Frequently Asked Questions 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.

Q: What is ovarian cancer?
A: Ovarian cancer grows from cells within the ovaries. However, not all tumors found in the ovaries are cancerous.

Q: What are the types of ovarian cancer?
A: These are the 3 main types of ovarian cancer.

• Epithelial carcinoma is the most common kind of ovarian tumor. They make up about 90% of ovarian cancer cases. This tumor starts in the epithelium, which is the outer layer of cells in the ovaries.
• Germ cell cancer starts in the cells that form eggs in the ovary. Only about 5% of ovarian cancers are germ cell cancers.
• Stromal cell cancer 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 5% 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 woman. These are called risk factors. But 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 and some risk factors are lifestyle choices, which can be controlled. Here are some of the possible risks for ovarian cancer.

• Having 2 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 60
• Never having been pregnant
• Having a condition called endometriosis, in which tissue from the uterus grows outside the uterus in other places in the body.
• Obesity
• Having used talcum powder on the genital area in the past
• Using estrogen replacement therapy for more than 10 years

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.

• Controlling weight
•  Using birth control pills for several years
•  Having the fallopian tubes tied, called tubal ligation
• Having the uterus removed, called hysterectomy

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.

• Back pain
• Abdominal discomfort, bloating, or swelling
• Pelvic pain
• Loss of appetite, indigestion, nausea, gas, or fullness even after eating small meals
• Pain during intercourse
• Changes in urination
• 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 perform a physical exam, which includes a pelvic exam. The doctor feels the vagina, rectum, and lower abdomen for lumps. The history and physical examination alone cannot tell if a lump is ovarian cancer. Therefore, if a woman has a lump, she will need more tests such as those below. If they suggest that ovarian cancer is present, the doctor may order these tests.

• Transvaginal Ultrasound
• CA 125 Blood test
• Biopsy

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, doctors use radiation therapy less often. When they do, it’s mostly to control symptoms.

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
• Having several options for how to treat the cancer
• Not being able to see a cancer expert such as a gynecologic oncologist
• 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 Gynecological Oncologists. The website is www.sgo.org. Women can find a doctor who specializes in ovarian cancer.
• 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 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
• Consult The Official ABMS Directory of Board Certified Medical Specialists. This book from the American Board of Medical Specialists lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries. You can also view it online at www.abms.org.
• Seek other options. Check with a local medical society, a nearby hospital, or medical school. Or 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 checkups should a woman who has been treated for ovarian cancer have?
A: After treatment for ovarian cancer, women tend to visit the doctor every 3 months for the first year. Then they visit every 6 months. The doctor will likely monitor them with tumor-marker blood tests called CA-125. Sometimes they receive chest X-rays or computed tomography (CT scans). Women should tell their doctors if they have any new symptoms such as abdominal pain or distention, swelling in their legs, or any other health changes.