A National Cancer Institute-designated Comprehensive Cancer Center

Make an appointment: 800-826-HOPE

Ovarian Cancer

About Ovarian Cancer
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).

An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue, too. Most ovarian cysts are benign (not cancer) and go away with time. Sometimes, a doctor will find a cyst that does not go away or that gets larger. The doctor may order tests to make sure that the cyst is not cancer.

Ovarian cancer can invade, shed or spread to other organs:
  • Invade. A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus.
  • Shed. Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
  • Spread. Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.
 

Risk Factors

Studies have found the following risk factors for ovarian cancer:

  • Family history of cancer
    Women who have a mother, daughter or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon or rectum may also have an increased risk of ovarian cancer.

    If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.
     
  • Personal history
    Women who have had cancer of the breast, uterus, colon or rectum have a higher risk of ovarian cancer.
     
  • Age
    Most ovarian cancers develop after menopause. Half of all ovarian cancers are found in women over the age of 63.
     
  • Reproductive history
    A woman who has had children has a lower risk of ovarian cancer than women who have no children. The risk gets even lower with each pregnancy. Breast feeding may lower the risk even further. Using oral contraceptives (also known as birth control pills) also lowers the risk of ovarian cancer.
     
  • Estrogen or hormone replacement therapy
    Studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
     
  • Obesity
    Various studies have looked at the relationship of obesity and ovarian cancer. A study from the American Cancer Society also found a higher rate of death from ovarian cancer in obese women. The risk was increased by 50 percent in the heaviest women.

Scientists have also studied whether taking certain fertility drugs and using talcum powder are risk factors. It is not clear whether these are risk factors, but if they are, they are not strong risk factors.

 

 

Symptoms

Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include:

  • Pressure or pain in the abdomen, pelvis, back, or legs
  • A swollen or bloated abdomen
  • Nausea, indigestion, gas, constipation or diarrhea
  • Feeling very tired all the time

Less common symptoms include:

  • Shortness of breath
  • Feeling the need to urinate often
  • Unusual vaginal bleeding (heavy periods, or bleeding after menopause)

Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor.

 

 

Diagnosing Ovarian Cancer

Several different tests are used to detect ovarian cancer:
 
  • Pelvic exam and history
    Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but does not collect ovarian cells. The Pap test detects cervical cancer. It is not used to diagnose ovarian cancer.
  • Blood tests
    The lab may check the level of several substances, including CA-125. CA-125 is found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment.
  • Ultrasound
    Ultrasound uses high-frequency sound waves to examine organs inside the pelvis. This allows radiologists to distinguish fluid-filled cysts from solid masses and to determine whether solid masses are benign or suspicious. Click here to download our "Diagnostic Ultrasound” brochure. For a better view of the ovaries, a special ultrasound device may be inserted into the vagina (transvaginal ultrasound).
  • CT or CAT (computerized axial tomography) scan
    This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • MRI (magnetic resonance imaging)
    MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
  • Laparoscopy
    In this test, a thin, lighted tube is inserted through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
  • Biopsy
    Tissue samples are examined under the microscope to determine what types of cells are present. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer.
 

Treatments

City of Hope uses a multidisciplinary approach to combat ovarian cancer. Our surgeons, medical and radiation oncologists and researchers collaborate closely throughout treatment to ensure ovarian cancer patients receive the best care possible.

Department of Surgery
Because ovarian cancer does not grow in a manner similar to most solid tumors, it is usually not possible for a surgeon to remove the entire tumor present in the abdomen. It has been shown, however, that removal of all visible manifestations of the tumor (often referred to as debulking surgery), followed by chemotherapy treatment, provides the best chance of a cure.

When applicable, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the da Vinci S Surgical System with robotic capabilities that allows for greater precision. These surgeries feature small incisions and potentially:

  • Less blood loss, pain and visible incisions;
  • Shorter hospital stay and recovery time;
  • Fewer complications and quicker return to normal activities.

Preventative Surgery
For women at high risk for developing cancer, we offer preventative surgery, called salpingo-oophorectomy, which involves the surgical removal of the ovaries and fallopian tubes. This procedure can reduce the chance of ovarian and related cancers by as much as 80 percent in women at high risk.

Radiation Therapy
Radiation therapy is often used in treating ovarian cancer. It may be employed as a stand-alone treatment for early stage cancer, or in combination with surgery and other treatments in more advanced cases, to help reduce the chance of recurrence.

Radiation therapy 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.

