Ovarian Cancer

What is ovarian cancer?
Ovarian cancer is cancer that begins in the cells that constitute the ovaries, including surface epithelial cells, germ cells, and the sex cord-stromal cells.

What are risk factors for ovarian cancer?
While the presence of one or more risk factors may increase a woman’s chance of getting ovarian cancer, it does not necessarily mean she will get the disease. A woman should be extra vigilant in watching for early symptoms. Risk factors include:
> Personal or family history of breast, ovarian, endometrial, prostate or colon cancer;
> Hereditary nonpolyposis colorectal cancer or syndrome;
> Increasing age;
> Unexplained infertility, no pregnancies and no history of birth control pill usage;
> Use of high dose estrogen for long periods without progesterone may be a risk factor;
> North American or North European heritage and/or Ashkenazi Jewish population;
> Living in an industrialized country.

What are prevention strategies for ovarian cancer?
Most women have at least one of the risk factors and the common risk factors only slightly increase the risk for ovarian cancer. Prevention measures for ovarian cancer are still under investigation. There are several ways to reduce the risk of developing epithelial ovarian cancer. These include lifestyle and surgery choices. These do not guarantee that a woman will not develop ovarian cancer. It is important that a woman discusses her risk and options with her doctor.
> Oral contraceptives – Those who use oral contraceptives for 3 or more years lower their risk by about 30-50%. It is important to note that oral contraceptives can increase the risk for other diseases including breast cancer.
> Pregnancy and breast feeding – Having more than one child and breast feeding for at least one year may decrease the risk of ovarian cancer. Doctors do not recommend making a choice when to have a child for reducing the risk of ovarian cancer.
> Diet – Some studies indicate that a diet high in vegetables may reduce the risk of ovarian cancer. It is important to eat a diet low in fat and high in fruits and vegetables. This reduces the risk of other cancers and diseases.
> Tubal ligation or hysterectomy – Tubal ligation may reduce the chance of developing ovarian cancer up to 67%. Hysterectomy may also reduce the risk. It is not clear why these reduce the risk for ovarian cancer. These procedures should only be done for valid medical reasons.
> Genetic counseling – For women with a family history of ovarian cancer it may be beneficial to receive genetic counseling to determine the benefits of genetic testing.

Is screening available?
Currently, there are no established national screening guidelines for ovarian cancer. If a woman is at risk for ovarian cancer, she should discuss with her doctor options for screening.

What are the symptoms of ovarian cancer?
Ovarian cancer is difficult to detect, especially in the early stages. This is partly due to the fact that these two small, almond shaped organs are deep within the abdominal cavity, one on each side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:
> Unexplained change in bowel and/or bladder habits such as constipation, urinary frequency, and/or incontinence;
> Gastrointestinal upset such as gas, indigestion, and/or nausea
> Unexplained weight loss or weight gain;
> Pelvic and/or abdominal pain or discomfort;
> Pelvic and/or abdominal bloating or swelling;
> A constant feeling of fullness
> Fatigue
> Abnormal or postmenopausal bleeding;
> Pain during intercourse.

How is ovarian cancer diagnosed?
If there is any reason to suspect ovarian cancer, the doctor will use one or more methods to find out if the disease is really present. One of the first steps one should take is to meet with a doctor who has special training in treating women with this type of cancer ( a gynecologic oncologist). Following are some of the tests that could be done:
> Imaging Studies: These tests can show whether there is a mass in the pelvis, but they cannot tell if it is cancer.
> Ultrasound uses sound waves to create an image on a video screen. Because tumors and normal tissue reflect sound waves differently, this test may be useful in finding tumors and in telling whether a mass is solid or a fluid-filled cyst.
> CT scans are useful in showing how large the tumor is, whether lymph nodes are enlarged, and whether the tumor has spread to other organs.
> MRI scans are helpful in looking at the brain and spinal cord.
>Chest x-rays may be taken to see if the cancer has spread to the lungs.
> Laparoscopy (lap-uh-ROS-ku-pe) is another method that lets the doctor see the ovaries and other pelvic organs.
The only way to tell for certain if a growth in the pelvis is cancer involves a biopsy. Usually this requires removing the ovary, especially if imaging studies or tumor markers are suspicious. A sample of tissue or fluid is removed and looked at under a microscope to see if cancer cells are present.

What is staging?
Staging describes the extent of the cancer. It determines if the cancer has spread and if so, what parts of the body are affected. Staging a cancer is important to assist the doctor with determining the appropriate course of treatment and assessing an accurate prognosis. The most common staging system is the TNM.
> T – size of the tumor
> N – degree to which regional lymph nodes are involved
> M – the absence or presence of distant metasteses
Once the TNM has been determined, then a stage of I, II, III or IV is assigned.
> Stage I – cancers are small and local and usually curable
> Stage II x III – typically these are locally advanced and could involve the lymph nodes
> Stage IV – cancer has metastasized and can be inoperable.

What are treatment options?
After the tests are done, your doctor will suggest one or more options for treatment. The choice of treatment depends largely on the type of cancer and the stage of the disease. The main treatments for ovarian cancer are surgery, chemotherapy, and radiation therapy. Think about these options without feeling rushed. If there is anything you don’t understand, ask to have it explained.

What clinical trials are available?
Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer. Clinical trials test new approaches to treatment, such as new drugs, new approaches to surgery or radiation therapy, or a combination of treatments. Learn more about clinical trials.

What questions should I ask my doctor?
It is often helpful to make a list of questions before an appointment. This will help to remember what the doctor says. Patients and care givers can write notes or ask if they may use a tape recorder. Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen. Below are a few suggested questions a patient may ask their doctor.

Will you please write down the type of cancer that I have?
What stage is my cancer and what does that mean?
What are my treatment options?
What treatment do you recommend and why?
What are the risks and benefits of each treatment?
What are possible side effects of treatment?
How will you help manage my side effects?
How will treatment affect my normal activities?
Are there specific things I must do to get ready for treatment?
Are there other things I can be doing to help with my treatment, such as diet and exercise?
What are resources that I can turn to learn more about my cancer and help me deal with it?

Make an appointment

Resources
American Cancer Society – 1-800-ACS-2345
Gilda’s Club Worldwide – 1-888-GILDA 4 U (1-888-445-3248)
Gynecologic Cancer Foundation – 1-800-444-4441 or 312-644-6610
National Cancer Institute – 1-800-4CANCER
National Ovarian Cancer Coalition – 1-888-682-7426 (to order materials)