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Epithelial ovarian cancer: About 90% of ovarian cancers start in the epithelium tissue, which is the lining on the outside of the ovary. This type of ovarian cancer is divided into serous, mucinous, endometrioid, clear cell, transitional and undifferentiated types. The risk of epithelial ovarian cancer increases with age, especially after the age of 50.
Germ cell ovarian cancer: Germ cell tumors account for about 5% of ovarian cancers. They begin in the egg-producing cells. This type of ovarian cancer can occur in women of any age, but about 80% are found in women under the age of 30. The main subtypes are teratoma, dysgerminoma, endodermal sinus tumor and choriocarcinoma.
Stromal ovarian cancer: These tumors, about 5% of ovarian cancers, grow in the connective tissue that holds the ovary together and makes estrogen and progesterone. Most are found in older women, but sometimes they occur in girls.
Stromal tumors usually do not spread as fast as other ovarian tumors. Sub-types include granulosa, granulosa-theca and Sertoli-Leydig cell tumors.
Primary peritoneal ovarian cancer is a rare cancer. It has cells like those on the outside of the ovaries, but it starts in the lining of the pelvis and abdomen. Women can get this type of cancer even after their ovaries have been removed. Symptoms and treatment are similar to epithelial ovarian cancer. Fallopian tube cancer is also a rare cancer. It starts in the fallopian tube and acts like epithelial ovarian cancer. Symptoms and treatment are similar to ovarian cancer.
Ovarian Cancer Screening
While no standardized screening tests for ovarian cancer have been shown to improve outcomes, MD Anderson is working to change that. CA-125, a cancer biomarker being studied at MD Anderson, as well as other new biomarkers, are being evaluated as a screening test.
MD Anderson recommends that women who are at high risk for ovarian cancer be screened regularly. You are considered high risk if you have:
- BRCA1 or BRCA2 gene
- Hereditary breast ovarian cancer syndrome
- Hereditary non-polyposis colorectal cancer (HNPCC), also called Lynch syndrome
- BRIP1, RAP51C, or RAD51D gene
Ovarian Cancer Risk Factors
Anything that increases your chance of getting ovarian cancer is a risk factor. These include:
- Age: The risk of ovarian cancer increases with age. About half of ovarian cancers are in women over 60.
- Family history of ovarian cancer
- Genetic factors: Approximately 10% to 15% of ovarian cancers are due to genes that make you more likely to develop cancer.
- Never having children. The more children you have, the less likely you are to develop ovarian cancer.
Not everyone with risk factors gets ovarian cancer. However, if you have risk factors, it’s a good idea to discuss them with your health care provider.
Some people have an elevated risk of developing ovarian cancer. Review the ovarian cancer screening guidelines to see if you need to be tested.
Some cases of ovarian cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Most women with ovarian cancer have vague symptoms. These signs often are like less serious conditions including indigestion, weight gain or aging.
Symptoms and signs of ovarian cancer vary from woman to woman, but they may include:
- General abdominal discomfort or pain (gas, indigestion, pressure, swelling, bloating, cramps)
- Bloating and/or a feeling of fullness, even after a light meal
- Nausea, diarrhea, constipation or frequent urination
- Unexplained weight loss or gain
- Loss of appetite
- Abnormal vaginal bleeding
- Unusual fatigue
- Back pain
- Pain during sex
- Menstrual changes
These symptoms do not always mean you have ovarian cancer, but it's a good idea to discuss them with your health care provider if they:
- Are new symptoms
- Last more than a few weeks
- Occur more than 12 times a month
At MD Anderson, our experts use the most advanced and accurate equipment available for ovarian cancer diagnosis and determine with pinpoint accuracy if and where it has spread. They have extensive experience with all types of ovarian cancer, including rare ovarian cancers. The chances for successful ovarian cancer treatment are much higher if the cancer is caught early and diagnosed accurately. If ovarian cancer is diagnosed in the early stages, the chances for successful treatment are high.
Testing for Ovarian Cancer
If you have symptoms that may signal ovarian cancer, your doctor will examine you and ask you questions about your health and family medical history. One or more of the following tests for ovarian cancer may be used to find out if you have the disease and if it has spread. These tests also may be used to find out if treatment is working.
The doctor inserts one or two gloved fingers into the vagina and presses on the lower abdomen with the other hand. Usually the doctor puts a finger in the vagina and rectum at the same time to feel deeper in the pelvis. A pelvic exam helps find out if there is a mass on either side of the uterus. This may be a sign of ovarian cancer.
