U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES
National Institutes of Health
What You Need
To Know About
TM
Ovarian
Cancer
National Cancer Institute

U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
National Cancer Institute
Contents
About This Booklet 1
The Ovaries 2
Understanding Cancer 3
Risk Factors 5
Symptoms 6
Diagnosis 7
Staging 9
Treatment 11
Supportive Care 20
Nutrition and Physical Activity 21
Follow-up Care 22
Complementary Medicine 23
Sources of Support 24
The Promise of Cancer Research 26
Dictionary 28
National Cancer Institute Information Resources 38

and progesterone. They also release eggs. An egg
travels from an ovary through a fallopian tube to the
womb (uterus).
When a woman goes through her “change of life”
(menopause), her ovaries stop releasing eggs and make
far lower levels of hormones.
2
This picture is of the ovaries and nearby organs.
Uterus
Vagina
Fallopian tubes
Lymph nodes
Ovaries
Understanding Cancer
Cancer begins in cells, the building blocks that make
up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells
as the body needs them. When cells grow old, they die,
and new cells take their place.
Sometimes, this orderly process goes wrong. New
cells form when the body does not need them, and old
cells do not die when they should. These extra cells
can form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant:
• Benign tumors are not cancer:
— Benign tumors are rarely life-threatening.
— Generally, benign tumors can be removed. They
usually do not grow back.
— Benign tumors do not invade the tissues around
them.

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.
When cancer spreads from its original place to
another part of the body, the new tumor has the same
kind of abnormal cells and the same name as the
original tumor. For example, if ovarian cancer spreads
to the liver, the cancer cells in the liver are actually
ovarian cancer cells. The disease is metastatic ovarian
cancer, not liver cancer. For that reason, it is treated as
ovarian cancer, not liver cancer. Doctors call the new
tumor “distant” or metastatic disease.
4
Risk Factors
Doctors cannot always explain why one woman
develops ovarian cancer and another does not.
However, we do know that women with certain risk
factors may be more likely than others to develop
ovarian cancer. A risk factor is something that may
increase the chance of developing a disease.
Studies have found the following risk factors for

fertility drugs, using talcum powder, or being obese are
risk factors. It is not clear whether these are risk
factors, but if they are, they are not strong risk factors.
Having a risk factor does not mean that a woman
will get ovarian cancer. Most women who have risk
factors do not get ovarian cancer. On the other hand,
women who do get the disease often have no known
risk factors, except for growing older. Women who
think they may be at risk of ovarian cancer should talk
with their doctor.
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)
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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.
Diagnosis
If you have a symptom that suggests ovarian cancer,

bounce off the organs. A computer creates a picture
from the echoes. The picture may show an ovarian
tumor. For a better view of the ovaries, the device
may be inserted into the vagina (transvaginal
ultrasound).
• Biopsy: A biopsy is the removal of tissue or fluid to
look for cancer cells. 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. To learn more
about surgery, see page 15 in the “Treatment”
section.
Although most women have a laparotomy for
diagnosis, some women have a procedure known as
laparoscopy. The doctor inserts a thin, lighted tube
(a laparoscope) 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.
A pathologist uses a microscope to look for cancer
cells in the tissue or fluid. If ovarian cancer cells are
found, the pathologist describes the grade of the
cells. Grades 1, 2, and 3 describe how abnormal the
cancer cells look. Grade 1 cancer cells are not as
likely as to grow and spread as Grade 3 cells.
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Staging
To plan the best treatment, your doctor needs to
know the grade of the tumor (see page 8) and the

ovaries. Cancer cells may be found on the surface of
the ovaries or in fluid collected from the abdomen.
• Stage II: Cancer cells have spread from one or both
ovaries to other tissues in the pelvis. Cancer cells
are found on the fallopian tubes, the uterus, or other
tissues in the pelvis. Cancer cells may be found in
fluid collected from the abdomen.
• Stage III: Cancer cells have spread to tissues
outside the pelvis or to the regional lymph nodes.
Cancer cells may be found on the outside of the
liver.
• Stage IV: Cancer cells have spread to tissues
outside the abdomen and pelvis. Cancer cells may
be found inside the liver, in the lungs, or in other
organs.
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Treatment
Many women with ovarian cancer want to take an
active part in making decisions about their medical
care. It is natural to want to learn all you can about
your disease and treatment choices. Knowing more
about ovarian cancer helps many women cope.
Shock and stress after the diagnosis can make it
hard to think of everything you want to ask your
doctor. It often helps to make a list of questions before
an appointment. To help remember what your doctor
says, you may take notes or ask whether you may use a
tape recorder. You may also want to have a family
member or friend with you when you talk to your
doctor—to take part in the discussion, to take notes, or

