Keeping on Top of Your Condition
The Ovaries
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 baby grows). Each ovary is about
the size and shape of an almond. The ovaries have two
functions: they produce eggs and female hormones
(chemicals that control the way certain cells or organs function).
Every month, during the menstrual
cycle, an egg is released from one ovary in a process called ovulation.
The egg travels from the ovary through the fallopian
tube to the uterus.
The ovaries are also the main source of the female hormones estrogen
and progesterone.
These hormones influence the development of a woman's breasts, body shape,
and body hair. They also regulate the menstrual cycle and pregnancy.
The ovaries and other female reproductive
organs
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Understanding Ovarian Cancer
Cancer is a group of many related diseases that begin in cells,
the body's basic unit of life. To understand cancer, it is helpful to know
about normal cells and what happens when they become cancerous.
The body is made up of many types of cells. Normally, cells grow,
divide, and produce more cells when the body needs them. This orderly
process helps to keep the body healthy. Sometimes, however, cells keep
dividing when new cells are not needed. These extra cells form a mass of
tissue,
called a growth or tumor.
Tumors can be benign
or malignant.
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Benign tumors are not cancer. They often can be removed and,
in most cases, they do not come back. Cells in benign tumors do not
spread to other parts of the body. Most important, benign tumors are
rarely a threat to life.
| Ovarian cysts
are a different type of growth. They are fluid-filled sacs that
form on the surface of an ovary. They are not cancer. Cysts often
go away without treatment. If a cyst does not go away, the doctor
may suggest removing it, especially if it seems to be growing.
|
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Malignant tumors are cancer. Cells in these tumors are
abnormal and divide without control or order. They can invade and damage
nearby tissues and organs. Cancer cells can also spread (metastasize)
from their original site to other parts of the body.
A malignant tumor that begins in the ovaries is called ovarian cancer.
There are several types of ovarian cancer. Ovarian cancer that begins on
the surface of the ovary (epithelial
carcinoma) is the most common type. This is the type of cancer
discussed in this booklet. Ovarian cancer that begins in the egg-producing
cells (germ
cell tumors) and cancer that begins in the supportive tissue
surrounding the ovaries (stromal
tumors) are rare and are not discussed in this booklet.
Ovarian cancer cells can break away from the ovary and spread to other
tissues and organs in a process called shedding. When ovarian cancer
sheds, it tends to seed (form new tumors) on the peritoneum
(the large membrane that lines the abdomen)
and on the diaphragm
(the thin muscle that separates the chest from the abdomen). Fluid may
collect in the abdomen. This condition is known as ascites.
It may make a woman feel bloated, or her abdomen may look swollen.
Ovarian cancer cells can also enter the bloodstream or lymphatic
system (the tissues and organs that produce and store cells that
fight infection and disease). Once in the bloodstream or lymphatic system,
the cancer cells can travel and form new tumors in other parts of the
body.
Ovarian Cancer: Who's at Risk?
The exact causes of ovarian cancer are not known. However, studies show
that the following factors may increase the chance of developing this
disease:
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Family history. First-degree relatives (mother, daughter,
sister) of a woman who has had ovarian cancer are at increased risk of
developing this type of cancer themselves. The likelihood is especially
high if two or more first-degree relatives have had the disease. The
risk is somewhat less, but still above average, if other relatives
(grandmother, aunt, cousin) have had ovarian cancer. A family history of
breast or colon cancer is also associated with an increased risk of
developing ovarian cancer.
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Age. The likelihood of developing ovarian cancer increases as
a woman gets older. Most ovarian cancers occur in women over the age of
50, with the highest risk in women over 60.
-
Childbearing. Women who have never had children are more
likely to develop ovarian cancer than women who have had children. In
fact, the more children a woman has had, the less likely she is to
develop ovarian cancer.
-
Personal history. Women who have had breast or colon cancer
may have a greater chance of developing ovarian cancer than women who
have not had breast or colon cancer.
-
Fertility
drugs. Drugs that cause a woman to ovulate may slightly
increase a woman's chance of developing ovarian cancer. Researchers are
studying this possible association.
-
Talc. Some studies suggest that women who have used talc in
the genital area for many years may be at increased risk of developing
ovarian cancer.
