125 levels are high.

Second-look surgery, after 6 cycles of chemotherapy, may be done in research studies or clinical trials if no sign of cancer is found during a physical exam; in blood tests; or with X-ray, CT, or MRI. More biopsies are done at the time of second-look surgery to determine the need for more treatment. Second-look surgery is not recommended as standard treatment because of the chance of complications and because it does not clearly increase survival rates.

Treatment if the condition gets worse

The long-term outcome (prognosis) for ovarian cancer that has returned after treatment (is recurrent) depends on whether the cancer has spread. Even with no sign of cancer after treatment, between 30% and 50% of women who are treated for ovarian cancer have cancer return within 5 years.⁵ Women who have cancer return within 6 months after their initial treatment are less likely to respond to more treatment with the same chemotherapy medicines than women whose cancer has returned more than 6 months after their initial treatment. Other chemotherapy medicines may be recommended for further treatment.

Palliative care

If your cancer gets worse, you may want to think about palliative care . Palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

Some treatments for recurrent ovarian cancer, such as chemotherapy and radiation, are considered palliative care. These treatments cannot cure your cancer, but they can extend your life, control your symptoms, reduce your pain, and make you feel more comfortable.

In addition to helping your body feel better, palliative care can help you feel better emotionally and spiritually. Talking with a palliative care provider may help you cope with your feelings about living with a long-term illness. It may also help your loved ones better understand your illness and how to support you. Or it could help you make future plans concerning your health and medical care.

If you are interested in palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.

For more information, see the topic Palliative Care.

Complementary therapies

In addition to conventional medical treatment, you may wish to try complementary therapies to help manage your symptoms. But complementary therapies are not a substitute for conventional medical treatment that is recommended for ovarian cancer. Complementary therapies include:

Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Visualization.
Vitamins and nutritional supplements.

Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

What To Think About

Some women with ovarian cancer may be interested in participating in research studies called clinical trials . Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries, for all stages of ovarian cancer.

Most treatments for ovarian cancer cause side effects. The side effects that you have depend on the type of treatment used, your age, and your overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
Side effects of surgery depend on how much surgery was done to treat the stage of your cancer.

Nausea and vomiting are side effects of chemotherapy for ovarian cancer. Your doctor can prescribe medicines to control nausea and vomiting.Talk to your doctor about what to expect and when you should call if you are having nausea or vomiting. Home treatment measures can also help you manage other side effects of treatment.

End-of-life issues

Some women with advanced-stage cancer may choose not to have treatment focused on prolonging life because they decide that for them the time, costs, and side effects of treatment are greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Care at the End of Life

Hospice Care

Prevention

Ovarian cancer cannot be prevented, but you may be able to reduce some of your chances for developing it.

Women may lower their risk of ovarian cancer by using birth control pills. This includes women who have a family history of ovarian cancer. Taking birth control pills for 5 years has been shown to reduce ovarian cancer risk by 50%.¹⁵ The protection lasts for many years after the pills were taken. The use of birth control pills may also help some women who have BRCA gene changes. But birth control pills have been linked to a slight increase in breast cancer and may have other health risks, so talk with your doctor about the risks and benefits before taking birth control pills.

Having surgery to close or tie off your fallopian tubes (bilateral tubal ligation ) will lower your chances of developing ovarian cancer.² But you will not be able to become pregnant after having this surgery. Talk to your doctor about whether this choice is right for you.

Having one or more babies lowers your chances for ovarian cancer. Breast-feeding for at least one year also lowers your chances.¹⁶

A small number of women with ovarian cancer have a first-degree female relative—such as a sister, mother, or daughter—or a second-degree female relative—such as an aunt or grandmother—who has had ovarian cancer. Changes (mutations) in two major genes, BRCA1 and BRCA2, are most closely related to a higher lifetime chance for ovarian cancer in these families.¹⁷ You may consider a BRCA gene test if you have a family history of ovarian cancer.

