Ovarian Cancer
Ovarian Cancer
Ovarian Cancer
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Ovarian Cancer
JASCAP
JEET ASSOCIATION FOR SUPPORT TO CANCER PATIENTS
MUMBAI, INDIA
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JASCAP
JEET ASSOCIATION FOR SUPPORT TO CANCER PATIENTS
c/o. Abhay Bhagat & Co., Office No.4, “Shilpa”, 7th.Road, Prabhat Colony,
Santacruz (East), Mumbai – 400 055
Tel.: 2617 7543, 2616 0007. Fax: 91-22-2618 6162
E-mail :[email protected] & [email protected]
Registered under the Societies Registration Act, 1860 No.1359 / 1996 G.B.B.S.D.,
Mumbai and under the Bombay Public Trusts Act, 1950 No. 18751 (Mumbai).
Donations to JASCAP qualify for deduction u/s 80G (1) of the Income Tax Act, 1961
vide Certificate No. DIT (E) / BC / 80G / 1383 / 96-97 dated 28.02.97 subsequently
renewed.
Contents
General
The ovaries
What is cancer?
Types of cancer
Types of ovarian cancer
Causes
Screening
Symptoms
Diagnosis
Staging & grading
Treatment
Treatment overview
Surgery
Chemotherapy
Radiotherapy
After treatment
Follow up
Clinical trials
Related cancers
Ovarian Cancer
The ovaries
The ovaries are two small, oval-shaped organs that are part of the female
reproductive system. They are in the lower part of the tummy (abdomen), which is
known as the pelvis. Other organs are very close to the ovaries (see diagrams
below). These include:
The ureters, which drain urine from the kidneys to the bladder.
The bladder.
The back passage (rectum).
The lower part of the small bowel.
The omentum (a membrane which surrounds all of the pelvic and abdominal
organs and keeps them in place). It is also called the peritoneum.
Groups of lymph nodes.
Each month, in women of childbearing age, one of the ovaries produces an egg. The
egg passes down the fallopian tube to the womb (uterus). If the egg is not fertilised
by a sperm it passes out of the womb and is shed, along with the lining of the womb,
as part of the monthly period.
The ovaries also produce the female sex hormones, oestrogen and progesterone. As
a woman nears the menopause („change of life‟) the ovaries make less of these
hormones and periods gradually stop.
Side view of the abdomen showing the peritoneum surrounding the abdominal
organs
What is cancer?
The organs and tissues of the body are made up of tiny building blocks called cells.
Cancer is a disease of these cells.
Cells in different parts of the body may look and work differently but most reproduce
themselves in the same way. Cells are constantly becoming old and dying, and new
cells are produced to replace them. Normally, cells divide in an orderly and controlled
manner. If for some reason the process gets out of control, the cells carry on dividing,
developing into a lump which is called a tumour.
In a benign tumour the cells do not spread to other parts of the body and so are not
cancerous. However, if they continue to grow at the original site, they may cause a
problem by pressing on the surrounding organs.
A malignant tumour consists of cancer cells that have the ability to spread beyond
the original area. If the tumour is left untreated, it may spread into and destroy
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surrounding tissue. Sometimes cells break away from the original (primary) cancer.
They may spread to other organs in the body through the bloodstream or lymphatic
system.
The lymphatic system is part of the immune system - the body's natural defence
against infection and disease. It is a complex system made up of organs, such as
bone marrow, the thymus, the spleen, and lymph nodes. The lymph nodes (or
glands) throughout the body are connected by a network of tiny lymphatic ducts.
When the cancer cells reach a new area they may go on dividing and form a new
tumour. This is known as a secondary cancer or metastasis.
It is important to realise that cancer is not a single disease with a single type of
treatment. There are more than 200 different kinds of cancer, each with its own name
and treatment.
Types of cancer
Carcinomas
The majority of cancers, about 85% (85 in a 100), are carcinomas. They start in the
epithelium, which is the covering (or lining) of organs and of the body (the skin). The
common forms of breast, lung, prostate and bowel cancer are all carcinomas.
Carcinomas are named after the type of epithelial cell that they started in and the part
of the body that is affected. There are four different types of epithelial cells:
squamous cells - that line different parts of the body, such as the mouth,
gullet (oesophagus), and the airways
adeno cells - form the lining of all the glands in the body and can be found in
organs such as the stomach, ovaries, kidneys and prostate
transitional cells - are only found in the lining of the bladder and parts of the
urinary system
basal cells - that are found in one of the layers of the skin.
A cancer that starts in squamous cells is called a squamous cell carcinoma. A cancer
that starts in glandular cells is called an adenocarcinoma. Cancers that start in
transitional cells are transitional cell carcinomas, and those that start in basal cells
are basal cell carcinomas.
