800-826-HOPE (4673)

Ovarian Cancer

Overview

I kept it in the back of my head — this is beatable …. City of Hope is behind me, Dr. Morgan is behind me, and they are going to take care of me. And we are going to beat this. Allisa Miller, ovarian cancer survivor.

Ovarian cancer care at City of Hope means you will be getting the best possible therapies our physicians, care team and technology have to offer. This includes leading-edge treatments, clinical trials and a comprehensive supportive care program addressing your quality of life needs — such as fertility and survivorship issues.

We will answer your questions, calm your concerns and design a personalized treatment plan to give you the best possible outcome.

Request a Consultation

If you have been diagnosed with ovarian cancer, are at a high risk for developing ovarian cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information. 

Highlights of our ovarian cancer program include:

  • A personalized treatment approach guided by your unique needs and background, including molecular and genetic testing of your cancer to find the most effective therapies
  • Our leadership and experience in minimally invasive and complex surgeries — such as cytoreductive (debulking) surgery that extensively removes cancerous tissue and pelvic floor reconstruction to restore continence and reduce discomfort
  • Highly precise radiation therapy delivery that can focus on tumors while sparing nearby organs and tissues
  • Our extensive experience, such as heated intraoperative peritoneal chemotherapy (HIPEC), which applies drugs directly into the abdominal region for greater cancer-fighting effectiveness
  • A wide portfolio of drugs that can fight cancer better with fewer side effects, including targeted therapy and immunotherapy that attacks ovarian cancer cells with greater accuracy
  • Supportive care services to address a wide range of disease- and treatment-related concerns
  • Tests, consultations and treatments that are coordinated and provided at our Women’s Center for greater convenience
  • A long-term survivorship and follow-up program focused on minimizing recurrence risk and improving quality of life
  • Ovarian cancer risk assessment based on genetics, personal, lifestyle and environmental factors

City of Hope has been named a best hospital for cancer and by U.S. News & World Report for over a decade, and U.S. News has also recognized our gynecology program as a “high performing” on. City of Hope is a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education. As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based ovarian cancer treatment guidelines for patients throughout the country.

NEWS & BREAKTHROUGHS

What is ovarian cancer?

Ovarian cancer is a disease in which cells of the ovaries divide uncontrollably, invading nearby tissues and possibly spreading to other areas of the body.

There are several types of cancerous ovarian tumors, depending on the type of cell that is affected. The major ones include:

  • Epithelial tumors: Approximately 90 percent of ovarian tumors are of this type, involving cells lining ovary’s outer surface.
  • Germ cell tumors: This type start from cells that produces the ova (eggs).
  • Stromal tumors: This cancer comes from the cells that produce the female hormones estrogen and progesterone.

What risk factors are linked to ovarian cancer?

Factors that can elevate risk ovarian cancer risk include:

  • Age: Ovarian cancer risk increases with age, and ovarian cancers develop after menopause.
  • Personal or family history of ovarian cancer, breast cancer or colorectal cancer
  • Hormone therapy, particularly estrogen-only therapy for more than five years
  • Inherited cancer syndromes, including BRCA gene mutations, hereditary nonpolyposis colorectal cancer (also known as HNPCC or Lynch syndrome), Peutz-Jeghers syndrome and MUTYH-associated polyposis
  • Reproductive history: Women who have never given birth or gave birth after the age of 35 have a greater ovarian cancer risk.
  • Endometriosis, a condition in which uterine lining grows outside of the uterus

Research has also shown that a low-fat diet and use of oral or injectable contraceptives may lower ovarian cancer risk. Some studies also show that aspirin and acetaminophen use may lower ovarian cancer risk. However, the results have not been consistent and women should not take these drugs solely for lowering ovarian cancer risk.

Ovarian cancer risk may also be reduced by prophylactic surgeries, such undergoing tubal ligation (severing, blocking or tying off the fallopian tubes), hysterectomy (surgical removal of the uterus) and/or oophorectomy (surgical removal of the ovaries). These methods are typically reserved for women with a greatly elevated risk of developing ovarian cancer, such as BRCA mutation carriers.

