Frequently Asked Questions
Ovarian cancer is the rapid growth of abnormal cells in the ovaries of the female reproductive system. The ovaries are the two small egg-filled sacs on each side of the uterus which produce estrogen and play a key role in conception and menstruation. Cancer can occur in one or both ovaries. When there is a malignancy, the ovaries typically enlarge, and cancer cells may fall off the ovary's surface and implant themselves throughout the abdominal cavity. Each one of these seedlings can then grow into a separate ovarian cancer tumor nodule.
Who is at risk for ovarian cancer?
Each year, more than 20,000 American women will be diagnosed with ovarian cancer. The disease most often affects post-menopausal women, although women of any age may develop it. While scientists have not uncovered the cause, women in any of the following categories are known to be at higher risk: those who are infertile, who have never been pregnant, who bore children at a later age, who have had breast cancer, and women with family members who have had ovarian cancer. You cannot transmit the disease through physical or sexual contact.
Taking birth control pills reduces your risk for the disease. Women who have had tubal ligations are also less likely to get ovarian cancer. And the more often a woman has been pregnant, the less likely she is to develop ovarian cancer.
What are the symptoms of ovarian cancer?
Cancer of the ovaries often develops with no early warning signs. The first indication of the disease may be a swelling or feeling of fullness in the lower abdomen. Ovarian cancer can also cause indigestion, unusual bowel or rectal pressure, and abdominal pain or discomfort. Persistent digestive problems such as stomach discomfort, distention and gas might also be symptoms.
Your doctor may notice an ovarian cyst or other growth during your regular pelvic exam. Cysts on the ovaries rarely turn out to be cancerous, especially in women under 40. Most of these growths are normal and related to the menstrual cycle, but your physician will want to watch you closely to be certain the cyst resolves.
Can ovarian cancer be prevented?
Women who have annual pelvic exams increase their chance of early detection and a better treatment outcome if the disease is discovered. If any family relative has had cancer of the ovaries, your physician may advise you to have checkups more frequently. The genes for ovarian cancer are not “sex linked,” which means that the gene for the disease can be inherited from either your mother or father.
What if my doctor detects a growth on my ovaries?
If your doctor suspects cancer of the ovaries based on your symptoms and on a pelvic examination – a number of diagnostic procedures can help determine whether the abnormal growth is cancerous. Frequently, growths on the ovaries turn out to be nonmalignant cysts.
To determine whether the tumor is malignant, you may be referred to a gynecologic oncologist (cancer specialist) for one or a combination of the following tests:
- Ultrasound – a painless, non-invasive sound wave technique that enables your doctor to examine the inside of your abdomen and the ovaries
- Lower GI series – produces an X-ray of your colon to determine whether pressure from an ovarian tumor is changing the shape and position of the colon and rectum
- CT or CAT Scan – an X-ray procedure that provides detailed pictures of cross sections of the body. The pictures are created by a computer
- Laparotomy or Laparoscopy – these surgical procedures involve making an incision in the abdomen to biopsy the suspicious ovarian tissue. The surgeon removes the entire affected ovary so that the disease, if present, doesn't spread. You may wish to obtain a second opinion from another physician before scheduling a laparotomy.
What are some questions I need to ask my physician if ovarian cancer is diagnosed?
- Have you had special training in the management of gynecologic cancers or can you refer me to such a specialist?
- Has the cancer spread?
- What are the surgical options?
- Will I need chemotherapy or radiation, too?
- What are the potential side effects of the recommended treatments?
- Will I be infertile after treatment or are there other options?
- Can I work and continue my normal activities during treatment?
How is cancer of the ovaries treated?
Treating ovarian cancer requires inpatient surgery, usually performed by a gynecologic oncologist. After confirming a diagnosis of cancer, your doctor will surgically remove the affected ovary. Most often – as a precautionary measure or because the cancer has spread – your doctor will remove both ovaries, along with the fallopian tubes and uterus. In addition, the surgeon will also take samples of nearby lymph nodes, and other internal structures including fluid from the abdomen to determine whether the cancer has spread.
