Ovarian Epithelial Cancer


General Information

What is 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. (Refer to Ovarian Germ Cell Tumor Treatment and Ovarian Low Malignant Potential Tumor Treatment for information about other types of ovarian cancer.)

Women who have a family history of ovarian cancer are at an increased risk of developing ovarian cancer. 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 ovarian cancer.

Some ovarian cancers are caused by inherited gene mutations (changes). 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 altered genes have been developed. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to Screening for Ovarian Cancer, Prevention of Ovarian Cancer, and Genetics of Breast and Ovarian Cancer for more information.)

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). It is not known if this procedure prevents ovarian cancer.

Ovarian cancer is hard to detect (find) early because usually there are no symptoms. Some women who have early stage ovarian cancer may have symptoms such as vague gastrointestinal (GI) discomfort, pressure in the pelvis, pain, swelling of the abdomen, and shortness of breath. Most of the time, there are no symptoms or they are very mild. By the time symptoms do appear, the cancer is usually advanced.

When found in its early stages, ovarian epithelial cancer can be cured in many patients. Women with any stage of ovarian epithelial cancer should consider taking part in a clinical trial.

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: A procedure to check the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size. (A Pap test does not help diagnose ovarian cancer.)

Ultrasound test: A procedure that bounces sound waves off the ovaries and changes the echoes into sonograms (pictures).

CA-125 assay: A blood test used to measure the level of CA-125, a substance sometimes found in an increased amount in the blood, other body fluids, or tissues and that may be a sign of ovarian cancer.

Barium enema (lower GI series): A procedure used to show tumors or other abnormal areas in the pelvis. A liquid containing barium is put into the rectum by way of the anus. Barium is a silver-white metallic compound that helps to show the image of the lower gastrointestinal tract on an x-ray.

Intravenous pyelogram: A series of x-rays of the kidneys, ureters, and bladder to help determine if cancer has spread outside the ovaries. The x-rays are taken after a dye is injected into a blood vessel. The dye is concentrated in the urine, which outlines the kidneys, ureters, and bladder on the x-rays.

CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.

Biopsy: Removal of tissue for examination under a microscope. 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 treatment options and prognosis (chance of recovery) depend on the patient's age and general health, the type and size of the tumor, and the stage of the cancer.

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 the best 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 other organs that contain cancer during the laparotomy. (See the Treatment Options by Stage section).

The following stages are used for ovarian epithelial cancer:

Stage I
In stage I, cancer is found in one or both of the ovaries. Stage I is divided into:

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.
-The tumor has ruptured the ovary wall.
-Cancer cells are found in fluid from the peritoneal cavity (the body cavity that contains most of the organs in the abdomen). The fluid may already be in the peritoneal cavity or it may be added by the doctor to wash the peritoneum (tissue lining the peritoneal cavity).

Stage II
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: 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 one of the following is true:

-Cancer is found on the outside surface of one or both ovaries.
-The tumor has ruptured the ovary wall.
-Cancer cells are found in fluid from the peritoneal cavity (the body cavity that contains most of the organs in the abdomen). The fluid may already be in the peritoneal cavity or it may be added by the doctor to wash the peritoneum (tissue lining the peritoneal cavity).

Stage III
In stage III, cancer is found in one or both ovaries and has spread to other parts of the abdomen. Cancer has spread to the surface of the liver. Stage III is divided into:

Stage IIIA: The tumor is found only in the pelvis, 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 not larger than 2 centimeters (less than 1 inch) 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 the abdomen. (Lymph nodes are small bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.)

Stage IV
In stage IV, cancer is found in one or both ovaries and has metastasized (spread) beyond the abdomen to other parts of the body. Cancer is found in the tissues of the liver.

Recurrent Ovarian Epithelial Cancer
Recurrent ovarian epithelial cancer is cancer that has recurred (come back) after it has been treated.

Treatment Option Overview

Different types of treatment are available for patients with ovarian epithelial cancer. Some treatments are standard, and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. 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.

Clinical trials are taking place in many parts of the country. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three kinds of standard treatment are used. These include the following:

Surgery
Most patients have surgery to remove as much of the tumor as possible. Different types of surgery may include:

-Hysterectomy (removal of the ovaries, fallopian tubes, and uterus).
-Unilateral salpingo-oophorectomy (removal of one ovary and one fallopian tube).
-Bilateral salpingo-oophorectomy (removal of both ovaries and both fallopian tubes).
-Omentectomy (partial removal of the lining of the abdominal cavity).
-Lymph node biopsy (removal of lymph nodes for examination under a microscope to check for cancer cells).

Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found.

Some women receive a treatment called intraperitoneal radiation therapy, in which radioactive liquid is put directly in the abdomen through a catheter.

Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Another way to give chemotherapy is intraperitoneal chemotherapy (delivering the drug directly into the abdomen through a catheter). With this method, most of the drug remains in the abdomen.

Other types of treatment are being tested in clinical trials.

Biological therapy
Biological therapy is treatment to stimulate the ability of the 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 disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

High-dose chemotherapy with bone marrow transplantation or peripheral blood stem cell transplantation.

Chemotherapy can reduce the ability of bone marrow to make blood cells. Bone marrow transplantation and peripheral blood stem cell transplantation have been tested as ways to help the blood recover so that higher than standard doses of chemotherapy can be given.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options by Stage

Stage I Ovarian Epithelial Cancer
Treatment of stage I ovarian epithelial cancer may include the following:

1.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.
2.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.
3.Internal or external radiation therapy.
4.Chemotherapy.
5.Watchful waiting (careful observation without immediate treatment).
6.A clinical trial.

Stage II Ovarian Epithelial Cancer
Treatment of stage II ovarian epithelial cancer may be:

Surgery to remove the tumor, 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.

After surgery, treatment may include the following:

1.Combination chemotherapy and internal or external radiation therapy.
2.Combination chemotherapy alone.
3.A clinical trial.

Stage III Ovarian Epithelial Cancer
Treatment of stage III ovarian epithelial cancer may be:

Surgery to remove the tumor, hysterectomy, bilateral salpingo-oophorectomy, and omentectomy.

After surgery, treatment may include the following:

1.Combination chemotherapy.
2.Combination chemotherapy followed by second-look surgery (surgery performed after the initial surgery to determine whether tumor cells remain).
3.A clinical trial.

Stage IV Ovarian Epithelial Cancer
Treatment of stage IV ovarian epithelial cancer is combination chemotherapy with or without surgery to reduce the size of the tumor.

Treatment Options for Recurrent Ovarian Epithelial Cancer
Treatment of recurrent ovarian epithelial cancer may include the following:

1.Chemotherapy with or without surgery.
2.A clinical trial of chemotherapy or biological therapy (treatment to stimulate or restore the ability of the immune system to fight cancer).

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.





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