Intensity modulated radiation therapy (IMRT)
IMRT targets tumors with pencil-thin “beamlets” of radiation. By sculpting the radiation to precisely match the tumor’s contours, a higher dose can be delivered to the cancer while avoiding unnecessary exposure of healthy tissues. Treatment with IMRT may also minimize certain side effects.

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

Chemotherapy
Medicines that slow or stop the growth of cancer cells are often included in a patient’s treatment plan. We provide both standard therapy and access to clinical trials of new, leading-edge therapies that offer the best chance for a cure.

Intraperitoneal chemotherapy
City of Hope offers the latest breakthrough in chemotherapeutic treatment of advanced ovarian cancer, which results in improved survival rates over that seen following standard intravenous chemotherapy.

Optimal treatment of advanced ovarian cancer includes aggressive debulking surgery followed by chemotherapy. Recently, results were published from the third largest national clinical trial comparing administration of chemotherapy directly into the abdomen (intraperitoneal chemotherapy, or IP) with chemotherapy delivered through the veins. In support of two other large clinical trials, this trial confirmed that IP delivery of chemotherapy results in a 16-month improvement in median survival compared to patients receiving intravenous chemotherapy alone. The National Cancer Institute issued an alert to physicians that all women with regionally advanced ovarian cancer should be considered for this route of treatment following surgery.

Resources

All of our patients have access to the  Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.


Additional Resources

Women’s Cancer Network
800-444-4441
The Women’s Cancer Network is an interactive Web site developed by the Gynecologic Cancer Foundation, which is dedicated to informing women around the world about gynecologic cancer. Its goal is to assist women who have developed cancer, as well as their families, to understand more about the disease, learn about treatment options and gain access to new or experimental therapies.

Ovarian Cancer National Alliance
866-399-6262
The Ovarian Cancer National Alliance is a patient-led, umbrella organization uniting ovarian cancer activists, women’s health advocates and health care professionals in the effort to increase public and professional understanding of ovarian cancer and to advocate for more effective diagnostics, treatments and a cure.

American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.

National Comprehensive Cancer Network (NCCN)
888-909- NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.

National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 

Research and Clinical Trials

City of Hope is at the forefront of some of the nation’s most promising ovarian cancer research and treatment programs. We conduct vital research and clinical trials to improve treatment and quality of life for women living with the disease, and early detection and prevention of ovarian cancer for all women. City of Hope's commitment to this crucial biomedical field will not only serve City of Hope patients, but the scientific knowledge generated here is shared with other top cancer centers across the country. This ensures that the most advanced therapies help women afflicted with ovarian cancer everywhere, every day.

To learn more about our clinical trials program and specifically about trials for ovarian cancer, click here.

Clinical Research

Novel Chemotherapy Agents
We are studying the effectiveness of several new chemotherapy options for treating women with recurrent ovarian cancer. City of Hope is collaborating with the National Cancer Institute on clinical trials of new ovarian cancer drugs including Bryostatin, a novel protein kinase C inhibitor derived from a mollusk which has been shown to be active in the treatment of ovarian cancer and also provides synergy when administered with platinum agents. A clinical trial is currently ongoing and actively accruing patients.

New dose-intensive approaches utilizing stem cell support to overcome the toxicity of chemotherapy are ongoing in patients with ovarian cancer who have residual or recurrent disease, which is responsive to chemotherapy. Novel intraperitoneal (abdominal) chemotherapy trials are in progress. Gemcitabine, a recently approved chemotherapeutic agent active in ovarian cancer has recently been shown by City of Hope clinical investigators to have excellent potential as an intraperitoneal agent. Accrual to the current clinical trial is continuing.

Radioimmunotherapy to Treat Ovarian Malignancy
This research study evaluates radiolabeled antibodies and standard therapy compared to standard therapy alone in patients with ovarian cancer.
 

Ovarian Cancer Videos

Watch highlights from this informative lecture on gynecological cancers. All women can benefit from this discussion on detection and treatment, as well as research, on ovarian and uterine cancers. Associated health issues including HPV (human papillomavirus) are also discussed.



Clips from "Ask the Experts - Women's Cancers and HPV"


Prevention of Ovarian Cancer
Robert Morgan, M.D. | June 2012
Click to view >>
Watch and share on YouTube >>

Screening for Ovarian Cancer
Robert Morgan, M.D. | June 2012
Click to view >>
Watch and share on YouTube >>

Ovarian Cancer: What's New in Treatment
Robert Morgan, M.D. | June 2012
 
 

Ovarian Cancer Team

Support This Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

 
 
The Positive Image Center is where licensed cosmetologists support and assist patients with building and maintaining self-confidence in their appearance. Services are free and provide a forum in which patients can access wig fittings and stylings and discuss cosmetic techniques.
 
