Cancer Education Slides Ovarian Cancer

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

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

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

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

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

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

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

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

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 www.cancer.net/genetics

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Clinical Trials Resources Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org) CenterWatch (www.centerwatch.com) National Cancer Institute (www.cancer.gov/clinical_trials) EmergingMed (www.emergingmed.com)

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 www.cancer.net/sideeffects

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

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

Cancer.Net (www.cancer.net) Comprehensive, oncologist-approved cancer information Guides to more than 120 types of cancer and cancer-related syndromes Coping resources Survivorship information Cancer information in Spanish Weekly feature articles The latest cancer news For patient information resources, please call 888-651-3038