Ovarian Epithelial Cancer
Ovarian epithelial cancer is a disease in which
malignant (cancer) cells form in the tissue covering the ovary.
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 fetus grows). Each ovary is about
the size and shape of an almond. The ovaries produce eggs and female hormones
(chemicals that control the way certain cells or organs function).
Ovarian epithelial cancer is one type of cancer that
affects the ovary.
Women who have a family history of ovarian cancer
are at an increased risk of developing ovarian cancer.
Anything that increases your risk of getting a disease
is called a risk factor. Women who have one first-degree relative (mother,
daughter, or sister) with ovarian cancer are at an increased risk of developing
ovarian cancer. This risk is higher in women who have one first-degree relative
and one second-degree relative (grandmother or aunt) with ovarian cancer. This
risk is even higher in women who have two or more first-degree relatives with
Some ovarian cancers are caused by inherited gene
The genes in cells carry the hereditary information
that is received from a person’s parents. Hereditary ovarian cancer makes up
approximately 5% to 10% of all cases of ovarian cancer. Three hereditary
patterns have been identified: ovarian cancer alone, ovarian and breast cancers,
and ovarian and colon cancers.
Tests that can detect mutated genes have been
developed. These genetic tests are sometimes done for members of families with a
high risk of cancer.
Women with an increased risk of ovarian cancer may
consider surgery to prevent it.
Some women who have an increased risk of ovarian
cancer may choose to have a prophylactic oophorectomy (the removal of healthy
ovaries so that cancer cannot grow in them). In high-risk women, this procedure
has been shown to greatly decrease the risk of developing ovarian cancer.
Possible signs of ovarian cancer include pain or
swelling in the abdomen.
Early ovarian cancer may not cause any symptoms. When
symptoms do appear, ovarian cancer is often advanced. Symptoms of ovarian cancer
may include the following:
These symptoms may be caused by other conditions and
not by ovarian cancer. If the symptoms get worse or do not go away on their own,
a doctor should be consulted so that any problem can be diagnosed and treated as
early as possible. When found in its early stages, ovarian epithelial cancer can
often be cured.
Women with any stage of ovarian cancer should think
about taking part in a clinical trial. Information about ongoing clinical trials
is available from the NCI Web site.
Tests that examine the ovaries, pelvic area, blood,
and ovarian tissue are used to detect (find) and diagnose ovarian cancer.
The following tests and procedures may be used:
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes,
ovaries, and rectum. The doctor or nurse inserts one or two lubricated,
gloved fingers of one hand into the vagina and the other hand is placed over
the lower abdomen to feel the size, shape, and position of the uterus and
ovaries. A speculum is also inserted into the vagina and the doctor or nurse
looks at the vagina and cervix for signs of disease. A Pap test or Pap smear
of the cervix is usually done. The doctor or nurse also inserts a
lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- Ultrasound exam: A procedure in which high-energy sound waves
(ultrasound) are bounced off internal tissues or organs and make echoes. The
echoes form a picture of body tissues called a sonogram. The picture can be
printed to be looked at later. An abdominal ultrasound or a transvaginal
ultrasound may be done.
- CA 125 assay: A test that measures the level of CA 125 in the blood.
CA 125 is a substance released by cells into the bloodstream. An increased
CA 125 level is sometimes a sign of cancer or other condition.
- Barium enema: A series of x-rays of the lower gastrointestinal
tract. A liquid that contains barium (a silver-white metallic compound) is
put into the rectum. The barium coats the lower gastrointestinal tract and
x-rays are taken. This procedure is also called a lower GI series.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A
contrast dye is injected into a vein. As the contrast dye moves through the
kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- CT scan (CAT scan): A procedure that makes a series of detailed
pictures of areas inside the body, taken from different angles. The pictures
are made by a computer linked to an x-ray machine. A dye may be injected
into a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- Biopsy: The removal of cells or tissues so they can be viewed under
a microscope by a pathologist to check for signs of cancer. The tissue is
removed in a procedure called a laparotomy (a surgical incision made in the
wall of the abdomen).
Certain factors affect treatment options and prognosis (chance of recovery).
The prognosis (chance of recovery) and treatment
options depend on the following:
- The stage of the cancer.
- The type and size of the tumor.
- The patient’s age and general health.
- Whether the cancer has just been diagnosed or has recurred (come back).
Stages of Ovarian Epithelial Cancer
After ovarian epithelial cancer has been diagnosed,
tests are done to find out if cancer cells have spread within the ovaries or to
other parts of the body.
The process used to find out if cancer has spread
within the ovary or to other parts of the body is called staging. The
information gathered from the staging process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
An operation called a laparotomy is usually done to
find out the stage of the disease. A doctor must cut into the abdomen and
carefully look at all the organs to see if they contain cancer. The doctor will
also perform a biopsy (cut out small pieces of tissue so they can be looked at
under a microscope to see whether they contain cancer). Usually the doctor will
remove the cancer and organs that contain cancer during the laparotomy.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and
travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and
travels through the blood to other places in the body.
