The ovaries are a pair of organs located in a woman’s pelvis. There’s one ovary on each side of the uterus. The ovaries are about the size and shape of an almond. They produce eggs and female hormones. The layer of tissue that covers the ovary is called the epithelium. Most ovarian cancers begin in this covering. Ovarian cancer is the fifth most common cancer among women.

Ovarian cancer has a tendency to spread easily because it’s located in cells that are on the surface of the ovary. This makes it easier to move throughout the pelvis and abdomen, even if the tumor itself is small.

Additionally, since there are many “lymphatic vessels” (similar to tiny veins, which carry lymph fluid) that supply the ovaries, it’s easier for cancer cells to move to the lymph nodes.

Early detection is challenging
Ovarian cancer has often been called “the silent killer,” because it so often goes undetected. Last year, a study indicated that women who have ovarian cancer experience a cluster of symptoms that should signal women and their doctors to determine whether ovarian cancer is, indeed, present.

Many women with ovarian cancer experience a swollen abdomen, a bloated feeling, and a strong need to urinate. The symptoms are persistent, meaning they pretty much don’t go away, and they are severe. The confusing thing is that many women who don’t have ovarian cancer also experience these symptoms, so it’s not always a clear signal that cancer is the cause. But the study showed that 43 percent of women with ovarian cancer experienced all three symptoms, while only eight percent of women who didn’t have cancer experienced all three.

Additionally, women with ovarian cancer were more likely to report the symptoms within several weeks after they started, rather than months or even years later. Their symptoms were also likely to be more severe and to occur every day or almost every day.

Your treatment options
As with just about all types of cancer, treatment for ovarian cancer depends upon the stage the cancer is in. Very early stage cancer is Stage 1; very advanced is Stage 5. There are three main types of treatment:

• Surgery
• Chemotherapy
• Radiation

If the cancer is in a very early stage, only surgery may be necessary, but very often, women with ovarian cancer have surgery and then chemotherapy and/or radiation.

Your overall health status also plays a role in treatment decisions, as does whether or not you plan to have children. Almost all treatments for ovarian cancer make women infertile (unable to have a child). If your cancer is found early enough, it may be possible to avoid infertility. Open, honest discussions with your doctor about your treatment are extremely important.

Surgery
There are three main reasons for ovarian cancer surgery:

• To make the diagnosis of ovarian cancer
• To determine what stage the cancer is in
• To remove as much of the cancer as possible (often called “debulking”)

Very often, your doctor will remove both ovaries and your uterus. This will cause you to go into menopause, if you haven’t already done so. If you are of childbearing age and your cancer is in a very early stage, your surgeon may be able to treat your cancer appropriately while keeping one ovary and your uterus.

In general, when you have surgery for ovarian cancer your doctor will make a vertical incision in your abdomen. In most cases, laparoscopy, which is less invasive surgery because it’s done using several smaller incisions, isn’t appropriate for ovarian cancer.

Most women are in the hospital for about 3 to 7 days after the operation. They generally need about 4 to 6 weeks before they can get back into their normal routine.

Chemotherapy
Chemotherapy drugs are given either by mouth or by injection into a vein. In some cases, women with ovarian cancer have their chemotherapy injected directly into the abdomen. This allows the drugs to reach cancer cells in the abdominal lining and to enter the bloodstream. Chemotherapy often consists of a combination of two drugs, usually a platinum and a taxane. Your doctor will talk with you about the drugs that are likely to give you the best possible outcome.

 Side effects of chemotherapy include

• Increased risk of infection because of loss of white blood cells
• More bleeding or bruising than usual after small cuts or injuries
• Extreme fatigue
• Hair loss

Be sure to talk with your healthcare team about your side effects. Very often, there are medications that can help reduce their severity.

Sometimes, the initial chemotherapy schedule isn’t able to destroy all of the cancer cells. In these cases, patients generally have more chemotherapy treatments.

Radiation therapy
Most women who have radiation therapy for ovarian cancer receive the external beam type. A machine is positioned outside the body so that the beams will be focused precisely on the cancer. Typically, you have treatments for 5 days per week for several weeks. The treatments themselves generally last only a few moments. It’s common for radiation to make skin in the treated area look and feel sunburned. Additionally, since the abdomen and pelvis can be sensitive to radiation, women sometimes experience nausea, fatigue or diarrhea after treatments. As with chemotherapy, be sure to talk with your healthcare team about any side effects you’re having, because there may be medications that can decrease their severity.

Treatment and beyond
Throughout your treatment and afterward, be sure to talk with your care team about how you’re feeling. If you’re having any pain, discuss that.

In some cases of ovarian cancer, there may come a time when symptoms keep recurring and at some point, there may no longer be effective treatment options remaining. At this point, you’ll need to talk with your care team about measures to take to relieve your symptoms. For example, sometimes ovarian cancer can cause a buildup of fluid in the chest, abdomen or both. This creates a feeling of pressure, but you don’t have to suffer through it. Most of the time, your doctor will be able to drain the fluid in a simple procedure. In other cases, cancer cells can press onto the intestine, making it impossible to eat. At that point, some patients decide to stop eating or drinking. This decision eventually leads to death. At other times, patients decide to receive nourishment through a large vein under the collarbone or through a tube into the intestinal tract.

Pain is another common effect of ovarian cancer. Be sure to let your doctor know if you’re having a lot of pain and if your pain medication is working. Don’t feel as though you have to suffer needlessly.

Follow-up care
After you’ve had your treatments for ovarian cancer, you’ll need frequent follow-up appointments to make sure the cancer hasn’t come back. This usually consists of thorough physical exams and blood tests that look for the presence of tumor markers. The CA-125 is a blood test that’s used for ovarian cancer. Imaging tests such as chest X-rays, CT scans and ultrasound may also be part of your follow-up.

Questions for your doctor
When you find out you have ovarian cancer, you need answers to a lot of questions. Questions you should be sure to ask your doctor include:

• What’s the stage of my cancer?
• What are my treatment options, and which do you think is best for me and why?
• What are the side effects and risks of the treatments?
• What can I do to reduce the side effects and get my recovery on a good track?
• How will you help me if I have pain?
• When will I be able to get into my daily activities?
• What are my chances of recovery?
• Are there any clinical trials that I should consider entering?

You may need to have your doctor repeat the answers to these questions, but that’s okay. It’s normal. You have a lot to think about, and it takes a while for everything to sink in. Ask questions until you feel satisfied—every step of the way.

Source:
American Cancer Society; Journal of the American Medical Association, 10 June 2004 National Cancer Institute;