Here are some answers to questions women often have about ovarian cancer.
Q: What are the ovaries?
A: The ovaries are female reproductive organs. There is one small, almond-shaped ovary on each side of the uterus. An ovary releases an egg every month in a woman who is still having her period. The ovaries also make most of the female hormones, including estrogen and progesterone. These hormones control the development of certain parts of a female, like the breasts, body shape, and body hair. They also control the menstrual cycle and pregnancy. When the ovaries stop producing estrogen and progesterone, menopause begins.
Q: What is ovarian cancer?
A: Ovarian cancer grows from cells within the ovaries. However, not all tumors found in the ovaries are cancerous. Ovarian cancer is more than one type of disease. Newer theories suggest that some cases of ovarian cancer may originate in the fallopian tubes or from the peritoneal lining.
Q: What are the types of ovarian cancer?
A: These are the 3 main types of ovarian cancer:
Epithelial carcinoma. This is the most common kind of ovarian tumor. It makes up about 85% to 90% of ovarian cancer cases. This tumor starts in the epithelium, which is the outer layer of cells in the ovaries.
Germ cell cancer. This type starts in the cells that form eggs in the ovary. Less than 2% of ovarian cancers are germ cell cancers. This type of cancer almost always occurs in girls, teenagers, and very young women. Although potentially dangerous, it is highly curable and can usually be treated without affecting fertility.
Stromal cell cancer. This starts in the stromal cells. These cells make up the connective tissue, which holds the ovaries together. They also make female hormones. Stromal cell cancer makes up only about 1% of all ovarian cancers.
Q: Who is at risk for ovarian cancer?
A: Certain factors can make one woman more likely to get ovarian cancer than another. These are called risk factors. Just because a woman has one or more risk factors does not mean she will get ovarian cancer.
Some risk factors are out of a woman's control while other risk factors are lifestyle choices, which can be controlled. Here are some of the possible risks for ovarian cancer:
Having two or more close relatives (mother or sister) who have had ovarian or breast cancer
Having had previous breast or colon cancer
Being older than age 55
Never having been pregnant
Having used talcum powder on the genital area in the past
Using estrogen replacement therapy
Q: What can a woman do to decrease her risk of ovarian cancer?
A: Every woman should know about her risk factors for ovarian cancer. Some cannot be changed, such as family history and age, but others can be. For instance, taking these actions may decrease a woman's risk:
Using birth control pills for several years
If you have a family history of ovarian, breast, colon, or uterine cancer, you should ask about whether you should undergo genetic counseling. There are genetic counselors who specialize in oncology. If a genetic risk is identified, there are medical and/or surgical interventions that can reduce your risk for these cancers.
Q: What are the symptoms of ovarian cancer?
A: The symptoms of ovarian cancer in its early stages are often subtle and could be signs of any number of other problems. These are some of the possible symptoms of ovarian cancer:
Abdominal discomfort, bloating, or swelling
Loss of appetite, indigestion, nausea, gas, or fullness even after eating small meals
Diarrhea, constipation, or frequent urination
Vaginal bleeding (rare) or irregular periods
Shortness of breath
Unintentional weight gain or loss
These symptoms are not specific to ovarian cancer; they may be signs of other problems. A woman with these symptoms should see her doctor.
Q: How do doctors diagnose ovarian cancer?
A: There are several ways to find out why a woman is having symptoms like those of ovarian cancer. The doctor will ask about her medical and family history and do a physical exam, which includes a pelvic exam. The doctor feels the vagina, rectum, and lower abdomen for any masses or lumps. If a mass is found, the history and physical exam alone cannot tell if it is ovarian cancer. Therefore, if a woman's pelvic exam is abnormal, she will need more tests such as:
Blood tests to check certain protein levels
If any of these tests show signs of cancer, it's likely the doctor will do a surgical biopsy to remove suspicious areas and check for cancer.
Q: What are the treatments for ovarian cancer?
A: The treatments for ovarian cancer depend on the type of cancer and its stage. Surgery is used to treat all stages of ovarian cancer. In early stages of ovarian cancer, before it has spread far, surgery may be the only treatment. The doctor may take out all the reproductive organs or in some cases just the ovary. For later stages, when the cancer has spread, doctors use both chemotherapy and surgery. Today, radiation therapy is rarely used to treat ovarian cancer.
Q: Should everyone get a second opinion for a diagnosis of ovarian cancer?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get one. Here are some of those reasons:
Not feeling comfortable with the treatment decision
Being diagnosed with a rare type of cancer
Wanting several options for how to treat the cancer
Not being able to see a cancer expert such as a gynecologic oncologist. It is very important that your particular findings be put into context by an expert. Gynecologic oncologists are subspecialists with advanced training in diagnosis, treatment and surveillance of female cancers including ovarian cancer.
Not being treated at a major medical center or special ovarian cancer treatment center
In some cases, it may help to have a second doctor review the diagnosis and treatment options before starting treatment. Some health insurance companies even require that a person with cancer seek a second opinion. Many other companies will pay for a second opinion if asked.
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:
Contact the Society of Gynecologic Oncology. Women can find a doctor who specializes in ovarian cancer on the society's website.
Get in touch with the Foundation for Women's Cancer (800-444-4441), a resource created by the Society of Gynecologic Oncologists.
Ask a primary care doctor. He or she may be able to suggest a gynecologic oncologist or surgeon specializing in this disease. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Check with a local medical society, a nearby hospital, or medical school. Talk with women in support groups to get names of doctors who can give you a second opinion. Ask other people who've had cancer for their recommendations.
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new types of treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than current types of treatment. People who participate in these studies get to use new treatments before the FDA approves them. People who join trials also help researchers learn more about cancer and help future cancer patients.
Here are some resources to learn more about clinical trials:
The National Cancer Institute. Visit its website to search for clinical trials by type of cancer and location of the study.
CancerTrialsHelp.org. This site offers an interactive guide to cancer clinical trials, as well as a search engine to help you find one that's right for you.
ClinicalTrials.gov. This site has regularly updated information about federally and privately funded clinical trials for all types of diseases.