1. Cancer Education Slides
Ovarian Cancer

2. What is Cancer? A group of 100 different diseases
The uncontrolled, abnormal growth of cells
Cancer may spread to other parts of the body

3. What is Ovarian Cancer?
Ninth most common type of cancer and fifth most frequent cause of cancer-related death in women
An estimated 21,550 new cases in the United States in 2009
A disease in which ovarian cells grow uncontrollably and form a tumor
85% to 90% of cases begin in cells on the outer surface of the ovary, called epithelial carcinoma

4. What is the Function of the Ovaries?
Every woman has two ovaries
Almond-shaped glands that contain the germ cells or eggs
During monthly ovulation, an egg is released from an ovary and travels to the uterus through the fallopian tube
Primary source of estrogen and progesterone, the hormones that influence breast growth, body shape, and body hair, and regulate the menstrual cycle and pregnancy

5. What are the Risk Factors for Ovarian Cancer?
Age
Family history
Genetics
Ethnicity
Reproductive history
Hormones
Obesity
Behavioral and social factors

6. Hereditary Ovarian Cancer: HBOC
Hereditary breast and ovarian cancer (HBOC) is caused by a mutation in BRCA1 and BRCA2 genes
Women with HBOC have a 15% to 40% lifetime risk of ovarian cancer
Women with HBOC should have increased screening for ovarian cancer
Screening options include pelvic examinations, ultrasound, and a CA-125 blood test
Genetic testing is available

7. Hereditary Ovarian Cancer: HNPCC
Hereditary non-polyposis colorectal cancer syndrome (HNPCC) is most often caused by a mutation in the MLH1, MSH2, MSH6, or PMS2 genes, though other genes have been linked to HNPCC
Women with HNPCC have a 9% to 12% risk of developing ovarian cancer
HNPCC is most commonly associated with an increased risk of colorectal cancer
Genetic testing is available

8. Hereditary Ovarian Cancer: Peutz-Jeghers Syndrome
Peutz-Jeghers syndrome (PJS) caused by a mutation in the STK11 gene (also called the LKB1 gene)
Women with PJS have about a 20% risk of developing ovarian cancer
The most common sign of PJS is multiple hamartomatous polyps in the digestive system
Women with PJS have increased pigmentation (dark spots on the skin) on the face and hands that appears in childhood but fades over time
Genetic testing is available

9. Hereditary Ovarian Cancer: NBCCS
Nevoid basal cell carcinoma syndrome (NBCCS) is caused by a mutation in the PTCH gene
Women with NBCCS have a increased risk of developing fibromas (benign fibrous tumors) of the ovaries
There is a small risk that these fibromas could develop into a type of ovarian cancer called a fibrosarcoma
Signs of NBCCS are macrocephaly (larger than average head size), unique facial features, and skeletal changes in the ribs and backbone
Genetic testing is available

10. Other Hereditary Ovarian Cancer Syndromes
Several other genes and genetic conditions can increase a woman’s risk of ovarian cancer
Talk with your doctor about finding a genetic counselor if you have a history of ovarian cancer in your family
For more information, visit

11. Ovarian Cancer and Early Detection
Certain factors may reduce a woman's risk of developing ovarian cancer
Taking birth control pills for more than 5 years
Breastfeeding
Pregnancy
A hysterectomy or a tubal ligation
Women with strong family histories of ovarian cancer may consider a risk-reducing salpingo-oophorectomy (removal of both ovaries and fallopian tubes)

12. What are the Symptoms of Ovarian Cancer?
More common symptoms
Other symptoms
Bloating
Pelvic or abdominal pain
Difficulty eating or feeling full quickly
Urinary symptoms (urgency or frequency)
Fatigue
Indigestion
Back pain
Pain with intercourse
Constipation
Menstrual irregularities

13. How is Ovarian Cancer Diagnosed?
A biopsy is rarely done as a separate procedure
Diagnosis is confirmed with an analysis of tumor tissue
Pelvic examination
Transvaginal ultrasound
CA-125 blood test
Lower gastrointestinal (GI) series
Computed tomography (CT or CAT) scan
Positron emission tomography (PET) scan
X-ray

14. Ovarian Cancer Staging
Staging is a way of describing a cancer, such as the size of a tumor and if or where it has spread
Staging is the most important tool doctors have to determine a patient’s prognosis
Staging is described by the TNM system: the size and location of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to other areas of the body)
Some stages are divided into smaller groups that help describe the tumor in even more detail
Treatment depends on the stage of the cancer
Recurrent cancer is cancer that comes back after treatment

15. Stage IA Ovarian Cancer
Tumor is encapsulated and limited to one ovary
No spread to lymph nodes or other parts of the body

16. Stage IB Ovarian Cancer
Cancer is encapsulated and located in both ovaries
No spread to lymph nodes or the rest of the body

17. Stage IC Ovarian Cancer
Cancer is in both ovaries with a ruptured capsule
There is spread to ovarian surface or malignant cells in the abdominal fluid

18. Stage IIA Ovarian Cancer
Cancer is in one or both ovaries and has spread to the pelvis
Cancer has spread to the uterus or fallopian tubes
No spread to lymph nodes or other parts of the body