When cancer cells break away from the primary
(original) tumor and travel through the lymph or blood to other places in the
body, another (secondary) tumor may form. This process is called metastasis. The
secondary (metastatic) tumor is the same type of cancer as the primary tumor.
For example, if breast cancer spreads to the bones, the cancer cells in the
bones are actually breast cancer cells. The disease is metastatic breast cancer,
not bone cancer.
The following stages are used for ovarian epithelial cancer:
In stage I, cancer is found in one or both of the
ovaries. Stage I is divided into stage IA, stage IB, and stage IC.
- Stage IA: Cancer is found in a single ovary.
- Stage IB: Cancer is found in both ovaries.
- Stage IC: Cancer is found in one or both ovaries and one of the
following is true:
cancer is found on the outside surface of one or both ovaries; or
the capsule (outer covering) of the tumor has ruptured (broken open); or
cancer cells are found in the fluid of the peritoneal cavity (the body
cavity that contains most of the organs in the abdomen) or in washings of
the peritoneum (tissue lining the peritoneal cavity).
In stage II, cancer is found in one or both ovaries
and has spread into other areas of the pelvis. Stage II is divided into stage
IIA, stage IIB, and stage IIC.
- Stage IIA: Cancer has spread to the uterus and/or
the fallopian tubes (the long slender tubes through which eggs pass from the
ovaries to the uterus).
- Stage IIB: Cancer has spread to other tissue
within the pelvis.
- Stage IIC: Cancer has spread to the uterus and/or
fallopian tubes and/or other tissue within the pelvis and cancer cells are found
in the fluid of the peritoneal cavity (the body cavity that contains most of the
organs in the abdomen) or in washings of the peritoneum (tissue lining the
In stage III, cancer is found in one or both ovaries
and has spread to other parts of the abdomen. Stage III is divided into stage
IIIA, stage IIIB, and stage IIIC.
- Stage IIIA: The tumor is found in the pelvis only,
but cancer cells have spread to the surface of the peritoneum (tissue that lines
the abdominal wall and covers most of the organs in the abdomen).
- Stage IIIB: Cancer has spread to the peritoneum
but is 2 centimeters or smaller in diameter.
- Stage IIIC: Cancer has spread to the peritoneum
and is larger than 2 centimeters in diameter and/or has spread to lymph nodes in
Cancer that has spread to the surface of the liver is
also considered stage III disease.
In stage IV, cancer is found in one or both ovaries
and has metastasized (spread) beyond the abdomen to other parts of the body,
such as the lungs, liver, lymph nodes, or bones.
Cancer that has spread to tissues in the liver is also
considered stage IV disease.
Recurrent or Persistent Ovarian Epithelial Cancer
Recurrent ovarian epithelial cancer is cancer that has
recurred (come back) after it has been treated. Persistent cancer is cancer that
does not go away with treatment.
Treatment Option Overview
There are different types of treatment for patients
with ovarian epithelial cancer.
Different types of treatment are available for
patients with ovarian epithelial cancer. Some treatments are standard, and some
are being tested in clinical trials. A treatment clinical trial is a research
study meant to help improve current treatments or obtain information on new
treatments for patients with cancer. When clinical trials show that a new
treatment is better than the treatment currently used as standard treatment, the
new treatment may become the standard treatment. Patients may want to think
about taking part in a clinical trial. Some clinical trials are open only to
patients who have not started treatment.
Three kinds of standard treatment are used. These
include the following:
Most patients have surgery to remove as much of the
tumor as possible. Different types of surgery may include:
- Total hysterectomy: A surgical procedure to remove the uterus,
including the cervix. If the uterus and cervix are taken out through the
vagina, the operation is called a vaginal hysterectomy. If the uterus and
cervix are taken out through a large incision (cut) in the abdomen, the
operation is called a total abdominal hysterectomy. If the uterus and cervix
are taken out through a small incision (cut) in the abdomen using a
laparoscope, the operation is called a total laparoscopic hysterectomy.
- Unilateral salpingo-oophorectomy: A surgical procedure to remove one
ovary and one fallopian tube.
- Bilateral salpingo-oophorectomy: A surgical procedure to remove both
ovaries and both fallopian tubes.
- Omentectomy: A surgical procedure to remove the omentum (a piece of
the tissue lining the abdominal wall).
- Lymph node biopsy: The removal of all or part of a lymph node. A
pathologist views the tissue under a microscope to look for cancer cells.
Radiation therapy is a cancer treatment that uses
high-energy x-rays or other types of radiation to kill cancer cells or keep them
from growing. There are two types of radiation therapy. External radiation
therapy uses a machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance sealed in needles,
seeds, wires, or catheters that are placed directly into or near the cancer. The
way the radiation therapy is given depends on the type and stage of the cancer
Some women receive a treatment called intraperitoneal
radiation therapy, in which radioactive liquid is put directly in the abdomen
through a catheter.
