| What is ovarian cancer? |
Women have two ovaries, one on each side of the uterus. The ovaries — each about the size of an almond — produce eggs (ova) as well as the female sex hormones estrogen and progesterone. Ovarian cancer occurs when cells grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries.
- Ultrasound. If the pelvic exam reveals a growth on an ovary, your doctor may order an ultrasound test. Ultrasound uses high-frequency sound waves to evaluate tissue and create an image of the sound pattern, called a sonogram. Research is under way to determine if this test is useful in women at high risk of ovarian cancer.
- CA 125 blood test. Cancer antigen (CA) 125 is a protein antigen found at abnormally high levels in the blood serum of many women with ovarian cancer. Most healthy women have CA 125 levels below 35 units per milliliter of blood serum. However, a number of noncancerous conditions can cause elevated CA 125 levels, and some women with ovarian cancer never have an elevated CA 125. Because of these limitations, this test isn't commonly used for routine screening in women who aren't at high risk or don't have specific signs and symptoms of the disease.
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Other diagnostic tests sometimes include a computerized tomography (CT) scan, which targets areas inside your body to provide detailed pictures produced by a computer that's linked to an X-ray machine. Your doctor may also choose to order an X-ray of your lower gastrointestinal tract to determine if the disease has spread to other organs. X-rays are taken after you've had a barium enema, which aids in visualizing any abnormal tissue in or displacement of the colon or rectum.
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If your pelvic examination or tests suggest ovarian cancer, you'll need surgery to confirm the diagnosis. In a surgical procedure called laparotomy, a surgeon explores your abdominal cavity to determine whether cancer is present. If a cancer diagnosis is confirmed, the surgeon and a pathologist identify the type of tumor and determine whether the cancer has spread. This will help determine the stage of the disease. It's important that this type of surgery be performed by a doctor specifically trained to treat gynecologic cancers.
Ovarian cancer is staged from I through IV, which indicates earliest to most advanced. Staging is determined at the time of surgical evaluation of the disease:
- Stage I ovarian cancer is confined to one or both of the ovaries.
- Stage II ovarian cancer has spread to other locations in the pelvis such as the uterus or
fallopian tubes.
- Stage III ovarian cancer has spread to the lining of the abdomen (peritoneum) or to the lymph
nodes within the abdomen. This is the most common stage of disease identified at the time of
diagnosis.
- Stage IV ovarian cancer has spread to organs beyond the abdomen.
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| Treatment |
Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Radiation is used occasionally.
If you want to preserve the option to have children and if your tumor is discovered early, your surgeon may remove only the involved ovary and its fallopian tube. However, this situation is rare. The most common type of tumor often occurs in both ovaries. In most cases the ideal treatment requires that your surgeon remove both ovaries and also your uterus, fallopian tubes, nearby lymph glands and a fold of fatty tissue known as the omentum, where ovarian cancer often spreads. In addition, your surgeon will take many samples of tissue and fluid from your abdomen to examine for cancer cells. This evaluation is critical in identifying the stage of your disease and determining if you need additional therapy.
If cancer is found during surgical exploration of the abdominal cavity (laparotomy), the surgeon performs definitive surgical treatment at that time. Usually, this surgical treatment involves removing the ovaries, uterus, fallopian tubes, nearby lymph glands and the omentum.
During this procedure, your surgeon also removes as much cancer as possible from the abdomen (surgical debulking). Ideally, less than a total of 1 cubic centimeter of tumor matter remains in the abdominal cavity after surgery (optimal debulking). This often involves removing part of the intestines or other radical procedures.
Following surgery, you'll most likely be treated with a combination of drugs. New combinations of chemotherapy drugs have demonstrated improved survival rates. For years, the standard treatment for ovarian cancer was a combination of two chemotherapy drugs, cisplatin (Platinol) and cyclophosphamide (Cytoxan). Today, the combination of the drugs cisplatin or carboplatin (Paraplatin) with the drug paclitaxel (Taxol) may improve survival rates among women with advanced-stage ovarian cancer.
Other treatments such as chemotherapy drugs, bone marrow transplants, gene therapy and immunotherapy are being investigated for use in treating ovarian cancer.
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| Prevention |
Several factors appear to reduce the risk of ovarian cancer. They include:
- Oral contraception (birth control pills). The use of oral contraceptives can decrease a
woman's risk of ovarian cancer by as much as 60 percent. Usage should total at least 5 years and does
not have to be continuous.
- Breast-feeding and pregnancy. Giving birth to one or more children, particularly if the
first child was born before you reached age 30, and breast-feeding may decrease your risk of
developing ovarian cancer.
- Undergoing a hysterectomy. Hysterectomy is the surgical removal of the uterus. Depending on
your condition, the surgery may also involve removal of organs and tissue in addition to the uterus.
Doctors caution that a woman should not have a hysterectomy just to avoid ovarian cancer risk. But if
you're having a hysterectomy for valid medical reasons, have a family history of ovarian or breast
cancer and are older than 40, you may want to talk with your doctor about ovary removal.