For women with BRCA gene changes, experts recommend considering surgery to remove the ovaries and fallopian tubes between ages 35 to 40, or when a woman is done having children.¹² This preventive surgery reduced the risk of ovarian cancer by 96%, according to one study. It also reduced the risk for breast cancer in these women by 50%.³

But because preventive surgery is such an important and personal decision, be sure to talk with your doctor about the risks and benefits. Removal of the ovaries in premenopausal women will cause early menopause . Removal of your ovaries may increase the risk for developing other problems, such as osteoporosis and cardiovascular disease . It may also increase the risk of death in women at average risk of ovarian cancer.¹⁸

There is still a small chance of getting ovarian cancer, even after the ovaries are removed. This is because there can already be a tiny cancer growing before the ovaries are removed. Those cancer cells can remain in the body after the surgery, where they continue to grow. It is also possible to develop cancer on the smooth tissue lining the abdominal cavity ( peritoneum ). This type of cancer—called peritoneal cancer—looks like ovarian cancer, has similar symptoms, and is treated in the same way.

Should I have a gene test for breast and ovarian cancer?

Should I have my ovaries removed to prevent ovarian cancer?

Including lots of fruits and vegetables in your diet may help protect against ovarian cancer.⁷

Home Treatment

During medical treatment for any stage of ovarian cancer , there are things you can do at home to help manage the side effects that may be caused by the cancer or its treatment. Home treatment may help manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration , such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Chemotherapy medicines used to treat ovarian cancer can cause severe nausea and vomiting. Your doctor also can prescribe medicines to control nausea and vomiting. Contact your doctor if you have ongoing nausea and vomiting. For more information on how to deal with these side effects, see:

Cancer: Controlling nausea and vomiting from chemotherapy.
Home treatment for diarrhea includes waiting to eat for several hours after having diarrhea to rest your stomach and watching for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.
Home treatment for constipation includes drinking a lot of fluids and including fruits, vegetables, and fiber in your diet each day. Do not use a laxative without consulting your doctor.

Other issues that may arise include:

Sleep problems. If you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day.
Fatigue. If you have very little energy and become weak easily, you can help your fatigue by getting extra rest, eating a well-balanced diet, and reducing your stress.
Urinary problems caused either by ovarian cancer or its treatment. You can help manage your urinary problems by eliminating caffeinated drinks from your diet and establishing a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
Hot flashes , especially if both ovaries were removed in your surgery. Some tips for managing hot flashes include drinking cold beverages rather than hot ones, limiting your intake of caffeine and alcohol, and dressing in layers so you can remove clothing as needed.
Hair loss. This may be unavoidable, but using mild shampoos and not using damaging hair products will lower the irritation of your scalp.

Many women with ovarian cancer face emotional issues as a result of their cancer or its treatment.

Finding out that you have cancer and having treatment are stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques—such as meditation—and support groups may be helpful.
Your feelings about your body may change following treatment for cancer. Managing your body image issues may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to organizations that can offer additional support and information.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many treatments are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Talk to your doctor if prescribed medicines are not controlling your pain.

For mild pain, you can take pain relievers that you can buy without a prescription, such as acetaminophen (Tylenol), ibuprofen (for example, Advil or Motrin) or similar medicines . Or you may try an alternative therapy, such as biofeedback , to help your physical and mental well-being. Be sure to tell your doctor about any home treatment you use for pain.

Some women who have advanced-stage cancer may choose not to have treatment because they decide that for them the time, costs, and side effects outweigh the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the following topics:

Care at the End of Life

Hospice Care

Medications

Chemotherapy is used to shrink ovarian cancer and slow cancer growth. Chemotherapy is recommended for most women after the initial surgery for ovarian cancer.

Medication Choices

Different chemotherapy drugs are given in different ways. Some are taken by mouth (oral), some are injected into a vein ( intravenous, or IV ), and others are injected through a thin tube into the belly (intraperitoneal, or IP). Oral and IV chemotherapy is called a systemic treatment because the medicines enter the bloodstream, travel through the body, and kill cancer cells both inside and outside the ovaries. In intraperitoneal chemotherapy, the drug is put into the body in the same area as the cancer. It is not a systemic treatment, but a little of the medicine still gets into the bloodstream.

Extensive research and clinical trials have studied the different chemotherapy medicines used to treat ovarian cancer. There are several drugs to treat ovarian cancer. Some are used alone, and some are combined with other drugs. Your doctor will recommend chemotherapy treatment that is specifically tailored to you.

Chemotherapy is recommended after surgery for most women with ovarian cancer. The number of cycles of treatment will depend on the stage of your disease. The side effects will depend on the medicines that are used and how the medicines are given. Some of the chemotherapy medicines used for ovarian cancer include:

Carboplatin.

Cisplatin.

Paclitaxel.

