Ovarian Cancer

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Ovarian Cancer 2 | Foundation for Women’s Cancer Introduction You and your family have learned of a diagnosis of ovarian cancer. The amount of information you receive at the time of diagnosis can feel overwhelming. All at once, you may feel there are many unanswered questions, decisions to be made, and so much information to understand. It can be helpful to have friends and family with you when discussing your diagnosis and treatment. A team of health care professionals will work with you and your family throughout your treatment process. Each of them has an important job but the most vital member of the team is you. In order to play an active role during your treatment, you should try to learn as much as possible about ovarian cancer. This booklet will take you through the basics of what you need to know about ovarian cancer. It will introduce you to the people who may be part of your treatment team. Also, it will identify the different types of treatments for ovarian cancer. Hopefully, this information will help prepare you to talk with your treatment team and to feel more confident about your treatment plan. Ovarian Cancer: Your Guide | 3 Ovarian cancer: an overview Cancer occurs when cells in an area of the body grow abnormally. Ovarian cancer is the seventh most common cancer among women. There are three types of ovarian cancer: epithelial ovarian cancer, germ cell cancer, and stromal cell cancer. Epithelial ovarian cancer is the most Equally rare, stromal cell cancer starts in common and accounts for 85% to the cells that produce female hormones 89% of ovarian cancers. It forms on and hold the ovarian tissues together. the surface of the ovary in the epithelial cells or from the fallopian tube. It Familial breast-ovarian cancer ranks fourth in cancer deaths among syndrome is a common inherited women and causes more deaths condition that causes 15–20% of all than any other cancer of the female ovarian cancers and 5–10% of all reproductive system. breast cancers. The association is so common that it is now recommended On the other hand, germ cell cancer that all women with epithelial ovarian is an uncommon form of ovarian cancer be tested for an inheritable cancer, accounting for only about 5% BRCA mutation. This has implications of ovarian cancers. Germ cell cancers for outcome, treatment, risk for breast start in the cells that form the eggs cancer, and risk for family members. in the ovaries. This cancer is usually However, the implications of testing found in adolescents and young are complex enough that consultation women, and usually affects only with a genetic counselor is helpful. one ovary. 4 | Foundation for Women’s Cancer Symptoms and diagnosis Historically, ovarian cancer was called These symptoms include fatigue, the “silent killer” because symptoms indigestion, back pain, pain with were not thought to develop until the intercourse, constipation, and chance of cure was poor. However, menstrual irregularities. However, these recent studies have shown this term is other symptoms are not as useful in untrue and that the following symptoms identifying ovarian cancer because are much more likely to occur in women they are also found in equal frequency with ovarian cancer than in women in in women in the general population the general population, even in patients who do not have ovarian cancer. an overview with early-stage disease. Medical evaluation These symptoms include: When a woman experiences • Bloating concerning symptoms, a pelvic exam, • Pelvic or abdominal pain including a rectovaginal exam, and • Difficulty eating or feeling a general physical exam should be full quickly performed. If the exam is abnormal, • Urinary symptoms women should undergo a transvaginal (urgency or frequency) or pelvic ultrasound to evaluate the ovaries, or a CT scan to look for Women with ovarian cancer report that distant disease. symptoms are persistent and represent a change from normal for their bodies. If the exam is adequate and normal, it The frequency and/or number of such is reasonable to wait 2 to 3 weeks to symptoms are key factors in the diagnosis see if the symptoms resolve. If they of ovarian cancer. Several studies show do not, then a transvaginal or pelvic that even early-stage ovarian cancer can ultrasound should be performed. If an produce these symptoms. abnormality of the ovaries is found, additional radiographic studies, Women who have these symptoms such as a CT scan or an MRI, and almost daily for more than a few weeks a blood test for CA 125 may be should see their doctor, preferably performed. CA 125 is elevated in a gynecologist. Prompt medical approximately 80% of women with evaluation may lead to detection advanced-stage epithelial ovarian at the earliest possible stage of cancer, but elevations can occur for the disease. Early-stage diagnosis reasons other than ovarian cancer. is associated with an improved For more information, please visit prognosis. Several other symptoms