In some other cases, a mass may be an ovarian cyst. Ovarian cysts are solid or fluid-filled pockets on the ovary and usually are not cancerous, although risk increases with age.
Blood Test for Ovarian Cancer
This blood test measures the level in your body of CA-125, a protein that is made by ovarian cancer cells. CA-125 is known as a tumor marker because its levels usually are higher in women with ovarian cancer. Testing CA-125 levels is most reliable when it is used to find cancer that has come back after treatment. Doctors look at how the levels of CA-125 have changed over time.
Measuring CA-125 levels also can be used:
- To see if treatment is working
- Predict if a treatment might be effective for ovarian and some other types of cancer
The CA-125 test alone cannot find ovarian cancer. A high level of CA-125 does not always mean you have ovarian cancer. Other conditions may raise the level of CA-125. Low levels of CA-125 do not mean you are cancer-free. Some types of ovarian cancer produce only low levels of CA-125 or none at all.
Ovarian Cancer Biopsy
The only way to find out for certain if a growth is ovarian cancer is for the doctor to remove cells from it and look at them under a microscope (biopsy). Tissue can be removed by:
- Fine needle aspiration (FNA)
Ovarian Cancer Imaging
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- PET (positron emission tomography) scans
- Chest X-rays
- Transvaginal ultrasound: A wand-shaped scanner is put into the vagina. It has a small ultrasound device on the end.
Genetic Testing for Ovarian Cancer
If you are at high risk for ovarian cancer because of personal or family history, your doctor may ask you to have more tests, including some that give information about your genes. These tests may help you make important decisions about cancer prevention for yourself and your children. There are benefits and risks with genetic testing, which you should discuss with your doctor. Blood tests can find out if you have a BRCA1 or BRCA2 gene, which can cause ovarian cancer as well as breast cancer. Others test for genes that play a part in Lynch syndrome, an inherited colon cancer syndrome.
Staging is a way of determining how much disease is in the body and where it has spread. This information is important because it helps your doctor decide the best type of treatment for you and the outlook for your recovery (prognosis). Staging of ovarian cancer is done during surgery. It usually requires removing the uterus, ovaries and fallopian tubes, as well as the omentum (a layer of fatty tissue covering the stomach area) and lymph nodes close to the tumor.
Once the staging classification is determined, it stays the same even if treatment works or the cancer spreads.
(source: National Cancer Institute)
Stage 1 Ovarian Cancer
The cancer is limited to the ovary or ovaries.
- Stage 1A: Cancer is in one ovary
- Stage 1B: Cancer is in both ovaries
- Stage 1C: Cancer is in one or both ovaries. It also is on the surface of the ovary or in abdominal fluid or a fluid-filled capsule has burst.
Stage 2 Ovarian Cancer
The cancer is in one or both ovaries. It has spread to other parts of the pelvis.
- Stage 2A: The tumor has spread to the uterus, Fallopian tubes or both
- Stage 2B: The tumor has spread to the bladder, rectum or colon
- Stage 2C: The tumor has spread to any of the above. Also, it is on the surface of the ovary, a fluid-filled capsule has burst or cancer cells are in abdominal fluid.
Stage 3 Ovarian Cancer
The cancer is in one or both ovaries. It has spread to nearby lymph nodes or other abdominal organs, not including the liver.
- Stage 3A: The cancer:
- Has spread to the lining of the abdomen
- Cannot be seen
- Has not spread to the lymph nodes
- Stage 3B: The cancer:
- Has spread into the abdomen
- Is visible (less than 2 centimeters, about 3/4 of an inch)
- Has not spread to the lymph nodes
- Stage 3C: The cancer:
- Has spread into the abdomen
- Deposits are larger than 2 centimeters
- Has spread to the lymph nodes
Stage 4 Ovarian Cancer
The cancer has spread to the lung, liver or other distant organs.
Recurrent Ovarian Cancer
The cancer has come back after it has been treated. It may appear in other parts of the body, but it is still ovarian cancer.
When you receive ovarian cancer treatment at MD Anderson, a team of some of the nation’s foremost experts customizes your care. This team of specialists communicates and collaborates at every step. They customize your ovarian cancer treatment to be sure you receive the highest chance for successful treatment with the least impact on your body.
Our physicians have extensive experience in treating every type of ovarian cancer, including rare ovarian cancers. We offer the latest, most-advanced therapies, including surgery, chemotherapy, hormonal therapies and targeted therapies.
Surgery usually is the first step in treating ovarian cancer. It is crucial that your surgeon be experienced in this delicate procedure. Studies have shown that patients with ovarian cancer have better outcomes and better chances for survival when the largest amount possible of the tumor is removed.
