Ovarian Cancer

Condition Basics

What is ovarian cancer?

Ovarian cancer is the abnormal growth of cells in or near your ovaries. The ovaries are two small glands, located on either side of your uterus. They produce female sex hormones and store and release eggs. Ovarian cancer can occur in anyone who has female pelvic organs.

What causes it?

Experts don't know exactly what causes ovarian cancer. Genetics, such as DNA changes, are a risk factor for a small number of those who get ovarian cancer. For example, the risk of ovarian cancer is higher for those who have BRCA1 or BRCA2 gene changes than for those without them.

What are the symptoms?

Symptoms of ovarian cancer may include bloating. They may also include pain in the belly or pelvis, trouble eating or feeling full quickly, an urgent need to urinate, or urinating more often than usual. If these symptoms are new and happen almost daily for a few weeks, see a doctor.

How is it diagnosed?

If your doctor suspects ovarian cancer, you will get a physical exam. You may also get tests. One blood test is called CA-125. You may also get an ultrasound or CT scan. Based on the test result, you may need a biopsy. An ovary is removed so it can be checked for cancer cells.

How is ovarian cancer treated?

Treatment for ovarian cancer is based on the stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the cancer. Other treatment options may include chemotherapy, targeted therapy, immunotherapy, and endocrine therapy.

What Increases Your Risk

In most cases, the risk of getting ovarian cancer is small. But the things that put you at risk for ovarian cancer are having:

• A family history of ovarian cancer. Having a close relative (like a mother or sister) who had ovarian cancer or certain other cancers raises your risk. And you are at even higher risk if you have two close relatives with cancer.
• Inherited gene changes. A small number of people with a family history of cancer have inherited gene changes. Having certain gene changes, such as BRCA changes, can put you at a higher risk for ovarian cancer.

Other things that put you at risk include:

• Being older. Ovarian cancer most often happens after menopause.
• Never having had a baby.
• Having started periods before age 12 and going through menopause after age 52.
• Having endometriosis.

Most people who get ovarian cancer don't have any of these risk factors.

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Lowering Your Risk

Here are some things that can lower your risk for ovarian cancer:

• Taking birth control pills. Talk with your doctor about the risks and benefits before taking them.
• Having a baby.
• Breast-feeding.
• Having surgery to remove the ovaries and fallopian tubes. This may be done for women who are at very high risk because of inherited genes. It greatly reduces your risk for ovarian cancer. But it will cause you to start menopause early, which may have other risks. Your doctor can talk with you about the risks and benefits of this surgery.

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Symptoms

In some cases, ovarian cancer may cause early symptoms. The most common symptoms of ovarian cancer include:

• Frequent bloating.
• Pain in your belly or pelvis.
• Trouble 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 people. They may not mean that you have ovarian cancer. But the early symptoms of ovarian cancer follow a 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 of ovarian cancer include:

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

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

What Happens

Ovarian cancer often spreads early. Because it grows in the tissues covering the ovaries, it can spread easily within the abdominal cavity to the bowels and bladder or the abdominal lining. From there it may travel to other organs in the body, such as the liver or lungs.

When to Call a Doctor

Talk to your doctor if you have any symptoms, such as:

• Bloating.
• Pain in your belly or pelvis.
• Trouble eating, or feeling full quickly.
• Urinary problems, such as feeling an urgent need to urinate or urinating more often than usual.

If you have been diagnosed with cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Exams and Tests

Your doctor may check you for ovarian cancer if a lump is found on an ovary during a pelvic exam or an ultrasound. You will likely also get a physical exam. You will be asked about any symptoms, your medical history, and your family's history of cancer.

You may also get some tests. They include lab tests. One of these is a blood test called CA-125. Too much CA-125 (cancer antigen 125) in your blood can be a sign of ovarian cancer. Other tests may also include imaging tests, such as an ultrasound or a CT scan.

If these tests show signs of cancer, you will get a biopsy. This involves surgery to remove an ovary. Tissue from the ovary will be looked at under a microscope to see if it has cancer cells.

Screening tests for ovarian cancer

Experts don't recommend routine screening for ovarian cancer for women who have an average risk for the disease and who have no symptoms. Having screening tests doesn't help them live longer. And the tests, such as the CA-125 test or transvaginal ultrasound, often have false-positive results that can lead to more tests and unneeded surgery.

Some women have a higher risk of ovarian cancer. This includes those with BRCA gene changes. For them, doctors may recommend the CA-125 test and a transvaginal ultrasound. If you are at higher risk, the benefits of screening may outweigh the harms.

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Treatment Overview

Treatment for ovarian cancer is based on the stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the cancer. Other treatment options may include chemotherapy, targeted therapy, immunotherapy, and endocrine therapy. Sometimes a clinical trial may be a good choice.

Your doctor will talk with you about your options and then make a treatment plan.

Surgery

The doctor removes as much of the cancer as possible. Often this means the doctor will remove:

• The ovaries and fallopian tubes. (This is called a bilateral salpingo-oophorectomy.)
• The uterus and cervix. (This is called a total hysterectomy.)
• Nearby lymph nodes and samples of nearby organs to check them for cancer.