Chemotherapy is a cancer treatment that uses drugs to
stop the growth of cancer cells, either by killing the cells or by stopping them
from dividing. When chemotherapy is taken by mouth or injected into a vein or
muscle, the drugs enter the bloodstream and can reach cancer cells throughout
the body (systemic chemotherapy). When chemotherapy is placed directly into the
spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly
affect cancer cells in those areas (regional chemotherapy).
A type of regional chemotherapy used to treat ovarian
cancer is intraperitoneal (IP) chemotherapy. In IP chemotherapy, the anticancer
drugs are carried directly into the peritoneal cavity (the space that contains
the abdominal organs) through a thin tube.
Treatment with more than one anticancer drug is called
The way the chemotherapy is given depends on the type
and stage of the cancer being treated.
New types of treatment are being tested in clinical
This section describes treatments that are being
studied in clinical trials. It may not mention every new treatment being
studied. Information about clinical trials is available from the NCI Web site.
Biologic therapy is a treatment that uses the
patient’s immune system to fight cancer. Substances made by the body or made in
a laboratory are used to boost, direct, or restore the body’s natural defenses
against cancer. This type of cancer treatment is also called biotherapy or
Targeted therapy is a type of treatment that uses
drugs or other substances to identify and attack specific cancer cells without
harming normal cells.
Patients may want to think about taking part in a
For some patients, taking part in a clinical trial may
be the best treatment choice. Clinical trials are part of the cancer research
process. Clinical trials are done to find out if new cancer treatments are safe
and effective or better than the standard treatment.
Many of today's standard treatments for cancer are
based on earlier clinical trials. Patients who take part in a clinical trial may
receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help
improve the way cancer will be treated in the future. Even when clinical trials
do not lead to effective new treatments, they often answer important questions
and help move research forward.
Patients can enter clinical trials before, during,
or after starting their cancer treatment.
Some clinical trials only include patients who have
not yet received treatment. Other trials test treatments for patients whose
cancer has not gotten better. There are also clinical trials that test new ways
to stop cancer from recurring (coming back) or reduce the side effects of cancer
Clinical trials are taking place in many parts of the
Follow-up tests may be needed.
Some of the tests that were done to diagnose the
cancer or to find out the stage of the cancer may be repeated. Some tests will
be repeated in order to see how well the treatment is working. Decisions about
whether to continue, change, or stop treatment may be based on the results of
these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time
to time after treatment has ended. The results of these tests can show if your
condition has changed or if the cancer has recurred (come back). These tests are
sometimes called follow-up tests or check-ups.
Treatment Options by Stage
For some types or stages of cancer, there may not be
any trials listed. Check with your doctor for clinical trials that are not
listed here but may be right for you.
Stage I and II Ovarian Epithelial Cancer
Treatment of stage I and stage II ovarian epithelial
cancer may include the following:
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and
omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are
removed and examined under the microscope to look for cancer cells.
- Total abdominal hysterectomy, unilateral salpingo-oophorectomy, and
omentectomy. Lymph nodes and other tissues in the pelvis and abdomen are
removed and examined under the microscope to look for cancer cells.
- A clinical trial of internal or external radiation therapy.
- A clinical trial of chemotherapy.
- A clinical trial of surgery followed by chemotherapy or watchful waiting
(closely monitoring a patient's condition without giving any treatment until
symptoms appear or change).
- A clinical trial of a new treatment.
Stage III and IV Ovarian Epithelial Cancer
Treatment of stage III and stage IV ovarian epithelial
cancer may be surgery to remove the tumor, total abdominal hysterectomy,
bilateral salpingo-oophorectomy, and omentectomy. After surgery, treatment
depends on how much tumor remains.
When the tumor that remains is 1 centimeter or
smaller, treatment is usually combination chemotherapy, including
intraperitoneal (IP) chemotherapy.
When the tumor that remains is larger than 1
centimeter, treatment may include the following:
- Combination chemotherapy, including intraperitoneal (IP) chemotherapy.
- A clinical trial of combination chemotherapy, including IP chemotherapy,
before and after second-look surgery (surgery performed after the initial
surgery to determine whether tumor cells remain).
- A clinical trial of biologic therapy or targeted therapy following
Treatment Options for Recurrent or Persistent
Ovarian Epithelial Cancer
Treatment of recurrent ovarian epithelial cancer may
include the following:
- Chemotherapy using one or more anticancer drugs, with or without
- A clinical trial of surgery.
- A clinical trial of biologic therapy alone or combined with anticancer
Check for U.S. clinical trials from NCI's PDQ Cancer
Clinical Trials Registry that are now accepting patients with ovarian epithelial
cancer. For more specific results, refine the search by using other search
features, such as the location of the trial, the type of treatment, or the name
of the drug. General information about clinical trials is available from the NCI
For more information from the NCI, please write to this address:
NCI Public Inquiries Office
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
U.S. residents may call the National Cancer Institute's (NCI's)
Cancer Information Service toll-free at 1.800.4.CANCER (1.800.422.6237) Monday
through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with
TTY equipment may call 1.800.332.8615.
Information about ongoing clinical trials is available from the NCI Web site.
Source: National Institutes of Health; National Cancer Institute
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