Sarcomas
Sarcomas are very rare. They are a group of cancers that form in the connective or
supportive tissues of the body such as muscle, bone and fatty tissue. They account
for less than 1% (1 in 100) of cancers.
serous
endometrioid.
mucinous
clear cell
undifferentiated or unclassifiable.
There are also less common types of ovarian cancer. These include germ cell
tumours (ovarian teratomas) and sarcomas. Germ cell tumours tend to affect younger
women and behave very differently to other types of ovarian cancer.
This booklet does not cover treatment for the rarer types of ovarian cancer.
Some factors are known to affect a woman‟s chance of developing ovarian cancer –
they may increase the risk or decrease it. These are described below.
Hormonal factors
Infertility and fertility treatments
Health factors
Lifestyle factors
Genetic factors
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Hormonal factors
Women who have not had children are slightly more likely to develop ovarian
cancer than women who have, although the risk is still very low. Having two or
more children may provide more protection than just one.
Breast feeding your children may slightly decrease your risk.
Starting your periods early or having a late menopause slightly increases your
risk of ovarian cancer.
Women who take the contraceptive pill are less likely to develop ovarian
cancer.
Using oestrogen-only hormone replacement therapy (HRT) can slightly
increase the risk. When HRT is stopped the risk of ovarian cancer gradually
reduces to the same level as women who haven‟t taken HRT.
Health factors
Lifestyle factors
Genetic factors
About 5–10 in 100 (5–10%) ovarian cancers are caused by an inherited faulty
gene in the family.
Women who have had breast cancer have an increased risk of ovarian
cancer. This is because breast and ovarian cancer can be caused by the
same faulty genes.
If any of the following are present in one side of your family, it is possible that there
may be an inherited faulty gene:
Having one elderly relative with ovarian cancer doesn‟t necessarily increase your risk
of ovarian cancer.
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Women who are worried that they may have an increased risk of developing ovarian
cancer, because of cancer in their family, can be referred to a genetic counselling
clinic.
If two or more of your close relatives have had ovarian cancer you may want to
consider having testing (screening) for ovarian cancer. However, it is not yet known
how effective screening is at detecting ovarian cancer (screening).
Women who may have an increased risk of ovarian cancer can ask their GP to refer
them to take part in an ovarian cancer screening research trial.
loss of appetite
vague indigestion, nausea, excessive gas (wind) and a bloated, full feeling
unexplained weight gain
swelling in the abdomen – this may be due to a build up of fluid (ascites),
which can cause shortness of breath
pain in the lower abdomen
changes in bowel or bladder habits, such as constipation, diarrhoea or
needing to pass urine more often
lower back pain
pain during sex
abnormal vaginal bleeding, although this is rare.
If you have any of the above symptoms it is important to have them checked by your
doctor, but remember they are common to many other conditions and most women
with these symptoms will not have cancer.
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At the hospital
Ultrasound scan
CT scan
MRI scan
Abdominal fluid aspiration
Laparoscopy
Exploratory laparotomy
At the hospital
At the hospital, the gynaecologist (specialist in women‟s illnesses) will ask you about
your general health and any previous medical problems, before examining you. This
will include an internal (vaginal) examination to check for any lumps or swellings.
The specialist may arrange for you to have a blood test and chest x-ray to check your
general health.
You may have a specific blood test to check whether there are higher than normal
levels of the CA125 protein in your blood. CA125 is a protein that most women have
in their blood. The level may be higher in women with ovarian cancer, as it is
sometimes produced by ovarian cancer cells. However, CA125 is not specific to
ovarian cancer, and the level can also be raised in women who have other non-
cancerous conditions.
Several tests may be used to diagnose cancer of the ovary. The tests may also show
the stage of the cancer – whether or not it has spread to other parts of the body.
These tests help your doctor to know the best way to treat the cancer.
Ultrasound scan
An ultrasound uses sound waves to build up a picture of the inside of the abdomen,
the liver and the pelvis. It will be done in the hospital scanning department.
If you have a pelvic ultrasound you will be asked to drink plenty of fluids so that
your bladder is full. This helps to give a clearer picture. Once you are lying
comfortably on your back a gel is spread onto your abdomen. A small device, which
produces sound waves, is then rubbed over the area. The sound waves are
converted into a picture by a computer.
If you have a vaginal ultrasound scan, a probe with a rounded end is put into your
vagina. The probe produces sound waves, which are then converted into a picture by
a computer. Although this type of ultrasound scan may sound uncomfortable, many
women find it more comfortable than having a pelvic ultrasound, as it is not
necessary to have a full bladder.