The gynecologic oncology surgeons at MD Anderson are some of the most experienced in the nation. This gives them a level of expertise that is available at few other cancer centers.
We’re constantly researching newer and more advanced ovarian cancer treatment, including working to understand it on the molecular and genetic level. In some cases, we can offer gene therapy and targeted therapies that are available at only a few places in the nation.
We are proud to house a prestigious federally funded ovarian cancer SPORE (Specialized Program of Research Excellence) program. This means we are able to offer a wide variety of clinical trials for new therapies.
Ovarian Cancer Treatments
If you are diagnosed with ovarian cancer, your doctor will discuss the best options to treat it. This depends on several factors, including:
- The stage of the cancer
- The size of the tumor after surgery (debulking)
- Your desire to have children
- Your age and overall health
One or more of the following therapies may be recommended to treat ovarian cancer or help relieve symptoms.
Ovarian Cancer Surgery
Surgery is the main treatment for ovarian cancer. Often times, ovarian cancer surgery is done to remove or biopsy a mass to find out if it is cancer. Once cancer is confirmed, the surgeon stages the cancer based on how far it has spread from the ovaries. If the disease seems to be limited to one or both ovaries, the surgeon will biopsy the pelvis and abdomen to find out if the cancer has spread.
Debulking Ovarian Cancer
If it is obvious during the surgery that ovarian cancer has spread, the surgeon will remove as much of the tumor as possible. This may help other treatments work better.
The ovaries, uterus, cervix, Fallopian tubes and omentum (fatty tissue around these organs), and any other visible tumors in the pelvic and abdominal areas may be removed during debulking. The spleen, lymph nodes, liver or intestines also may be removed partially or completely. Sometimes debulking is not possible because the patient is not healthy enough or the tumor may be attached to other organs. In these cases, any tumor left will be treated with chemotherapy.
Chemotherapy for Ovarian Cancer
You may need chemotherapy after surgery to destroy ovarian cancer cells that are still in the body.
Intraperitoneal chemotherapy (IP therapy) for ovarian cancer is a way to give chemotherapy drugs. It may be used if a small amount of tumor is left after debulking. Sometimes IP chemotherapy works better than regular chemotherapy. In IP treatment, concentrated chemotherapy is put into the abdominal cavity through a catheter (tiny tube) or implanted port. This allows it to come into contact with the cancer and the area of the body where the cancer is likely to spread. The drugs also get into the blood and travel through the body.
Radiation for Ovarian Cancer
Although radiation therapy rarely is used to treat ovarian cancer, it may help destroy any cancer cells that are left in the pelvic area. It also may be used if the cancer has come back after other treatments. In most cases, the main goal of radiation therapy is to control symptoms such as pain, not to treat the cancer.
Ovarian Cancer Targeted Therapy
MD Anderson is among just a few cancer centers in the nation that are able to offer targeted therapy for some types of ovarian cancer. These new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow.
Our Ovarian Cancer Clinical Trials
MD Anderson leads the nation in innovative research into the causes, prevention, detection and treatment of ovarian cancer. In fact, we are one of the few cancer centers in the nation to house a prestigious federally funded ovarian SPORE (Specialized Program of Research Excellence) program. This means we are able to offer a variety of clinical trials of new treatments for ovarian cancer.
Research fuels our mission to end cancer. Learn how MD Anderson researchers and physician scientists are fighting cancer by improving prevention, detection and treatment strategies.
Why choose MD Anderson for ovarian cancer care?
A team of some of the nation's top experts works together to address your specific condition when you come to MD Anderson's Gynecologic Oncology Center for ovarian cancer treatment and diagnosis.
This group follows you every step of the way, communicating and collaborating closely to deliver outstanding care. Their aim is to deliver the most advanced ovarian cancer therapies with the least impact on your body.
You benefit from this approach, as well as the expertise of some of the nation's top radiologists, radiation oncologists, surgical oncologists and pathologists. They are joined by a support staff extensively trained to provide the highest level of ovarian cancer treatment.
Ovarian Cancer Care Planned Just For You
Your treatment for ovarian cancer is personalized to include leading-edge technologies and techniques. These may include advanced surgical procedures, chemotherapy options and targeted therapies. In addition, we offer treatment for benign (not cancer) tumors of the ovaries.
We are one of the most active centers in the nation for treatment of rare ovarian cancers, offering the highest level of care, as well as clinical trials and innovative approaches, including targeted therapies.
