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Ovarian Cancer

Ovarian Cancer
City of Hope’s aggressive approach to fighting ovarian cancer places us in the forefront of research and treatment of the disease nationwide. We combine the most advanced diagnostic technologies, promising therapies and sophisticated surgical options with an extensive array of support programs designed to nurture and heal the whole person.
As a cancer research hospital and NCI-designated comprehensive cancer center, City of Hope is uniquely able to offer patients access to the latest treatments not available elsewhere. These emerging therapies are designed to improve outcomes while minimizing the side effects of treatment.
About Ovarian Cancer
The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a fetus grows). Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones (chemicals that control the way certain cells or organs function).

An ovarian cyst may be found on the surface of an ovary or inside it. A cyst contains fluid. Sometimes it contains solid tissue, too. Most ovarian cysts are benign (not cancer) and go away with time. Sometimes, a doctor will find a cyst that does not go away or that gets larger. The doctor may order tests to make sure that the cyst is not cancer.

Ovarian cancer can invade, shed or spread to other organs:
  • Invade. A malignant ovarian tumor can grow and invade organs next to the ovaries, such as the fallopian tubes and uterus.
  • Shed. Cancer cells can shed (break off) from the main ovarian tumor. Shedding into the abdomen may lead to new tumors forming on the surface of nearby organs and tissues. The doctor may call these seeds or implants.
  • Spread. Cancer cells can spread through the lymphatic system to lymph nodes in the pelvis, abdomen and chest. Cancer cells may also spread through the bloodstream to organs such as the liver and lungs.

Ovarian Cancer Risk Factors
Studies have found the following risk factors for ovarian cancer:
  • Family history of cancer
    Women who have a mother, daughter or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon or rectum may also have an increased risk of ovarian cancer. If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.
  • Personal history
    Women who have had cancer of the breast, uterus, colon or rectum have a higher risk of ovarian cancer.
  • Age
    Most ovarian cancers develop after menopause. Half of all ovarian cancers are found in women over the age of 63.
  • Reproductive history
    A woman who has had children has a lower risk of ovarian cancer than women who have no children. The risk gets even lower with each pregnancy. Breast feeding may lower the risk even further. Using oral contraceptives (also known as birth control pills) also lowers the risk of ovarian cancer.
  • Estrogen or hormone replacement therapy
    Studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.
  • Obesity
    Various studies have looked at the relationship of obesity and ovarian cancer. A study from the American Cancer Society also found a higher rate of death from ovarian cancer in obese women. The risk was increased by 50 percent in the heaviest women.
  • Scientists have also studied whether taking certain fertility drugs and using talcum powder are risk factors. It is not clear whether these are risk factors, but if they are, they are not strong risk factors.
Ovarian Cancer Symptoms
Early ovarian cancer may not cause obvious symptoms. But, as the cancer grows, symptoms may include:
  • Pressure or pain in the abdomen, pelvis, back, or legs
  • A swollen or bloated abdomen
  • Nausea, indigestion, gas, constipation or diarrhea
  • Feeling very tired all the time
Less common symptoms include:
  • Shortness of breath
  • Feeling the need to urinate often
  • Unusual vaginal bleeding (heavy periods, or bleeding after menopause)
Most often these symptoms are not due to cancer, but only a doctor can tell for sure. Any woman with these symptoms should tell her doctor.

Diagnosing Ovarian Cancer

Several different tests are used by City of Hope to detect ovarian cancer:
  • Pelvic exam and history
    Your doctor feels the ovaries and nearby organs for lumps or other changes in their shape or size. A Pap test is part of a normal pelvic exam, but does not collect ovarian cells. The Pap test detects cervical cancer. It is not used to diagnose ovarian cancer.
  • Blood tests
    The lab may check the level of several substances, including CA-125. CA-125 is found on the surface of ovarian cancer cells and on some normal tissues. A high CA-125 level could be a sign of cancer or other conditions. The CA-125 test is not used alone to diagnose ovarian cancer. This test is approved by the Food and Drug Administration for monitoring a woman's response to ovarian cancer treatment and for detecting its return after treatment.
  • Ultrasound
    Ultrasound uses high-frequency sound waves to examine organs inside the pelvis. This allows radiologists to distinguish fluid-filled cysts from solid masses and to determine whether solid masses are benign or suspicious. Click here to download our "Diagnostic Ultrasound” brochure. For a better view of the ovaries, a special ultrasound device may be inserted into the vagina (transvaginal ultrasound).
  • CT or CAT (computerized axial tomography) scan
    This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • MRI (magnetic resonance imaging)
    MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
  • Laparoscopy
    In this test, a thin, lighted tube is inserted through a small incision in the abdomen. Laparoscopy may be used to remove a small, benign cyst or an early ovarian cancer. It may also be used to learn whether cancer has spread.
  • Biopsy
    Tissue samples are examined under the microscope to determine what types of cells are present. Based on the results of the blood tests and ultrasound, your doctor may suggest surgery (a laparotomy) to remove tissue and fluid from the pelvis and abdomen. Surgery is usually needed to diagnose ovarian cancer.

Ovarian Cancer Treatment

City of Hope uses a multidisciplinary approach to combat ovarian cancer. Our surgeons, medical and radiation oncologists and researchers collaborate closely throughout treatment to ensure ovarian cancer patients receive the best care possible.

Because ovarian cancer does not grow in a manner similar to most solid tumors, it is usually not possible for a surgeon to remove the entire tumor present in the abdomen. It has been shown, however, that removal of all visible manifestations of the tumor (often referred to as debulking surgery), followed by chemotherapy treatment, provides the best chance of a cure.

