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Ovarian cancer

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From MayoClinic.com

When to seek medical advice

See your doctor if you have abdominal pain or swelling that doesn't go away. Remember that the signs and symptoms of ovarian cancer are often not easy to detect. Regular pelvic exams are the best way to protect against ovarian cancer or to catch it before it progresses too far.

Because most cases of ovarian cancer are detected late, women with a family history of ovarian cancer should be especially committed to regular pelvic exams. If you have a history of ovarian cancer in your family, strongly consider seeing a physician trained to care for ovarian cancer patients so that you can talk about screening and treatment options while you are disease-free.

Screening and diagnosis

No standardized screening test exists to reliably detect ovarian cancer. Still, several screening procedures may help detect the disease. They include:

  • Pelvic examination. Your physician examines your vagina, rectum and lower abdomen for masses or growths. Whatever your age, schedule a yearly pelvic exam. If you've had your uterus removed but still have your ovaries, still schedule an annual pelvic exam.

  • Ultrasound. If the pelvic exam reveals a growth on an ovary, your doctor may order an ultrasound test. Ultrasound uses high-frequency sound waves to evaluate tissue and create an image of the sound pattern, called a sonogram. Research is under way to determine if this test is useful in women at high risk of ovarian cancer.

One test is used primarily to check for the recurrence of ovarian cancer in women who have previously had the disease:

  • CA 125 blood test. Cancer antigen (CA) 125 is a protein antigen found at abnormally high levels in the blood serum of many women with ovarian cancer. Most healthy women have CA 125 levels below 35 units per milliliter of blood serum. However, a number of noncancerous conditions can cause elevated CA 125 levels, and some women with ovarian cancer never have an elevated CA 125. Because of these limitations, this test isn't commonly used for routine screening in women who aren't at high risk or don't have specific signs and symptoms of the disease.

Other diagnostic tests sometimes include a computerized tomography (CT) scan, which targets areas inside your body to provide detailed pictures produced by a computer that's linked to an X-ray machine. Your doctor may also choose to order an X-ray of your lower gastrointestinal tract to determine if the disease has spread to other organs. X-rays are taken after you've had a barium enema, which aids in visualizing any abnormal tissue in or displacement of the colon or rectum.

If your pelvic examination or tests suggest ovarian cancer, you'll need surgery to confirm the diagnosis. In a surgical procedure called laparotomy, a surgeon explores your abdominal cavity to determine whether cancer is present. If a cancer diagnosis is confirmed, the surgeon and a pathologist identify the type of tumor and determine whether the cancer has spread. This will help determine the stage of the disease. It's important that this type of surgery be performed by a doctor specifically trained to treat gynecologic cancers.

Ovarian cancer is staged from I through IV, which indicates earliest to most advanced. Staging is determined at the time of surgical evaluation of the disease:

  • Stage I ovarian cancer is confined to one or both of the ovaries.

  • Stage II ovarian cancer has spread to other locations in the pelvis such as the uterus or fallopian tubes.

  • Stage III ovarian cancer has spread to the lining of the abdomen (peritoneum) or to the lymph nodes within the abdomen. This is the most common stage of disease identified at the time of diagnosis.

  • Stage IV ovarian cancer has spread to organs beyond the abdomen.


Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy. Radiation is used occasionally.

If you want to preserve the option to have children and if your tumor is discovered early, your surgeon may remove only the involved ovary and its fallopian tube. However, this situation is rare. The most common type of tumor often occurs in both ovaries. In most cases the ideal treatment requires that your surgeon remove both ovaries and also your uterus, fallopian tubes, nearby lymph glands and a fold of fatty tissue known as the omentum, where ovarian cancer often spreads. In addition, your surgeon will take many samples of tissue and fluid from your abdomen to examine for cancer cells. This evaluation is critical in identifying the stage of your disease and determining if you need additional therapy.

If cancer is found during surgical exploration of the abdominal cavity (laparotomy), the surgeon performs definitive surgical treatment at that time. Usually, this surgical treatment involves removing the ovaries, uterus, fallopian tubes, nearby lymph glands and the omentum.

During this procedure, your surgeon also removes as much cancer as possible from the abdomen (surgical debulking). Ideally, less than a total of 1 cubic centimeter of tumor matter remains in the abdominal cavity after surgery (optimal debulking). This often involves removing part of the intestines or other radical procedures.

Following surgery, you'll most likely be treated with a combination of drugs. New combinations of chemotherapy drugs have demonstrated improved survival rates. For years, the standard treatment for ovarian cancer was a combination of two chemotherapy drugs, cisplatin (Platinol) and cyclophosphamide (Cytoxan). Today, the combination of the drugs cisplatin or carboplatin (Paraplatin) with the drug paclitaxel (Taxol) may improve survival rates among women with advanced-stage ovarian cancer.

Other treatments such as chemotherapy drugs, bone marrow transplants, gene therapy and immunotherapy are being investigated for use in treating ovarian cancer.

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