foundationforwomenscancer.org have been commonly reported by for a brochure entitled CA 125 Levels: women with ovarian cancer. Your Guide. Ovarian Cancer: Your Guide | 5 Working yourwith treatment team During your treatment, you will come in contact with many health care professionals. These people make up your treatment team. They will work with each other and you to provide the special care you need. Your treatment team may include some of the health care professionals listed below. Gynecologic oncologists are board- Women with ovarian cancer who have certified obstetrician- gynecologists their surgery done by a gynecologic who have an additional three to four oncologist have higher cure rates years of specialized training in treating than women who have surgery done gynecologic cancer from an American by another type of doctor. The better Board of Obstetrics and Gynecology- survival is related to the fact that approved fellowship program. A gynecologic oncologists are more likely gynecologic oncologist can manage to remove all of the cancer at the time of your care from diagnosis to surgery. Many gynecologic oncologists completion of treatment. will also plan and administer the chemotherapy program. To find a gynecologic oncologist in your area, log onto the Foundation for Women’s Cancer website (foundationforwomenscancer.org) and enter your zip code in the “Find a Gynecologic Oncologist” section. 6 | Foundation for Women’s Cancer You also may be treated by: Medical oncologist who specializes in Nutritionist or registered dietitian using drug therapy (chemotherapy) to who is an expert in helping you treat cancer. maintain or initiate healthy eating habits. This is important in the Radiation oncologist who specializes recovery process. These professionals in using radiation therapy to treat cancer. can help you overcome potential side effects of treatment such as poor Oncology nurse who specializes in appetite, nausea, or mouth sores. It is cancer care. An oncology nurse can important to note that natural remedies work with you on every aspect of your and supplements should be taken only care, from helping you understand your under the supervision of a naturopathic diagnosis and treatment to providing physician in consultation with your emotional and social support. gynecologic oncologist. Social worker who is professionally Talking with your team trained in counseling and practical You deserve expert advice and assistance, community support treatment from your treatment team. programs, home care, transportation, Be sure to talk openly about your medical assistance, insurance, and concerns with the members of your entitlement programs. Social workers treatment team. Let them know what is are very helpful advocates, especially important to you. If it is hard for you to when you are first diagnosed and speak for yourself, these tips may help: unsure about what to do next. • Make a list of questions before your visit. Ask the most important Patient navigator who educates questions first. patients about the disease and serves • Take notes or ask if you can tape- as an advocate on behalf of the patient record your medical office visits and and her caregivers throughout cancer phone conversations. treatment. • If you don’t understand something, Clinical trial/research nurse if you are ask the treatment team member to participating in a clinical trial. Clinical explain it again in a different way. trials are necessary for finding new • If possible, bring another person with treatments and improving patient care. you when you meet with members of Clinical trial nurses play a key role in your treatment team to discuss test this research by ensuring patients’ results and treatment options. safety and offering support throughout • Be truthful in reporting how you feel the research study. and any side effects. Ovarian Cancer: Your Guide | 7 Surgical staging When ovarian cancer is diagnosed, it is vital to determine if the cancer has spread beyond the ovaries. Your treatment team may do more tests to determine this. In addition, during surgery, certain additional steps should be performed to determine the extent of the disease. This process is called staging. Staging helps to determine the exact extent of your cancer and what treatment plan is best for you. Following surgery, your cancer will be It is important that your surgery categorized into Stage I, II, III, or IV, be performed by a gynecologic illustrated on the following page. The oncologist, a physician with special cancer will also be assigned a grade. training in the care of women’s Grade refers to how abnormal the reproductive cancers. Studies show cells appear under a microscope. Low that patients treated by gynecologic grade tumors, also called grade 1, have oncologists at high-volume centers features that resemble normal ovarian have improved outcomes. cells. In contrast, in high grade tumors (grade 3) the microscopic appearance is greatly altered from normal.
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