After surgery, most patients receive chemotherapy (anti-cancer drugs) for approximately six months to destroy any remaining cancer cells.
What are the side effects of treatment?
For several days after surgery, a woman may have problems emptying her bladder and having normal bowel movements. Doctors generally advise patients not to have sexual intercourse for 6 to 8 weeks after surgery. Removal of the ovaries also triggers menopause immediately. Symptoms such as hot flashes may be more severe than when menopause happens naturally.
The side effects of chemotherapy depend on the drug that is administered. Each woman will also respond differently to the medication. Typical temporary side effects may include lowered resistance to infections, loss of energy, loss of appetite, nausea, vomiting, hair loss, hearing problems, mouth sores and tingling or numbness of the fingers or toes.
What is the prognosis for ovarian cancer?
Follow-up care is important. You will require regular pelvic exams and lab tests to be sure the cancer has not returned. Your physician may recommend a "second look" laparotomy after completion of therapy to ensure the treatment has been successful. Women treated for ovarian cancer also have an increased risk of developing other types of cancer later in life and need special monitoring.
What are clinical trials?
When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.
By participating in a clinical trial you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.
To find out more about current clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.
For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).
Jefferson also offers a number of cancer support and education programs as well as a Buddy Program in which survivors of cancer provide support and encouragement to patients who are newly diagnosed and an active cancer advocacy group. You'll find information on the Jefferson web site about these programs or by calling 1-800-JEFF-NOW.
Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.
How can I receive palliative care?
Palliative care is provided if a person has a serious illness and one or more of the following:
- Patient, family, or team need assistance with complex decision making and determination of goals of care
- Difficult-to-control pain or other symptom distress (such as dyspnea, delirium, nausea) related to a serious medical illness
- Difficult-to-control psychosocial or spiritual issues related to a serious medical illness
- Multiple hospitalizations for same diagnosis
- Progressive decline in functional status
- Progressive metastatic cancer
- New diagnosis of life limiting illness for symptom control or determination of goals of care
- Need for Advance Care Planning or clarification of DNR status
- Utilization of ICU setting in patient with documented poor prognosis
- Prolonged ICU stay or transfer to the ICU setting without evidence of progress
- Questions regarding artificial nutrition or hydration in cognitively impaired, seriously ill or actively dying patients
- Patient or family requests for care determined by primary team to be differences in family and team goals of care
- Patient, family, or team request for information regarding hospice appropriateness
What can I expect?
At Jefferson, palliative care is provided in the hospital and in an outpatient setting. In addition, you can expect:
- Relief from symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping
- Support with emotional, spiritual, or financial stressors that may affect you or a family member during treatment for cancer
- Help carrying on with your daily life
- Improved ability to go through medical treatments.
- Help with understanding your cancer diagnosis and your choices for medical care
- An improved overall quality of life
Will my insurance cover palliative care?
Most insurance plans, including Medicare and Medicaid, cover palliative care. If costs concern you, a social worker or financial consultant can help you navigate through the benefits process.
Here at Jefferson, we want our patients to be as educated and informed as possible when it comes to their cancer care. We suggest you bring a list of questions and a notepad to ensure you get the most information possible during your visit with us. Some frequent questions asked of our radiation oncologists about cancer include:
- What type and stage of cancer do I have?
- How will radiation therapy help me?
- How does radiation therapy work? Is it internal or external?
- How many and how long will I receive radiation treatments?
- What are the chances that radiation therapy will work?
- What is the chance that the cancer will spread or come back if I do not have radiation therapy?
- Will I need chemotherapy, surgery or other treatments?
- How can I expect to feel during treatment and in the weeks following radiation therapy?
- Can I drive myself to and from the treatment facility?
- Will I be able to continue my normal activities?
- What side effects may occur from the radiation?
- Will radiation therapy affect my ability to have children?
- What are some of the support groups I can turn to during treatment?