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Ovarian Epithelial Cancer Treatment (PDQ)

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General Information About Ovarian Epithelial Cancer
Stages of Ovarian Epithelial Cancer
Recurrent or Persistent Ovarian Epithelial Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent or Persistent Ovarian Epithelial Cancer
To Learn More About Ovarian Epithelial Cancer
Changes to This Summary (09/02/2014)
About This PDQ Summary
Get More Information From NCI

General Information About 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 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 make eggs and female hormones (chemicals that control the way certain cells or organs work).

Anatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina.Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Ovarian epithelial cancer is one type of cancer that affects the ovary. See the following PDQ treatment summaries for information about other types of ovarian tumors:

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

There are tests that can detect mutated genes. These genetic tests are sometimes done for members of families with a high risk of cancer. See the following PDQ summaries 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). In high-risk women, this procedure has been shown to greatly decrease the risk of ovarian cancer. (See the PDQ summary on Ovarian Cancer Prevention for more information.)

Signs and symptoms of ovarian cancer include pain or swelling in the abdomen.

Ovarian cancer may not cause early signs or symptoms. When signs or symptoms do appear, ovarian cancer is often advanced. Signs and symptoms of ovarian cancer may include the following:

These signs and symptoms also may be caused by other conditions and not by ovarian cancer. If the signs or symptoms get worse or do not go away on their own, check with your doctor 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 and pelvic area are used to detect (find) and diagnose ovarian cancer.

The following tests and procedures may be used:

Certain factors affect treatment options and prognosis (chance of recovery).

The prognosis (chance of recovery) and treatment options depend on the following:

Stages of Ovarian Epithelial Cancer

After ovarian 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 whether cancer has spread within the ovaries 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. The results of the tests used to diagnose ovarian cancer are often also used to stage the disease. (See the General Information section.)

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if ovarian epithelial cancer spreads to the lung, the cancer cells in the lung are actually ovarian epithelial cancer cells. The disease is metastatic ovarian epithelial cancer, not lung cancer.

The following stages are used for ovarian epithelial cancer:

Stage I

Three-panel drawing of stage IA, IB, and IC ovarian cancer; first panel shows a stage IA tumor inside one ovary. The second panel shows two stage IB tumors, one inside each ovary. The third panel shows two stage IC tumors, one inside each ovary, and one tumor has a ruptured capsule. An inset shows cancer cells floating in the peritoneal fluid surrounding abdominal organs. Also shown are the fallopian tubes, uterus, cervix, and vagina.Ovarian cancer stage IA, IB, and IC. In stage IA, cancer is found inside a single ovary. In stage IB, cancer is found inside both ovaries. In stage IC, cancer is found in one or both ovaries and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

In stage I, cancer is found in one or both ovaries. Stage I is divided into stage IA, stage IB, and stage IC.

Stage II

Three-panel drawing of stage IIA, IIB, and IIC ovarian cancer; first panel shows two stage IIA tumors, one inside each ovary, that have spread to the uterus and fallopian tube. The second panel shows two stage IIB tumors, one inside each ovary, that have spread to the uterus, fallopian tube,  and  colon. The third panel shows two stage IIC tumors, one inside each ovary, that have spread to the uterus and colon. An inset shows cancer cells floating in the peritoneal fluid surrounding abdominal organs. Also shown are the cervix and vagina.Ovarian cancer stage IIA, IIB, and IIC. In stage IIA, cancer is found inside one or both ovaries and has spread to the uterus and/or the fallopian tubes. In stage IIB, cancer is found inside one or both ovaries and has spread to other tissues within the pelvis. In stage IIC, cancer is found inside one or both ovaries and has spread to the uterus and/or fallopian tubes and/or other tissue within the pelvis, and one of the following is true: (a) cancer is found on the outside surface of one or both ovaries, (b) the capsule (outer covering) of the ovary has broken open, or (c) cancer cells are found floating in the peritoneal fluid surrounding abdominal organs or in washings of the peritoneum.

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.

Tumor size compared to everyday objects; shows various measurements of a tumor compared to a pea, peanut, walnut, and limePea, peanut, walnut, and lime show tumor sizes.

Stage III

In stage III, cancer is found in one or both ovaries and has spread outside the pelvis to other parts of the abdomen and/or nearby lymph nodes. Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.

Cancer that has spread to the surface of the liver is also considered stage III ovarian cancer.

Stage IV

Stage IV ovarian cancer; drawing shows parts of the body where ovarian cancer may spread, including the liver, lung, lymph nodes, and bone. An inset shows a close-up of cancer spreading through the blood and lymph to other parts of the body.Stage IV ovarian cancer. Cancer is found in one or both ovaries and may spread to other parts of the body, such as the lymph nodes, lung, liver, and bone. Cancer cells may also be found in an area between the lungs and the chest wall that has filled with fluid.

In stage IV, cancer has spread beyond the abdomen to other parts of the body, such as the lungs or tissue inside the liver.

Cancer cells in the fluid around the lungs is also considered stage IV ovarian cancer.

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:

Surgery

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

Radiation therapy

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 being treated.

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 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 cerebrospinal fluid, 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 combination chemotherapy.

The way the chemotherapy is given depends on the type and stage of the cancer being treated.

See Drugs Approved for Ovarian Cancer for more information.

New types of treatment are being tested in clinical trials.

This summary 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

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 immunotherapy.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody being studied in treating ovarian epithelial cancer.

PARP inhibitors are targeted therapy drugs that block DNA repair and may cause cancer cells to die. PARP inhibitor therapy is being studied in treating ovarian epithelial cancer that remains after chemotherapy.

Patients may want to think about taking part in a clinical trial.

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 treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

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

Stage I and II Ovarian Epithelial Cancer

Treatment of stage I and stage II ovarian epithelial cancer may include the following:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I ovarian epithelial cancer and stage II 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. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

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:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III ovarian epithelial cancer and stage IV 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. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent or Persistent Ovarian Epithelial Cancer

Treatment of recurrent ovarian epithelial cancer may include the following:

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent 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. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the NCI Web site.

To Learn More About Ovarian Epithelial Cancer

For more information from the National Cancer Institute about ovarian epithelial cancer, see the following:

For general cancer information and other resources from the National Cancer Institute, see the following:

Changes to This Summary (09/02/2014)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of ovarian epithelial cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." 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.

Clinical trials are listed in PDQ and can be found online at NCI's Web site. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

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The best way to cite this PDQ summary is:

National Cancer Institute: PDQ Ovarian Epithelial Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/treatment/ovarianepithelial/Patient. Accessed <MM/DD/YYYY>.

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Physicians version: CDR0000062829
Date last modified: 2014-09-02

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