- Tubal ligation. In this surgical procedure, the fallopian tubes are tied to prevent pregnancy. Tubal ligation doesn't prevent all or even most cases of ovarian cancer. It shouldn't be done solely to reduce the risk of ovarian cancer.
When childbearing is complete, the NIH recommends a surgical procedure called prophylactic oophorectomy for certain women considered to be at extremely high risk of developing ovarian cancer. This procedure involves removing both ovaries.
Prophylactic oophorectomy reduces, but doesn't completely eliminate, ovarian cancer risk. Although removing the ovaries is generally quite protective, it doesn't prevent all cases of malignancy. Because ovarian cancer usually develops in the thin lining of the abdominal cavity that covers the ovaries, women who have had their ovaries removed can still get a similar but less common form of cancer called primary peritoneal cancer. This type of cancer develops similar to ovarian cancer and accounts for a small percentage of all cases of ovarian cancer.
In addition, prophylactic oophorectomy is controversial because it induces early menopause and may have a substantial negative impact your quality of life. If you're considering having this procedure done, be sure to discuss the pros and cons with your doctor.
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| Self-care |
Eating well, managing stress and exercising are ways to promote your overall health and cope with any form of cancer.
Eating well
Good nutrition is especially important for people undergoing cancer treatment. But eating well can be difficult if your treatment includes chemotherapy or radiation therapy. You may feel nauseated or lose your appetite, and foods may seem tasteless. You may find that the last thing you want to do is plan meals.
Even so, eating well during cancer treatment can help you maintain your stamina and your ability to cope with the side effects of treatments. Good nutrition may also help you prevent infections and remain more active.
Remember these strategies for eating well when you don't feel well:
- Eat protein-rich foods. Foods high in protein can help build and repair body tissues.
Choices include eggs, yogurt, cottage cheese, peanut butter, poultry and fish. Kidney beans, chickpeas
and black-eyed peas also are good sources of protein, especially when combined with rice, corn or
bread.
- Keep an open mind about the foods you might eat. Something that is unappealing today might
taste better to you next week.
- When you do feel well, make the most of it. Eat as many healthy foods as you can. Prepare
meals that you can easily freeze and reheat. Also look for low-fat frozen dinners and other prepared
foods.
- Give meals a pleasant atmosphere. Whenever possible, eat at a table set with attractive
dishes and flowers.
- Pack calories into the foods you eat. For example, spread butter, jam or honey on bread.
Sprinkle foods with chopped nuts.
- Eat smaller amounts of food more frequently. If you can't face the thought of a large meal,
try eating small amounts of food more often. Keep fruits and vegetables handy for snacking.
- Stay active. Even if you don't feel well, try to stay physically active. A short walk or climbing the stairs can keep your muscles from deteriorating due to lack of use.
Methods for reducing physical tension can help you manage stress. One simple and powerful technique is to close your eyes and notice your breathing. Pay attention to each inhalation and exhalation. Your breathing will become slower and deeper, promoting relaxation. Another technique is to lie down, close your eyes and mentally scan your entire body for any points of tension.
In addition, activities such as running and swimming, which require repetitive movements, can produce a mental state similar to that achieved with meditation. The same is true of yoga and other stretching exercises.
Your doctor may have more specific suggestions about how to best care for yourself before, during and after treatment for ovarian cancer.
| Coping skills |
A diagnosis of cancer can be extremely challenging. Even when a full recovery is likely, you may worry about a recurrence of the disease. But no matter what your concerns or prognosis, you're not alone. Here are some strategies and resources that may make dealing with cancer easier:
- Know what to expect. Find out everything you can about your cancer — type, stage, treatment
options and side effects. The more you know, the more active you can be in your own care. In addition
to talking with your doctor, look for information at your local library and on the Internet. You can
contact the National Cancer Institute at 800-4-CANCER (800-422-6237) or the American Cancer Society at
800-227-2345.
- Be proactive. Although you may feel tired and discouraged, don't let others — including
your family or your doctor — make important decisions for you. It's vital that you take an active role
in your treatment.
- Maintain a strong support system. Studies show that strong relationships are crucial for
surviving cancer. Although friends and family can be your best allies, they may sometimes have trouble
dealing with your illness. When this is the case, the concern and the understanding of a formal
support group or other cancer survivors can be especially helpful. Although support groups aren't for
everyone, they can be a good source of practical information. You may also find that you develop deep
and lasting bonds with people who are going through the same things you are. Support groups for the
families of cancer survivors are also available.
- Set reasonable goals. Having goals helps you feel in control and can give you a sense of
purpose. But don't choose goals you can't possibly reach. You may not be able work a 50-hour week, for
example, but you may be able work at least half time. In fact, many people find that continuing to
work can be helpful.
- Take time for yourself. Eating well, relaxing and getting enough rest can help combat the
stress and fatigue of cancer. Also, plan ahead for the downtimes when you may need to rest more or
limit what you do.
- Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself seems to be a key factor in coping with and surviving cancer.
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— December 3, 2002 —