Surgery often is needed for an ovarian cancer diagnosis, and it often is the first line of treatment. Because MD Anderson is a leading cancer center with one of the most active ovarian cancer programs, our surgeons have a high level of expertise that sets them apart from many others.
We are leaders in studying ovarian cancer on the molecular level and translating research into advanced ways to find and treat the disease. Through our high risk ovarian cancer screening clinic and gynecologic cancer genetics clinic, we offer genetic testing for women with hereditary breast ovarian cancer syndrome (HBOC) and other high-risk inherited conditions.
MD Anderson leads the nation in innovative research into the causes, prevention, detection and treatment of ovarian cancer, including rare ovarian cancers. In fact, we are one of the few cancer centers in the nation to house a prestigious federally funded ovarian cancer SPORE (Specialized Program of Research Excellence) program. This means we offer a variety of clinical trials of new ovarian cancer treatments.
Going through cancer gives you an opportunity to see what you're made of.
Ovarian Cancer Moon Shot
MD Anderson’s Ovarian Cancer Moon Shot™ aims to rapidly and dramatically improve the disease’s survival rates and reduce suffering through prevention, early detection, research and new treatments.Learn more about the Ovarian Cancer Moon Shot
BY Megan Maisel
When Cathy Tompkins complained of an unusual pain near her sternum, doctors took an X-ray and told her she was likely constipated. When her pain persisted and a second X-ray didn’t indicate what was wrong, a friend urged her to seek a second opinion.
Cathy got a concerning call from her new doctor while she and her husband were celebrating their 48th wedding anniversary at a Texas Hill Country cabin: her CT scan showed cancer cells. The doctor suspected they originated in one of her ovaries.
“My first thought was, I wonder if I’m going to make it to my 49th wedding anniversary,” Cathy recalls.
She was immediately referred to MD Anderson where she was diagnosed with stage IV high-grade serous ovarian cancer, an especially aggressive form of the disease.
The cancer diagnosis was a shock to the 67-year-old, who had always lived an active and healthy lifestyle and who had few ovarian cancer symptoms. “I’m the one in the family who never gets sick,” she says.
Confidence in her care
Cathy was familiar with MD Anderson, as she’d been a caregiver for both her mother and father when they were treated here many years before. “It never crossed my mind that I would be the one getting the treatment,” she recalls.
During her first appointment with Shannon Westin, M.D., associate professor in Gynecologic Oncology and Reproductive Medicine, Cathy felt confident that MD Anderson was her best choice for care. “She hadn’t been in the room five minutes before I said, ‘I’m good. She is going to take care of me. She is on it!’”
A Moon Shots Program immunotherapy clinical trial
Cathy enrolled in a clinical trial that includes:
- Nine weeks of chemotherapy (carboplatin and taxol) combined with an immunotherapy drug called Durvalumab;
- Debulking surgery to remove as much of the cancer as possible;
- An additional nine weeks of the chemo and immunotherapy combination; and
- 28 weeks of the Durvalumab immunotherapy by itself, to prevent recurrence.
The clinical trial is part of MD Anderson’s Moon Shots Program™, a focused effort to dramatically and quickly reduce cancer deaths.
Cathy says she’s impressed at how well taken care of she feels by the entire team involved in her clinical trial, including her research nurse, Sara Sharafi. “Everyone has bent over backwards to help,” she exclaims.
Three times a week, Cathy travels to MD Anderson for an infusion and injections that bolster her white blood cell count. She drives an hour and a half each way from her home near Beaumont, Texas.
The aid of friends
Cathy credits her family and what she refers to as her “travel team” for helping her through her cancer treatment. The travel team comprises close friends who take turns making the journey with her to MD Anderson and help keep her entertained during her drug infusions.
“The best part is having so many people who are willing to help you,” she says.
She’s touched by many others who have prayed for her and helped to lift her spirits. Each week she receives a card signed by all the participants of a bible study group in Concan, Texas, though she only knows one member.
“Cancer has taught me what it is to be a true friend,” Cathy says. “It makes you realize when someone gets a diagnosis like this – or is going through tough times – it’s a big deal if you send them a card or give them a call.”
She’s also learned not to sweat the small stuff. “When you have cancer, you learn more about what’s important and what’s not.”
Life after ovarian cancer treatment
Once her clinical trial is complete, Cathy’s looking forward to getting around to the “someday we should” activities with her husband, who she calls her “biggest supporter,” and spending more time with her children, grandchildren and new great-granddaughter.
“I’ve got a bunch of kids I’ve got to see grow up,” she says.
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