What are the symptoms of ovarian cancer?

Common symptoms of ovarian cancer include:

  • Pelvic, abdominal or back pain
  • Bloating
  • Loss of appetite or feeling full quickly
  • Urinary symptoms, such as increased urgency or frequency
  • Menstrual changes
  • Pain during sex
  • Constipation
  • Fatigue

Although these symptoms can be caused by other conditions, you should check with your doctor to get a definitive diagnosis.

Sources: National Cancer Institute and American Cancer Society

Precise ovarian cancer tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of ovarian cancer.

Highlights of our screening and diagnosis services include:

  • Advanced imaging technology to better identify and locate cancerous cells
  • Genetic screening, testing and counseling for women with high ovarian cancer risk
  • Genomic and molecular profiling of the cancer, which can lead to more effective, less toxic treatments

Many of these tests are conveniently offered at our Women’s Center.

How is ovarian cancer detected?

Your doctor may use the following tests to look for ovarian cancer:

  • Physical exam
  • Blood tests: In addition to standard tests, such as blood cell counts and liver enzyme levels, your doctor may also order tests looking for substances associated with ovarian cancer, such as abnormal hormone levels and various tumor marker proteins, including CA-125, lactate dehydrogenase (LDH) and alpha-fetoprotein (AFP).
  • Ultrasound: A small probe is placed on the abdomen or inside the vagina. Sound waves are emitted from the probe to help generate an image of the pelvic region, including any cysts, tumors or abnormal masses within or near the ovaries.
  • Laparoscopy: The test uses a thin, lighted tube that is inserted through a small incision the abdomen. The doctor can then examine the pelvic and abdominal areas for signs of ovarian cancer.
  • Biopsy: Surgical removal of suspicious tissues for further examination
  • Genetic screening: Women with elevated risk factors (such as a family history of breast or ovarian cancers) may undergo genetic screening to see if they have mutations that put them at higher risk for developing the disease.

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

  • Genomic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations or molecular markers, which can be used to help determine disease progression, optimal treatments or identify risk for other cancers.
  • Positron emission tomography (PET) scan: A test that uses a small amount of radioactive sugar and a PET scanner to locate ovarian cancer cells throughout the body
  • Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images to form a computer-generated image, which determines tumor size, location and spread. Special dyes may be used to enhance this scan.

Based on the results of these tests, the ovarian cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs. Generally, ovarian cancer caught in earlier stages will have better outcomes than those caught in advanced or metastasized stages.

What are the current screening guidelines for ovarian cancer?

There are currently no screening guidelines for ovarian cancer, since no screenings have been shown to lower risk of dying from ovarian cancer for women of average risk. However, your physician may recommend more vigorous monitoring if you are at a high risk of developing this disease, which includes:

  • Personal/family history of breast or ovarian cancer
  • Inherited conditions, such as BRCA gene mutations and Lynch syndrome
  • History of infertility or use of assisted reproductive therapies
  • Using hormone replacement therapy
  • Endometriosis

For high risk groups, monitoring may include transvaginal ultrasound and/or blood test of ovarian cancer markers, such as the CA-125 protein.

We have many drugs that work for ovarian cancer, and they have gotten so much better over the years … It is a very complex illness, and you need someone who specializes specifically in ovarian cancer to get the best possible treatment. Robert J. Morgan, M.D., Co-director, Gynecological Oncology/Peritoneal Malignancies Program

Your ovarian cancer is every bit as unique as you are, and that is why City of Hope’s ovarian cancer program is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

Our ovarian cancer treatment highlights include:

  • Cytoreductive (debulking) surgery with heated intraperitoneal chemotherapy (HIPEC), which extensively removes cancerous tissue followed by applying cancer-fighting drugs directly into the abdominal and pelvic area, increasing its effectiveness in killing any remaining cancer cells
  • Pelvic floor reconstruction procedures that can restore continence and reduce discomfort
  • Image-guided radiation delivery systems that can accurately target radiation to tumor sites while minimizing exposure in normal, healthy tissues
  • Fertility-preserving options for patients who wish to have children after cancer treatment
  • Innovative ovarian cancer clinical trials with treatments that may be more effective and less toxic, including cancer-fighting viruses, immunity-boosting vaccine therapies and drugs that can overcome the cancer’s defense mechanisms

Learn more about our ovarian cancer treatment options below:

Surgery

Surgery is a primary treatment option for most ovarian cancer patients. The extensiveness of the operation depends on the patient’s health and how far the cancer has spread.

In addition to removing as much tumor tissue as possible, surgery is also used to help determine the ovarian cancer’s stage. This information is used to guide future treatments, depending on how early or advanced the disease is.

Our gynecologic oncology team are recognized leaders in surgical approaches to ovarian cancers. Our expertise include:

  • Cytoreductive (debulking) surgeries to remove as much tumor as possible from the pelvic and abdominal areas, improving outcomes and reducing likelihood of recurrence
  • When possible, a minimally invasive approach will be taken to reduce discomfort, blood loss and recovery time, allowing the patient to resume normal activities or other cancer therapies sooner.
  • Coordination with other surgical specialties (including urologic, thoracic, hepatobiliary and neurosurgeons) who can expertly remove secondary tumors in other parts of the body — sometimes in the same operation as the primary tumor removal
  • Fertility-sparing surgery for early stage germ cell or stromal tumors confined to one ovary, preserving the patient’s ability to have children
  • Hyperthermic intraoperative peritoneal chemotherapy, where the surgeon helps deliver and circulate cancer-fighting drugs in the abdominal cavity immediately after surgery. The direct application of heated chemotherapy can help kill more cancer cells than chemotherapy delivered orally or intravenously.
  • Pelvic floor reconstruction procedures that can treat bladder, bowel or sexual symptoms associated with gynecologic surgeries. Sometimes, these procedures can be performed in the same operation as the cancer removal surgery.

For patients who have a high ovarian cancer risk (such as BRCA gene mutation carriers), City of Hope also offers risk-reducing surgery (typically a bilateral oophorectomy to remove both ovaries) that can greatly lower a woman’s likelihood of developing ovarian cancer.

LEARN MORE:

Heated Intraoperative Peritoneal Chemotherapy

Drug Therapy

Drug therapy may be given to patients to fight ovarian cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:

  • Chemotherapy, which targets rapidly-dividing cells, including ovarian cancer cells
  • Targeted therapy, which selectively attacks cancer cells based on specific characteristics
  • Immunotherapy, which stimulates the patient’s own immune system to attack the cancer cells

The drug or drug combination used depends on the type and stage of ovarian cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope is a leader in intraperitoneal chemotherapy or hyperthermic intraoperative peritoneal chemotherapy delivery, which allows doctors to deliver a more concentrated dose of cancer-fighting drugs directly into the abdominal cavity, increasing its effectiveness.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.

LEARN MORE:

Ovarian Cancer Treatment: New Guidelines Reflect Better Outcomes

Hormone Therapy

For hormone-sensitive ovarian cancers — usually ovarian stromal tumors — hormone therapies can fight cancer by blocking the hormones that fuel their growth. For ovarian cancers, these drugs typically block the production or action of estrogen, and may include:

  • Luteinizing-hormone-releasing hormone agonists, which block estrogen production in the ovaries
  • Tamoxifen, which inhibits estrogen activity in the body
  • Aromatase inhibitors, which prevent the conversion of other hormones into estrogen

Based on the disease characteristics and patient’s health, City of Hope doctors can prescribe a hormone therapy regimen that is most effective against ovarian cancer while minimizing potential side effects.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be delivered externally using focused beams of energy, or internally, placing an energy emitting substance in or near the tumor site.