-
Hormone
replacement therapy (HRT). Some evidence suggests that women
who use HRT after menopause
may have a slightly increased risk of developing ovarian
cancer.
| About 1 in every 57 women in the United States will develop
ovarian cancer. Most cases occur in women over the age of 50, but
this disease can also affect younger women. |
As we learn more about what causes ovarian cancer, we may also learn
how to reduce the chance of getting this disease. Some studies have shown
that breast feeding and taking birth control pills (oral contraceptives)
may decrease a woman's likelihood of developing ovarian cancer. These
factors decrease the number of times a woman ovulates, and studies suggest
that reducing the number of ovulations during a woman's lifetime may lower
the risk of ovarian cancer.
Women who have had an operation that prevents pregnancy (tubal
ligation) or have had their uterus and cervix
removed (hysterectomy)
also have a lower risk of developing ovarian cancer. In addition, some
evidence suggests that reducing the amount of fat in the diet may lower
the risk of developing ovarian cancer.
Women who are at high risk for ovarian cancer due to a family history
of the disease may consider having their ovaries removed before cancer
develops (prophylactic oophorectomy).
This procedure usually, but not always, protects women from developing
ovarian cancer. The risks associated with this surgery and its side
effects should be carefully considered. A woman should discuss the
possible benefits and risks with her doctor based on her unique
situation.
Having one or more of the risk
factors mentioned here does not mean that a woman is sure to
develop ovarian cancer, but the chance may be higher than average. Women
who are concerned about ovarian cancer may want to talk with a doctor who
specializes in treating women with cancer: a gynecologist,
a gynecologic
oncologist, or a medical
oncologist. The doctor may be able to suggest ways to reduce the
likelihood of developing ovarian cancer and can plan an appropriate
schedule for checkups.
Detecting Ovarian Cancer
The sooner ovarian cancer is found and treated, the better a woman's
chance for recovery. But ovarian cancer is hard to detect early. Many
times, women with the disease have no ovarian cancer symptoms or just mild symptoms
until the disease is in an advanced stage. Scientists are studying ways to
detect ovarian cancer before symptons develop. They are exploring the
usefulness of measuring the level of CA
125, a substance called a tumor
marker, which is often found in higher-than-normal amounts in the
blood of women with ovarian cancer. They also are evaluating transvaginal
ultrasound, a test that may help detect the disease early.
Recognizing Ovarian Cancer Symptoms
Ovarian cancer often shows no obvious signs or symptoms until late in
its development. Ovarian cancer symptoms may include:
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General abdominal discomfort and/or pain (gas, indigestion, pressure,
swelling, bloating, cramps)
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Nausea, diarrhea, constipation, or frequent urination
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Loss of appetite
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Feeling of fullness even after a light meal
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Weight gain or loss with no known reason
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Abnormal bleeding from the vagina
These symptoms may be caused by ovarian cancer or by other, less
serious conditions. It is important to check with a doctor about any of
these symptoms.
To help find the cause of symptoms, a doctor evaluates a woman's
medical history. The doctor also performs a physical exam and orders
diagnostic tests. Some exams and tests that may be useful are described
below:
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Pelvic exam includes feeling the uterus, vagina, ovaries,
fallopian tubes, bladder,
and rectum
to find any abnormality in their shape or size. (A Pap
test, a good test for cancer of the cervix, is often done along
with the pelvic exam, but it is not a reliable way to find or diagnose
ovarian cancer.)
-
Ultrasound
refers to the use of high-frequency sound waves. These waves, which
cannot be heard by humans, are aimed at the ovaries. The pattern of the
echoes they produce creates a picture called a sonogram.
Healthy tissues, fluid-filled cysts, and tumors look different on this
picture.
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CA-125 assay is a blood test used to measure the level of
CA-125, a tumor marker that is often found in higher-than-normal amounts
in the blood of women with ovarian cancer.
-
Lower
GI series, or barium
enema, is a series of x-rays
of the colon
and rectum. The pictures are taken after the patient is given an enema
with a white, chalky solution containing barium. The barium outlines the
colon and rectum on the x-ray, making tumors or other
abnormal areas easier to see.
-
CT
(or CAT) scan is a series of detailed pictures of areas
inside the body created by a computer linked to an x-ray
machine.