Docetaxel.

Other medicines that may be used if ovarian cancer recurs include:

Cyclophosphamide.

Doxorubicin.

Gemcitabine.

Topotecan.

Oxaliplatin.

Treatment of ovarian cancer with chemotherapy can cause nausea and vomiting. Your doctor will prescribe medicinesyou can take with your treatments and when you get home, to help relieve any nausea that you may have.

What To Think About

Most chemotherapy causes some side effects. Home treatment may help manage your symptoms. If your doctor has given you instructions or medicines to treat your symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Surgery

Surgery for ovarian cancer

Your doctor confirms that you have ovarian cancer and determines its extent (or stage) by taking biopsies during laparotomy surgery. Your long-term outcome (prognosis) is improved under the care of an experienced gynecologic oncologist whose expertise can help determine the best treatment choices at the time of surgery.⁴ Your surgery may include:

A hysterectomy, which removes your uterus, and salpingo-oophorectomies, which remove your ovaries and fallopian tubes.
Taking a sample of peritoneal fluid (peritoneal washings) from the abdominal cavity to look for cancer cells.
Removing and checking the pelvic and aortic lymph nodes, to see if the cancer has spread.
Checking the abdominal organs and tissues for cancer cells. Biopsies may be done.
Removing and checking the fatty tissue (omentum) attached to some of the abdominal organs, to see if the cancer has spread.
An appendectomy, which removes your appendix.

Surgery Choices

If you have very early-stage ovarian cancer and wish to have children (preserve fertility), discuss your choices with your doctor.

Most women who have advanced-stage cancer have a hysterectomy to remove the uterus and an oophorectomy to remove both ovaries. The fallopian tubes are usually removed also.

In advanced-stage surgery, your surgeon will take a sample of peritoneal fluid, remove lymph nodes and fatty tissue (omentum), and remove any abdominal tissue that is thought to have cancer.

What To Think About

Side effects from your surgery can include difficulty urinating or problems with bowel functioning, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

If your ovaries are removed, you may have symptoms of menopause . Talk with your doctor about medicines to manage these symptoms.

Ovarian cancer may grow and spread to the point that it blocks the bowel . Or the first surgery to remove the cancer may cause problems, such as a blocked bowel. For more information, see the topic Bowel Obstruction.

Other Treatment

Complementary therapies alone are not a substitute for the standard treatment recommended for ovarian cancer . Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies.

Other Treatment Choices

Complementary therapies include:

Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Visualization.
Vitamins and nutritional supplements.

For more information, see the topic Complementary Medicine.

What To Think About

The combination of conventional medical treatment and complementary medicine is an approach that is sometimes called integrative medicine, in which both conventional and complementary therapies are used together for the best outcome. Complementary therapies alone are not a substitute for the standard treatment recommended for ovarian cancer.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 toll-free
Web Address:	www.cancer.org

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.

Cancer.Net
Phone:	1-888-651-3036 (571) 483-1300
Fax:	(571) 366-9530
E-mail:	foundation@asco.org
Web Address:	www.cancer.net

Cancer.Net is the information Web site of the American Society of Clinical Oncology (ASCO) for people living with cancer and for those who care for them. ASCO is the world's leading professional organization representing physicians of all oncology subspecialties. Cancer.Net provides current oncologist-approved information on living with cancer.

National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:	1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:	1-800-332-8615
E-mail:	cancergovstaff@mail.nih.gov
Web Address:	www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people with cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.

National Ovarian Cancer Coalition
2501 Oak Lawn Avenue
Suite 435
Dallas, TX 75219
Phone:	(214) 273-4200 1-888-OVARIAN (1-888-682-7426) helpline
Fax:	(214) 273-4201
E-mail:	nocc@ovarian.org
Web Address:	www.ovarian.org

The National Ovarian Cancer Coalition works to raise awareness about ovarian cancer and to improve the survival rate and the quality of life for women with ovarian cancer. This Web site offers information for women who have just discovered that they have ovarian cancer. It also has sections for survivors and caregivers; the section for caregivers includes information on how to talk about having cancer to children and also how to do your own research on the internet.