When applicable, our specialists utilize minimally invasive surgery with advanced technologies such as laparoscopy and the da Vinci S Surgical System with robotic capabilities that allows for greater precision.

These surgeries feature small incisions and potentially:

  • Less blood loss, pain and visible incisions;
  • Shorter hospital stay and recovery time;
  • Fewer complications and quicker return to normal activities.

Preventative Surgery

For women at high risk for developing cancer, we offer preventative surgery, called salpingo-oophorectomy, which involves the surgical removal of the ovaries and fallopian tubes. This procedure can reduce the chance of ovarian and related cancers by as much as 80 percent in women at high risk.

Radiation therapy is often used in treating ovarian cancer. It may be employed as a stand-alone treatment for early stage cancer, or in combination with surgery and other treatments in more advanced cases, to help reduce the chance of recurrence.

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Intensity modulated radiation therapy (IMRT)

IMRT targets tumors with pencil-thin “beamlets” of radiation. By sculpting the radiation to precisely match the tumor’s contours, a higher dose can be delivered to the cancer while avoiding unnecessary exposure of healthy tissues. Treatment with IMRT may also minimize certain side effects.

Some women receive a treatment called intraperitoneal radiation therapy, in which radioactive liquid is put directly in the abdomen through a catheter.

Medicines that slow or stop the growth of cancer cells are often included in a patient’s treatment plan. We provide both standard therapy and access to clinical trials of new, leading-edge therapies that offer the best chance for a cure.

Intraperitoneal chemotherapy

City of Hope offers the latest breakthrough in chemotherapeutic treatment of advanced ovarian cancer, which results in improved survival rates over that seen following standard intravenous chemotherapy.

Optimal treatment of advanced ovarian cancer includes aggressive debulking surgery followed by chemotherapy. Recently, results were published from the third largest national clinical trial comparing administration of chemotherapy directly into the abdomen (intraperitoneal chemotherapy, or IP) with chemotherapy delivered through the veins. In support of two other large clinical trials, this trial confirmed that IP delivery of chemotherapy results in a 16-month improvement in median survival compared to patients receiving intravenous chemotherapy alone. The National Cancer Institute issued an alert to physicians that all women with regionally advanced ovarian cancer should be considered for this route of treatment following surgery.

Ovarian Cancer Resources

All of our ovarian cancer patients have access to the Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.

Additional Resources

Foundation for Women's Cancer
Here you will find information about the Foundation’s many awareness, educational and fundraising programs plus comprehensive information about gynecologic cancer risk, prevention, early detection and optimal treatment provided by expert gynecologic oncologists and other healthcare professionals.

Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance is a patient-led, umbrella organization uniting ovarian cancer activists, women’s health advocates and health care professionals in the effort to increase public and professional understanding of ovarian cancer and to advocate for more effective diagnostics, treatments and a cure.

American Cancer Society
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.

National Comprehensive Cancer Network (NCCN)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.

National Cancer Institute (NCI)
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.

Research/Clinical Trials

City of Hope is at the forefront of some of the nation’s most promising ovarian cancer research and treatment programs. We conduct vital research and clinical trials to improve treatment and quality of life for women living with the disease, and early detection and prevention of ovarian cancer for all women.
City of Hope's commitment to this crucial biomedical field will not only serve City of Hope patients, but the scientific knowledge generated here is shared with other top cancer centers across the country. This ensures that the most advanced therapies help women afflicted with ovarian cancer everywhere, every day.

Learn more about our clinical trials program and specifically about trials for ovarian cancer.
Clinical Research

Novel Chemotherapy Agents

We are studying the effectiveness of several new chemotherapy options for treating women with recurrent ovarian cancer.
  • City of Hope is collaborating with the National Cancer Institute on clinical trials of new ovarian cancer drugs including Bryostatin, a novel protein kinase C inhibitor derived from a mollusk which has been shown to be active in the treatment of ovarian cancer and also provides synergy when administered with platinum agents.
  • New dose-intensive approaches utilizing stem cell support to overcome the toxicity of chemotherapy are ongoing in patients with ovarian cancer who have residual or recurrent disease, which is responsive to chemotherapy.
  • Novel intraperitoneal (abdominal) chemotherapy trials are in progress. Gemcitabine, a recently approved chemotherapeutic agent active in ovarian cancer has recently been shown by City of Hope clinical investigators to have excellent potential as an intraperitoneal agent.
Radioimmunotherapy to Treat Ovarian Malignancy

This research study evaluates radiolabeled antibodies and standard therapy compared to standard therapy alone in patients with ovarian cancer.

Ovarian Cancer Team

Ovarian Cancer Videos

Watch highlights from this informative lecture on gynecological cancers. All women can benefit from this discussion on detection and treatment, as well as research on ovarian and uterine cancers. Associated health issues including HPV (human papillomavirus) are also discussed.
Robert Morgan, M.D., co-director of Gynecological Oncology/Peritoneal Malignancy Program talks about ovarian cancer prevention, screening and latest treatments.

Prevention of Ovarian Cancer


Screening for Ovarian Cancer
Ovarian Cancer: What's New in Treatment


Support This Program

We deliver exquisite care at the leading edge of cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts - and those of our supporters today -- have built the foundation for the care we provide and the research we conduct. It enables City of Hope to strive for new breakthroughs and better therapies - helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact:

Janet Morgan

Senior Director
Phone: 213-241-7250
Email: jmorgan@coh.org

Patient Care Overview

Introduction to City of Hope
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
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