About Your Diagnosis

Ovarian cancer is a tumor of the female reproductive organs called ovaries. The ovaries produce the female hormones called estrogen and progesterone, which help regulate the menstrual cycle and pregnancy. The ovaries release eggs monthly in preparation for fertilization (when the sperm and egg unite). Nearly 27,000 cases of ovarian cancer are diagnosed each year, and about 1 in 70 women has this cancer in her lifetime. The cause of ovarian cancer is unknown, but there are certain risk factors that increase one’s risk for ovarian cancer. The risks include:
1. Family history. There is a 5% risk if a close relative has the disease. The risk increases to 50% if two family members have the disease.
2. Age. It is uncommon for ovarian cancer to occur before 40 years of age, but the risk increases with age, peaking in the 70s.
3. Breast cancer. Women who have breast cancer are at high risk for ovarian cancer.
4. Infertility, use of drugs to induce fertility (drugs used before in vitro fertilization), frequent miscarriages, and never being pregnant. Women who use birth control pills are less likely to have ovarian cancer than those who do not use the pill. Ovarian cancer is difficult to detect in its early stages. This is because the tumor produces no symptoms in its initial stage to make the patient or physician aware anything is wrong. There is no effective early screening method. During pelvic examinations a physician attempts to feel for the ovaries and any abnormal lumps. Even with this method early ovarian cancer usually goes undetected. A Papanicolaou (Pap) smear is not reliable for ovarian cancer but is highly reliable for cancer of the cervix. Transvaginal ultrasonography (examination with an ultrasound probe placed in the vagina to look for ovarian tumors) has been tried as a screening tool, but it gives many false-positive results. A blood test to measure CA-125 (Cancer Antigen-125) has been tried as a screening test, but again there are many false-positive results. Unless there is are risk factors, screening is usually not performed on the general population. The best way to diagnose ovarian cancer is to obtain tissue by means of a surgical procedure and examine it with a microscope (biopsy).

Living With Your Diagnosis
In the early stages, ovarian cancer produces no symptoms. As the cancer grows and spreads, you may have lower abdominal discomfort, feel bloated and swollen, and have a loss of appetite. As the tumor presses on nearby organs such as the bladder and intestine (bowel), you may have frequent urination, constipation, and sometimes although not frequently, vaginal bleeding. Ovarian cancer can also produce fluid in the abdominal cavity called
ascites.

Treatment
All women with suspected ovarian cancer undergo an abdominal operation (laparotomy). This allows the surgeon to diagnose and stage the disease. In the case of tumor that has spread, the surgeon removes as much of the cancer as possible. This is called debulking and reduces the amount of cancer to be treated with chemotherapy or radiation therapy. Complications are pain, menopausal effects such as hot flashes and vaginal dryness, and infection. Depending on the stage of the disease (stage I, confined to the ovary; stage II, confined to the pelvis; stage III, spread into the abdomen; stage IV, spread outside the abdomen), the oncologist decides what chemotherapeutic drugs to use. Side effects depend on the drug used, but nausea, vomiting, hair loss, easy bruising and bleeding, and infections can occur. The use of radiation therapy depends on the stage of the disease. Side effects include dry, itchy, red skin over the treated area. Radiation treatment to the lower abdomen can cause nausea, vomiting, diarrhea, pain with urination, vaginal dryness, and pain with intercourse.

The DOs
• Address symptoms with your primary care physician, especially if you are at high risk.
• Request second opinions about all types of treatment (surgical, radiation, and chemotherapy) if you are not sure what to do.
• Ask for pain medications after surgical treatment.
• Understand the importance of nutrition after treatment.
• Ask questions about prognosis of the tumor, survival times, and recurrence of the tumor.

The DON’Ts
• Do not miss follow-up appointments. When treatment is over, regular examinations are performed to look for recurrence of the tumor. This includes the examination, computed tomography (CT), and measurement of CA-125 in the blood. The blood level is often high before surgical treatment and returns to normal afterward. If CA-125 level begins to rise again, the cancer may have recurred.
• Do not be afraid to ask about emotional support groups.

When to Call Your Doctor
• If you have vaginal bleeding with abdominal swelling, bloating, or pain.
• If you have fever with chemotherapy.
• If you have drainage from the wound site, fever, or pain after your operation.
• If you have diarrhea, urinary frequency, or vaginal pain after radiation.