Talk to your doctor if the cancer is in only one ovary and there's a chance that you might want to get pregnant later. The doctor may be able to remove only the affected ovary and its fallopian tube. This is called fertility-sparing surgery.

Medicines

Medicines used to treat ovarian cancer include:

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells. Chemotherapy is often used after surgery. But sometimes it is used to shrink the cancer before surgery.

To treat ovarian cancer, the medicine is most often injected into a vein. Sometimes it's put into the belly through a thin tube. Or it may be warmed and put into the belly during surgery.

Targeted therapy.

These medicines target cancer cells and may cause less harm to normal cells. They help keep cancer from growing or spreading. Tissue removed during surgery may be tested for certain genes. This will help your doctor choose the best targeted medicines.

Immunotherapy.

This treatment helps your immune system fight cancer. It may be given in several ways.

Endocrine therapy.

These medicines block hormones that cause certain cancers to grow. This helps slow or stop cancer growth. Medicines that help block estrogen and progesterone include tamoxifen and aromatase inhibitors.

Clinical trials

Clinical trials are research studies that test new treatments to find out how well they work. Your medical team can tell you if there's a clinical trial that might be right for you.

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Supportive Care

Palliative care is a type of care for people who have a serious illness. It's different from care to cure your illness, called curative treatment. Palliative care provides an extra layer of support that can improve your quality of life—not just in your body, but also in your mind and spirit. Sometimes palliative care is combined with curative treatment.

The kind of care you get depends on what you need. Your goals guide your care. You can get both palliative care and care to treat your illness. You don't have to choose one or the other.

Palliative care can help you manage symptoms, pain, or side effects from treatment. It may help you and those close to you better understand your illness, talk more openly about your feelings, or decide what treatment you want or don't want. It can also help you communicate better with your doctors, nurses, family, and friends.

End-of-life care

It can be hard to live with an illness that cannot be cured. But if your health is getting worse, you may want to make decisions about end-of-life care. Planning for the end of your life does not mean that you are giving up. It is a way to make sure that your wishes are met. Clearly stating your wishes can make it easier for your loved ones. Making plans while you are still able may also ease your mind and make your final days less stressful and more meaningful.

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Self-Care

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may get medicine for nausea and vomiting if you have these side effects.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early. Eating smaller portions more often may help as well.
• Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
• Take steps to control your stress and workload. Learn relaxation techniques.
  • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
  • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
  • Express yourself through art. Try writing, dance, art, or crafts to relieve tension. Some dance, writing, or art groups may be available just for people who have cancer.
  • Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and help reduce stress.
  • Get help if you need it. Discuss your concerns with your doctor or counselor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• Take care of your urinary tract to prevent problems such as infection, which can be caused by ovarian cancer and its treatment. Limit drinks with caffeine, drink plenty of fluids, and urinate every 3 or 4 hours.
• If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

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Complementary Treatments

Some people use complementary therapies along with medical treatment. They may help relieve the symptoms and stress of cancer or the side effects of cancer treatment. Therapies that may be helpful include:

• Acupuncture to relieve pain and other symptoms.
• Meditation or yoga to relieve stress.
• Massage and biofeedback to reduce pain and tension.
• Breathing exercises to help you relax.

Talk with your doctor about any of these options you would like to try. And let your doctor know if you are already using any complementary therapies. They are not meant to take the place of standard medical treatment. But they may help you feel better and cope better with treatment.

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Getting Support

Relationships take on new importance when you're faced with cancer. Your family and friends can help support you. You may also want to look beyond those who are close to you.

• Reach out to your family and friends.

  Remember that the people around you want to support you, and asking for help isn't a sign of weakness.

• Tell them how they can help.

  Your friends and family want to help, but some of them may not know what to do. It may help to make a list. For example, you might ask them to:

  • Run errands or pick up kids.
  • Deliver meals or groceries to your home.
  • Drive you to appointments.
  • Go to doctor visits with you and take notes.
• Look for help from other sources.

  Places to turn for support include:

  Counseling.

  Counseling can help you cope with cancer and the effect cancer is having on your life. Different types of counseling include family therapy, couples therapy, group counseling, and individual counseling.

  Your health care team.

  Your team should be supportive. Be open and honest about your fears and concerns. Your doctor can help you get the right medical treatments, including counseling.

  Spiritual or religious groups.

  These groups can provide comfort and may be able to help you find counseling or other social support services.

  Social groups.

  Social groups can help you meet new people and get involved in activities you enjoy. Focus on activities that bring you comfort, such as spending time outdoors or being with children.

  A cancer support group.

  Cancer support groups offer support and practical advice. You can hear others talk about:

  • What it's like to live with cancer.
  • Practical ways to manage your cancer treatment and its side effects.
  • Ways to cope with your illness.

Adjusting to body changes after treatment

Your feelings about your body may change after treatment for ovarian cancer. Surgery and other treatments may cause physical or emotional changes that affect your body image. Or they may affect your desire to be intimate with a partner. Everyone has their own reaction to the challenges of cancer treatment.

If you have concerns, try to talk openly with your partner, if you have one. Or discuss your feelings with your doctor or nurse. Your care team may be able to help. Or they may refer you to counseling or a support group. Talking with others who've had similar feelings can be very helpful.

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