City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.

LEARN MORE:

Radiation Therapy and Gynecologic Cancers

City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat cancer, coupled with our enduring belief in providing unparalleled compassionate care.

Female Pelvic Medicine and Reconstructive Surgery

Christopher Chung, M.D.

Clinical Specialties

  • Female Pelvic Medicine and Reconstructive Surgery
  • Urogynecology

Gynecologic Oncology

Thanh H. Dellinger, M.D.

Clinical Specialties

  • Gynecologic Oncology
Amy Hakim, M.D., M.S.

Clinical Specialties

  • Gynecologic Oncology
Ernest S. Han, M.D., Ph.D., F.A.C.O.G.

Clinical Specialties

  • Gynecologic Oncology
Stephen J. Lee, M.D.

Clinical Specialties

  • Gynecologic Oncology
Paul Lin, M.D.

Clinical Specialties

  • Gynecologic Oncology
Wei-Chien Michael Lin, M.D.

Clinical Specialties

  • Gynecologic Oncology
Mark Wakabayashi, M.D., M.P.H.

Clinical Specialties

  • Gynecologic Oncology
Maria C.B. de Leon, M.D.

Clinical Specialties

  • Gynecologic Oncology

Medical Oncology

Mihaela C. Cristea, M.D.

Clinical Specialties

  • Medical Oncology
Lucille A Leong, M.D.

Clinical Specialties

  • Medical Oncology
  • Hematology
Robert J. Morgan, Jr., M.D., F.A.C.P.

Clinical Specialties

  • Medical Oncology

Radiation Oncology

Yi-Jen Chen, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

At City of Hope, ovarian cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Some of our current research projects include:

  • Developing a cancer vaccine against a mutant variation of the p53 protein, which has lost the tumor suppressing ability of a normal p53 protein and instead may help ovarian and other cancers grow and spread
  • Enhancing the use of cytoreductive (debulking) surgery followed by hyperthermic intraperitoneal chemotherapy for ovarian cancer patients, including using magnetic resonance imaging to help detect and locate tumor sites before and during the surgery
  • Using adoptive T cell therapy to reprogram a patient’s immune system to recognize and attack ovarian cancer cells throughout the body.
  • Building oncolytic —– or cancer-killing — viruses that can destroy ovarian cancer cells at the tumor sites and throughout the body
  • City of Hope researchers have found that a group of proteins called TWIST is responsible for ovarian cancer’s resistance against chemotherapy, and are now looking to develop drugs (TWIST inhibitors) that can overcome this defense mechanism.
  • Enhancing the quality of life for ovarian cancer patients and survivors by engaging them in a peer-to-peer support program with other survivors

LEARN MORE:

Women’s Cancers: Clinical Trials Play Pivotal Role

Women’s Cancers: Discoveries Start with Basic Research

City of Hope is a recognized leader in ovarian cancer research. We offer access to numerous clinical trials and new therapies that are not readily available elsewhere. Our latest research includes developing more precise surgical and radiation techniques for better tumor removal, identifying drugs that can better fight the cancer throughout the body and boosting quality of life for our patients and survivors.

Browse through some of our clinical trials and research projects here.

When you see how many people are touched by City of Hope, it’s impossible not to find a way to connect to it. Ryan Chavira, ovarian cancer survivor and Walk for Hope participant

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your ovarian cancer treatment.

We can help with all of the following concerns, and more:

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE) or the Women’s Center at 800-934-5555.

LEARN MORE:

Ovarian cancer survivor leans on family, faith and City of Hope to defy odds

Ryan Chavira Success Story Image
Ryan, ovarian survivor

With her cancer in remission, Ryan has been participating in Walk for Hope each year since, raising awareness, support and hope for cancer patients and survivors nationwide.

Allisa Miller, ovarian cancer survivor

Allisa Miller was 29 years old when she was diagnosed with ovarian cancer. Then the mother of a 2-year-old daughter, Miller was determined to fight the disease.

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