1–800–4–CANCER, can tell you about nearby
treatment centers. Information Specialists also
can assist you online through LiveHelp at
/>• A local or state medical society, a nearby hospital, or
a medical school can usually provide the names of
specialists.
• The American Board of Medical Specialties
(ABMS) has a list of doctors who have had training
and passed exams in their specialty. You can find
this list in the Official ABMS Directory of Board
Certified Medical Specialists. The Directory is in
most public libraries. Also, ABMS offers this
information at . (Click on
“Who’s Certified.”)
• NCI provides a helpful fact sheet called “How To
Find a Doctor or Treatment Facility If You Have
Cancer.” Page 39 tells how to get NCI fact sheets.
Treatment Methods
Your doctor can describe your treatment choices and
the expected results. Most women have surgery and
chemotherapy. Rarely, radiation therapy is used.
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Cancer treatment can affect cancer cells in the
pelvis, in the abdomen, or throughout the body:
• Local therapy: Surgery and radiation therapy are
local therapies. They remove or destroy ovarian
cancer in the pelvis. When ovarian cancer has
spread to other parts of the body, local therapy may
be used to control the disease in those specific areas.
• Intraperitoneal chemotherapy: Chemotherapy can

cancer spread from the ovaries? If so, to
where?
• What are my treatment choices? Do you
recommend intraperitoneal chemotherapy for
me? Why?
• Would a clinical trial be appropriate for me?
• Will I need more than one kind of treatment?
• What are the expected benefits of each kind of
treatment?
• What are the risks and possible side effects of
each treatment? What can we do to control side
effects? Will they go away after treatment
ends?
• What can I do to prepare for treatment?
• Will I need to stay in the hospital? If so, for
how long?
• What is the treatment likely to cost? Will my
insurance cover the cost?
• How will treatment affect my normal
activities?
• Will treatment cause me to go through an early
menopause?
• Will I be able to get pregnant and have
children after treatment?
• How often should I have checkups after
treatment?
Surgery
The surgeon makes a long cut in the wall of the
abdomen. This type of surgery is called a laparotomy.
If ovarian cancer is found, the surgeon removes:

about your symptoms so that you can develop a
treatment plan together. There are drugs and lifestyle
changes that can help, and most symptoms go away or
lessen with time.
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You may want to ask your doctor these
questions about surgery:
• What kind of surgery do you recommend for
me? Will lymph nodes and other tissues be
removed? Why?
• How soon will I know the results from the
pathology report? Who will explain them to
me?
• How will I feel after surgery?
• If I have pain, how will it be controlled?
• How long will I be in the hospital?
• Will I have any long-term effects because of
this surgery?
• Will the surgery affect my sex life?
Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer
cells. Most women have chemotherapy for ovarian
cancer after surgery. Some women have chemotherapy
before surgery.
Usually, more than one drug is given. Drugs for
ovarian cancer can be given in different ways:
• By vein (IV): The drugs can be given through a thin
tube inserted into a vein.
• By vein and directly into the abdomen: Some
women get IV chemotherapy along with

or mouth and lip sores. Ask your health care team
about medicines that help with these problems.
Some drugs used to treat ovarian cancer can cause
hearing loss, kidney damage, joint pain, and tingling or
numbness in the hands or feet. Most of these side
effects usually go away after treatment ends.
You may find it helpful to read NCI’s booklet
Chemotherapy and You: A Guide to Self-Help During
Cancer Treatment. Page 39 tells how to get NCI
booklets.
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You may want to ask your doctor these
questions about chemotherapy:
• When will treatment start? When will it end?
How often will I have treatment?
• Which drug or drugs will I have?
• How do the drugs work?
• Do you recommend both IV and IP
(intraperitoneal) chemotherapy for me? Why?
• What are the expected benefits of the
treatment?
• What are the risks of the treatment? What side
effects might I have?
• Can I prevent or treat any of these side effects?
How?
• How much will it cost? Will my health
insurance pay for all of the treatment?
Radiation Therapy
Radiation therapy (also called radiotherapy) uses
high-energy rays to kill cancer cells. A large machine

Cancer and Their Families, Get Relief from Cancer
Pain, and Understanding Cancer Pain. Page 39 tells
how to get NCI booklets.
• Swollen abdomen (from abnormal fluid buildup
called ascites): The swelling can be uncomfortable.
Your health care team can remove the fluid
whenever it builds up.
• Blocked intestine: Cancer can block the intestine.
Your doctor may be able to open the blockage with
surgery.
• Swollen legs (from lymphedema): Swollen legs can
be uncomfortable and hard to bend. You may find
exercises, massages, or compression bandages
helpful. Physical therapists trained to manage
lymphedema can also help.
• Shortness of breath: Advanced cancer can cause
fluid to collect around the lungs. The fluid can make
it hard to breathe. Your health care team can remove
the fluid whenever it builds up.
• Sadness: It is normal to feel sad after a diagnosis of
a serious illness. Some people find it helpful to talk
about their feelings. See the “Sources of Support”
section on page 24 for more information.
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You can get information about supportive care
on NCI’s Web site at />cancerinfo/coping and from NCI’s Cancer Information
Service at 1–800–4–CANCER or LiveHelp
(
Nutrition and Physical Activity
It’s important for women with ovarian cancer to take

body after treatment.
Checkups help ensure that any changes in your
health are noted and treated if needed. Checkups may
include a pelvic exam, a CA-125 test, other blood tests,
and imaging exams.
If you have any health problems between checkups,
you should contact your doctor.
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