19. Stage IIB Ovarian Cancer
Cancer is in one or both ovaries and has spread to the pelvis
Cancer has spread to other pelvic tissue
No spread to lymph nodes or other parts of the body

20. Stage IIC Ovarian Cancer
Cancer is in one or both ovaries and has spread to the pelvis
Cancer has spread to pelvic area
Cancer is shedding cancer cells into the abdominal fluid

21. Stage IIIA Ovarian Cancer
Cancer is in one or both ovaries, the pelvis, and has spread to the peritoneum
Cancer has spread microscopically throughout the pelvis

22. Stage IIIB Ovarian Cancer
Cancer is in one or both ovaries and has spread to the pelvis
Cancer has spread to other pelvic tissue
No spread to lymph nodes or other parts of the body

23. Stage IIIC Ovarian Cancer
Cancer is in one or both ovaries and has spread to the pelvis
Cancer has spread to pelvic area
Cancer is shedding cancer cells into the abdominal fluid

24. Stage IV Ovarian Cancer
Cancer has spread to distant organs
Treatment includes surgery and chemotherapy

25. How is Ovarian Cancer Treated?
Treatment depends on stage of cancer
More than one treatment may be used
Surgery
Chemotherapy
Radiation therapy

26. Cancer Treatment: Surgery
Primary treatment
Removal of ovaries, fallopian tubes, the uterus, and/or the omentum, the thin tissue covering the stomach and large intestine
Lymph nodes, tissue samples, and fluid from the abdomen may be removed to determine if the cancer has spread
It may be possible to remove only one ovary and fallopian tube
Surgery may cause short-term pain and tenderness or difficulty emptying the bladder
Women may have menopausal symptoms, including hot flashes and vaginal dryness if both ovaries are removed

27. Cancer Treatment: Chemotherapy
Use of drugs to kill cancer cells
Given to destroy cancer remaining after surgery, slow tumor growth, or reduce side effects
A combination of drugs is often used

28. Types of Chemotherapy
Most drugs used to treat ovarian cancer are given intravenously (IV) or intraperitoneally (IP)
Either injected into a vein or through a catheter
Women with advanced ovarian cancer may have a combination of IV and IP chemotherapy
Side effects may include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea

29. Cancer Treatment: Radiation Therapy
The use of high-energy x-rays to destroy cancer cells
Different methods of delivery
Radiation treatment is not usually used to treat ovarian cancer, but may be used to relieve side effects of progressive cancer, such as tumor growth in the pelvic area
Side effects may include fatigue, mild skin reactions, upset stomach, and loose bowel movements
Doctors may advise their patients not to have sexual intercourse during radiation therapy

30. Current Research
Risk reduction: vitamins and drugs that may reduce the risk of ovarian cancer
Targeted therapy: treatment targeting faulty genes or proteins that contribute to cancer growth
Gene therapy: correcting or replacing damaged genes that increase cancer risk
Cancer vaccines: trigger the body’s immune system to kill cancer cells

31. The Role of Clinical Trials for the Treatment of Ovarian Cancer
Clinical trials are research studies involving people
They test new treatment and prevention methods to determine whether they are safe, effective, and better than the standard treatment
The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process
Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

32. Clinical Trials: Patient Safety
Informed consent: participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks; informed consent is an ongoing process
Participation is always voluntary, and patients can leave the trial at any time
Other safeguards exist to ensure ongoing patient safety

33. Clinical Trials: Phases
Phase I trials determine the appropriate dose of a new treatment in a small group of people and provide preliminary information about the drug’s safety
Phase II trials provide information about the safety of the new treatment and provide the first evidence as to whether or not the new treatment is effective in treating the cancer that is being studied
Phase III trials compare two or more different treatments. Most commonly, they test whether a new treatment is better than the standard treatment. Patients are typically divided randomly into two or more different groups. Each group gets a different treatment, and the researchers evaluate which group has had the best results. This is the best way to measure whether a new treatment results in longer life or better quality of life for patients

34. Clinical Trials Resources
Coalition of Cancer Cooperative Groups (
CenterWatch (
National Cancer Institute (
EmergingMed (

35. Coping with Side Effects
Side effects are treatable; talk with the doctor or nurse
Fatigue is a common, treatable side effect
Pain is treatable; non-narcotic pain-relievers are available
Antiemetic drugs can reduce or prevent nausea and vomiting
For more information, visit

36. After Treatment
Talk with the doctor about developing a follow-up care plan
Doctors may recommend a pelvic exam every two to four months for the first two years after treatment, and every six months for the following three years
Other tests may include a chest x-ray, CT scan, urinalysis, and blood tests, such as a CA-125 test
Fear of recurrence is common; talk with your doctor about ways to cope

37. Where to Find More Information Cancer.Net Guide to Ovarian Cancer (www.cancer.net/ovarian)
Overview
Medical Illustrations
Risk Factors
Symptoms
Diagnosis
Staging With Illustrations
Treatment
Clinical Trials
Side Effects
After Treatment
Current Research
Questions to Ask the Doctor
Patient Information Resources

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