-
Biopsy
is the removal of tissue for examination under a microscope. A pathologist
studies the tissue to make a diagnosis.
To obtain the tissue, the surgeon performs a laparotomy
(an operation to open the abdomen). If cancer is suspected, the surgeon
performs an oophorectomy (removal of the entire ovary). This is
important because, if cancer is present, removing just a sample of
tissue by cutting through the outer layer of the ovary could allow
cancer cells to escape and cause the disease to spread.
If the diagnosis is ovarian cancer, the doctor will want to learn the
stage
(or extent) of disease. Staging
is a careful attempt to find out whether the cancer has spread and, if
so, to what parts of the body. Staging may involve surgery,
x-rays and other imaging
procedures, and lab tests. Knowing the stage of the disease helps the
doctor plan treatment.
Treatment for Ovarian Cancer
Treatment depends on a number of factors, including the stage of the
disease and the general health of the patient. Patients are often treated
by a team of specialists. The team may include a gynecologist,
a gynecologic
oncologist, a medical
oncologist, and/or a radiation
oncologist. Many different treatments and combinations of
treatments are used to treat ovarian cancer.
-
Surgery
is the usual initial treatment for women diagnosed with ovarian cancer.
The ovaries, the fallopian tubes, the uterus, and the cervix are usually
removed. This operation is called a hysterectomy with bilateral salpingo-oophorectomy.
Often, the surgeon also removes the omentum
(the thin tissue covering the stomach and large intestine) and lymph
nodes (small organs located along the channels of the lymphatic
system) in the abdomen.
Staging during surgery (to find out whether the cancer has spread)
generally involves removing lymph nodes, samples of tissue from the
diaphragm and other organs in the abdomen, and fluid from the abdomen.
If the cancer has spread, the surgeon usually removes as much of the
cancer as possible in a procedure called tumor
debulking. Tumor debulking reduces the amount of cancer that
will have to be treated later with chemotherapy or radiation
therapy.
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Chemotherapy
is the use of drugs to kill cancer cells. Chemotherapy may be given to
destroy any cancerous cells that may remain in the body after surgery,
to control tumor growth, or to relieve ovarian cancer symptons.
Most drugs used to treat ovarian cancer are given by injection into a
vein (intravenously,
or IV). The drugs can be injected directly into a vein or given
through a catheter,
a thin tube. The catheter is placed into a large vein and remains there
as long as it is needed. Some anticancer drugs are taken by mouth.
Whether they are given intravenously or by mouth, the drugs enter the
bloodstream and circulate throughout the body.
Another way to give chemotherapy is to put the drug directly into the
abdomen through a catheter. With this method, called intraperitoneal
chemotherapy, most of the drug remains in the abdomen.
After chemotherapy is completed, second-look
surgery may be performed to examine the abdomen directly. The
surgeon may remove fluid and tissue samples to see whether the
anticancer drugs have been successful.
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Radiation
therapy, also called radiotherapy, involves the use of
high-energy rays to kill cancer cells. Radiation therapy affects the
cancer cells only in the treated area. The radiation may come from a
machine (external
radiation). Some women receive a treatment called intraperitoneal
radiation therapy in which radioactive
liquid is put directly into the abdomen through a catheter.
Clinical
trials (research studies) to evaluate new ways to treat cancer
are an important treatment option for many women with ovarian cancer. In
some studies, all patients receive the new treatment. In others, doctors
compare different therapies by giving the promising new treatment to one
group of patients and the usual (standard) therapy to another group.
Through research, doctors learn new, more effective ways to treat cancer.
Possible Side Effects of Treatment
The side
effects of cancer treatment depend on the type of treatment and
may be different for each woman. Doctors and nurses will explain the
possible side effects of treatment, and they can suggest ways to help
relieve problems that may occur during and after treatment.
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Surgery causes short-term pain and tenderness in the area of
the operation. Discomfort or pain after surgery can be controlled with
medicine. Patients should feel free to discuss pain relief with their
doctor. For several days after surgery, the patient may have difficulty
emptying her bladder and having bowel movements.
When both ovaries are removed, a woman loses her ability to become
pregnant. Some women may experience feelings of loss that may make
intimacy difficult. Counseling or support for both the patient and her
partner may be helpful.