Ovarian Cancer National Alliance
910 17th Street NW
Suite 1190
Washington, DC 20006
Phone:	(202) 331-1332 1-866-399-6262 toll-free
Fax:	(202) 331-2292
E-mail:	ocna@ovariancancer.org
Web Address:	www.ovariancancer.org

The Ovarian Cancer National Alliance was formed to link individuals and organizations into a national movement to find a cure for ovarian cancer. The alliance would like every woman to know the symptoms of ovarian cancer and be diagnosed earlier, and every woman with ovarian cancer to live a longer, better life. This Web site has information on what people can do to advance ovarian cancer research and to help women learn about risk factors and how to get good medical treatment.

Women's Cancer Network
Gynecologic Cancer Foundation
230 West Monroe
Suite 2528
Chicago, IL 60606
Phone:	(312) 578-1439
Fax:	(312) 578-9769
E-mail:	info@thegcf.org
Web Address:	www.wcn.org

The Women's Cancer Network (WCN) is an interactive Web site developed by the Gynecologic Cancer Foundation. Their goal is to help women who have developed cancer. Links at this Web site offer information on different types of cancer, treatment options, ways to improve quality of life, genetics and hereditary cancer risks, and other background information, such as understanding test results.

Related Information

Endometrial (Uterine) Cancer

References

Citations

Wooster R, Weber BL (2003). Breast and ovarian cancer. New England Journal of Medicine, 348(23): 2339–2347.

Ozols RF, et al. (2005). Epithelial ovarian cancer. In WJ Hoskins et al., eds., Principles and Practice of Gynecologic Oncology, 4th ed., chap. 25, pp. 895–987. Philadelphia: Lippincott Williams and Wilkins.

Cannistra SA, et al. (2008). Ovarian cancer, fallopian tube carcinoma, and peritoneal carcinoma. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 1568–1594. Philadelphia: Lippincott Williams and Wilkins.

National Comprehensive Cancer Network (2009). Ovarian cancer, including fallopian tube cancer and primary peritoneal cancer. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/ovarian.pdf.

Brennan K, et al. (2007). Premalignant and malignant disorders of the ovaries and oviducts. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 971–884. New York: McGraw-Hill.

National Comprehensive Cancer Network and American Cancer Society (2008). Genetic/Familial High-Risk Assessment: Breast and Ovarian, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf.

Zografos GC, et al. (2004). Common risk factors of breast and ovarian cancer: recent view. International Journal of Gynecological Cancer, 14: 721–740.

Speroff L, Fritz MA (2005). Postmenopausal hormone therapy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 689–777. Philadelphia: Lippincott Williams and Wilkins.

Beral V, et al. (2007). Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet, 369(9574): 1703–1710.

Edmondson RJ, Monaghan JM (2001). The epidemiology of ovarian cancer. International Journal of Gynecological Cancer, 11: 423–429.

U.S. Preventive Services Task Force (2004). Screening for ovarian cancer. Available online: http://www.ahrq.gov/clinic/3rduspstf/ovariancan/ovcanrs.pdf.

National Cancer Institute (2007). Genetics of Breast and Ovarian Cancer (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/genetics/breast-and-ovarian/healthprofessional.

Cannistra SA (2007). Gynecologic cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 10. New York: WebMD.

Trimble EL, et al. (2008). Intraperitoneal chemotherapy for women with epithelial ovarian cancer. Oncologist, 13: 403–409.

Cass II, Karlan BY (2008). Ovarian and tubal cancers. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 1022–1060. Philadelphia: Lippincott Williams and Wilkins.

American Cancer Society (2008). Overview: Ovarian Cancer: What is Ovarian Cancer? Available online: http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_ovarian_cancer_33.asp?sitearea=.

National Cancer Institute (2002). Genetic testing for BRCA1 and BRCA2: It's your choice. Available online: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA.

Parker WH, et al. (2009). Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study. Obstetrics and Gynecology, 113(5): 1027–1037.

Other Works Consulted

Cass II, Karlan BY (2008). Ovarian and tubal cancers. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 1022–1060. Philadelphia: Lippincott Williams and Wilkins.

Coleman RL, Gershenson DM (2007). Neoplastic diseases of the ovary. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 839–881. Philadelphia: Mosby Elsevier.

Kehoe S, Morrison J (2009). Ovarian cancer (advanced), search date September 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

National Cancer Institute (2008). Ovarian Epithelial Cancer (PDQ): Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/healthprofessional.

Credits

Author	Bets Davis, MFA
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Tracy Landauer
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer	Ross Berkowitz, MD - Obstetrics and Gynecology
Last Updated	June 15, 2009