Cooper Finkel Women’s Health Center
Many gynecological cancer and breast cancer  services at City of Hope are provided at the Rita Cooper Finkel and J. William Finkel Women's Health Center. Here, women receive the highest quality care, whether seeking prevention and screening services or coping with a cancer diagnosis.
Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.

To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The Sheri & Les Biller Patient and Family Resource Center embodies the heart and soul of City of Hope’s mission to care for the whole person.
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
NEWS & UPDATES
  • For breast cancer survivors, a common worry is a recurrence of their cancer. Currently, these patients are screened with regular mammograms, but there’s no way to tell who is more likely to have a recurrence and who is fully cleared of her cancer. A new blood test – reported in Cancer Research, a journal of the...
  • Metastasis — the spreading of cancer cells from a primary tumor site to other parts of the body — generally leads to poorer outcomes for patients, so oncologists and researchers are constantly seeking new ways to detect and thwart this malicious process. Now City of Hope researchers may have identified a substa...
  • Deodorant, plastic bottles, grilled foods, artificial sweeteners, soy products … Do any of these products really cause cancer? With so many cancer myths and urban legends out there, why not ask the experts? They can debunk cancer myths while sharing cancer facts that matter, such as risk factors, preventi...
  • Cancer risk varies by ethnicity, as does the risk of cancer-related death. But the size of those differences can be surprising, highlighting the health disparities that exist among various ethnic groups in the United States. Both cancer incidence and death rates for men are highest among African-Americans, acco...
  • George Winston, known worldwide for his impressionistic, genre-defying music, considers music to be his first language, and admits he often stumbles over words – especially when he attempts languages other than English. There’s one German phrase he’s determined to perfect, however: danke schön. Winston thinks h...
  • Few decisions are more important than those involving health care, and few decisions can have such lasting impact, not only on oneself but on relatives and loved ones. Those choices, especially, should be made in advance – carefully, deliberately, free of pain and stress, and with much weighing of values and pr...
  • Using a card game to make decisions about health care, especially as those decisions relate to the end of life, would seem to be a poor idea. It isn’t. The GoWish Game makes those overwhelming, but all-important decisions not just easy, but natural. On each card of the 36-card deck is listed what seriously ill,...
  • Young adults and adolescents with cancer face unique challenges both during their treatment and afterward. Not only are therapies for children and older adults not always appropriate for them, they also must come to terms with the disease and treatment’s impact on their relationships, finances, school or ...
  • Breast cancer is the most common cancer, other than skin cancer, among women in the United States. It’s also the second-leading cause of cancer death, behind lung cancer. In the past several years, various task force recommendations and studies have questioned the benefits of broad screening guidelines fo...
  • Paternal age and the health effects it has on potential offspring have been the focus of many studies, but few have examined the effect parental age has on the risk of adult-onset hormone-related cancers (breast cancer, ovarian cancer and endometrial cancer). A team of City of Hope researchers, lead by Yani Lu,...
  • Hormone therapy, which is prescribed to women for relief of menopausal symptoms such hot flashes, night sweats and vaginal dryness, has recently seen a decline in popularity (and use) due to its link to an increased risk of breast and endometrial cancer. But City of Hope researchers have found that menopausal h...
  • Myeloproliferative neoplasms can’t be narrowed down to a single cancer, but they can be described by a defining characteristic: too many blood cells. The diseases bring with them a host of frustrating, potentially life-altering symptoms, and management of the diseases and their symptoms is crucial. An upcoming ...
  • More than 18,000 researchers, clinicians, advocates and other professionals will convene at the 105th American Association for Cancer Research (AACR) annual meeting taking place in San Diego from April 5 to 9. With more than 6,000 findings being presented over this five-day period, the amount of information can...
  • Cancer of the prostate is the No. 2 cancer killer of men, behind lung cancer, accounting for more than 29,000 deaths annually in this country. But because prostate cancer advances slowly, good prostate health and early detection can make all the difference. Many prostate cancer tumors don’t require immedi...
  • Despite advances made in detecting and treating nonsmall cell lung cancer, its prognosis remains grim. Even patients whose cancers are caught at their earliest stage have only a 50 percent chance of five-year survival. This poor prognosis is due in part to the cancer’s ability to resist treatment, renderi...