Also, removing the ovaries means that the body's natural source of
estrogen and progesterone is lost, and menopause occurs. Symptoms of
menopause, such as hot flashes and vaginal dryness, are likely to appear
soon after the surgery. Some form of hormone replacement therapy may be
used to ease such symptoms. Deciding whether to use it is a personal
choice; women with ovarian cancer should discuss with their doctors the
possible risks and benefits of using hormone replacement therapy.
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Chemotherapy affects normal as well as cancerous cells. Side
effects depend largely on the specific drugs and the dose (amount of
drug given). Common side effects of chemotherapy include nausea and
vomiting, loss of appetite, diarrhea, fatigue, numbness and tingling in
hands or feet, headaches, hair loss, and darkening of the skin and
fingernails. Certain drugs used in the treatment of ovarian cancer can
cause some hearing loss or kidney
damage. To help protect the kidneys while taking these drugs, patients
may receive extra fluid intravenously.
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Radiation therapy, like chemotherapy, affects normal as well
as cancerous cells. Side effects of radiation therapy depend mainly on
the treatment dose and the part of the body that is treated. Common side
effects of radiation therapy to the abdomen are fatigue, loss of
appetite, nausea, vomiting, urinary discomfort, diarrhea, and skin
changes on the abdomen. Intraperitoneal radiation therapy may cause
abdominal pain and bowel obstruction
(a blockage of the intestine).
| Doctors and nurses will explain the possible side effects of
treatment, and they can suggest ways to help relieve problems that
may occur during and after treatment. |
The Importance of Followup Care
Followup care after treatment for ovarian cancer is important. Regular
checkups generally include a physical exam, as well as a pelvic exam and
Pap test. The doctor also may perform additional tests such as a chest
x-ray, CT scan, urinalysis, complete blood count, and CA-125
assay.
In addition to having followup exams to check for the return of ovarian
cancer, patients may also want to ask their doctor about checking them for
other types of cancer. Women who have had ovarian cancer may be at
increased risk of developing breast or colon cancer. In addition,
treatment with certain anticancer drugs may increase the risk of second
cancers, such as leukemia.
Emotional Support
Living with a serious disease is challenging. Apart from having to cope
with the physical and medical challenges, people with cancer face many
worries, feelings, and concerns that can make life difficult. They may
need help coping with the emotional aspects of their disease.
In fact, attention to the emotional burden of having cancer is often a
part of a patient's treatment plan. The support of the health care team
(doctors, nurses, social workers), support groups, and patient-to-patient
networks can help people feel less isolated and distressed and can improve
the quality of their lives. Cancer support groups provide an environment
where cancer patients can talk about living with cancer with others who
may be having similar experiences. Patients may want to speak with their
health care team about finding a support group.
Ovarian Cancer: What the Future Holds
The National Cancer Institute is supporting and conducting research on
the causes and prevention of ovarian cancer. Researchers have discovered
that changes in certain genes
(basic units of heredity) are responsible for an increased risk of
developing ovarian and breast cancers. Members of families with many cases
of these diseases may consider having a special blood test to see if they
have a genetic change that increases the risk of these types of cancer.
Although having such a genetic change does not mean that a woman is sure
to develop ovarian or breast cancer, those who have the genetic change may
want to discuss their options with a doctor.
Questions for Your Doctor
This booklet is designed to help you work with your doctor to get the
information you need to make informed decisions about your health care. In
addition, asking your doctor the following questions will help you further
understand your condition. To help you remember what the doctor says, you
may take notes or ask whether you may use a tape recorder. Some people
also want to have a family member or friend with them when they talk to
the doctor -- to take part in the discussion, to take notes, or just to
listen.
Diagnosis
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What tests can diagnose ovarian cancer?
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Are they painful? Do they carry any other risks to my health?
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How soon after the tests will I learn the results?
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What type of ovarian cancer do I have?
Treatment
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What treatments are recommended for me?
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What clinical trials are appropriate for my type of cancer?
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Will I need to be in the hospital to receive my treatment? For how
long?
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How might my normal activities change during my
treatment?
Side Effects
Followup
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After treatment, how often do I need to be checked? What type of
followup care should I have?
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Will I eventually be able to resume my normal activities?
The Health Care Team
Resources
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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