CT scan
A CT (computerised tomography) scan takes a series of x-rays which builds up a
three-dimensional picture of the inside of the body. The scan is painless but takes
from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very
unlikely to harm you and will not harm anyone you come into contact with. You will be
asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye which allows particular areas to be
seen more clearly. For a few minutes, this may make you feel hot all over. If you are
allergic to iodine or have asthma you could have a more serious reaction to the
injection, so it is important to let your doctor know beforehand. You will probably be
able to go home as soon as the scan is over.
Having a CT scan
MRI scan
An MRI (magnetic resonance imaging) scan is similar to a CT scan, but uses
magnetic fields instead of x-rays to build up a series of cross-sectional pictures of the
body. During the test you will be asked to lie very still on a couch inside a metal
cylinder that is open at both ends. The whole test may take up to an hour and is
painless – although the machine is very noisy. You will be given earplugs or
headphones to wear.
The cylinder is a very powerful magnet, so before going into the room you should
remove all metal belongings. You should also tell your doctor if you have ever
worked with metal or in the metal industry or if you have any metal inside your body
(for example, a cardiac monitor, pacemaker, surgical clips, or bone pins). You may
not be able to have an MRI because of the magnetic fields.
Some people are given an injection of dye into a vein in the arm, but this usually
does not cause any discomfort. You may feel claustrophobic inside the cylinder, but
you may be able to take someone with you into the room to keep you company. It
may also help to mention to the staff beforehand if you do not like enclosed spaces.
They can then offer extra support during your test.
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Laparoscopy
This operation allows the doctor to look at the ovaries, fallopian tubes, the womb and
the surrounding area. It‟s done under a general anaesthetic. Most women usually go
home the same day but you may have to stay in hospital overnight.
While you are under anaesthetic, the doctor makes 3–4 small cuts, approximately
1cm (½ inch) in length, in the skin and muscle of the lower abdomen. A thin fibre-
optic tube (laparoscope) is then inserted. By looking through the laparoscope the
doctor can look at the ovaries and take a small sample of tissue (biopsy) for
examination under a microscope.
During the operation, carbon dioxide gas is passed into the abdominal cavity and this
can cause uncomfortable wind and/or shoulder pains. The pain is often eased by
walking about or by taking sips of peppermint water. If the pain continues when you
are at home you should contact the hospital for advice.
After a laparoscopy you will have one or two stitches in your lower abdomen. You
should be able to get up as soon as the effects of the anaesthetic have worn off.
Exploratory laparotomy
Sometimes cancer of the ovary cannot be diagnosed before a full operation
(laparotomy) is carried out.
It will probably take several days for the results of your tests to be ready and a follow-
up appointment will be arranged for you before you go home. Obviously, this waiting
period is an anxious time and it may help you to talk things over with a close friend, a
relative, the hospital specialist nurse, or a support organisation.
Staging
The stage of a cancer is a term used to describe its size and whether it has spread
beyond its original area of the body. Knowing the extent of the cancer and the grade
helps the doctors to decide on the most appropriate treatment. It‟s often not possible
to stage an ovarian cancer before a laparotomy is done and the results of any
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biopsies are known (see diagnosis). A commonly used staging system is described
below.
Borderline tumours are made up of low-grade cells that are unlikely to spread. They
are usually completely cured by surgery and rarely require further treatment.
Stage 1 ovarian cancer only affects the ovaries. This stage is divided into three sub-
groups:
Stage 2 ovarian cancer has begun to spread outside the ovaries within the pelvis.
There are three sub-groups:
Stage 3 The cancer has spread beyond the pelvis to the lining of the abdomen (a
fatty membrane called the omentum), and/or to abdominal organs such as the lymph
nodes in the abdomen, or the upper part of the bowel.
Stage 3a The tumours in the abdomen are very small and cannot be seen
except under a microscope.
Stage 3b The tumours in the abdomen can be seen but they are smaller than
2cm.
Stage 3c The tumours in the abdomen are larger than 2cm.
Stage 4 The cancer has spread to other parts of the body such as the liver, lungs, or
distant lymph nodes (for example in the neck).
If the cancer comes back after initial treatment this is known as recurrent cancer.
Grading
Grading refers to the appearance of the cancer cells when they are looked at under
the microscope. The grade gives an idea of how quickly the cancer may develop.
There are three grades: grade 1 (low-grade), grade 2 (moderate-grade) and grade 3
(high-grade).
Low-grade means that the cancer cells look very like the normal cells of the
ovary. They usually grow slowly and are less likely to spread.
Moderate-grade means that the cells look more abnormal than low-grade
cells.
High-grade means that the cells look very abnormal. They are likely to grow
more quickly and are more likely to spread.
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Multidisciplinary team
Giving your consent
Second opinion
Multidisciplinary team
Your treatment will be planned by a team of specialists who work together to decide
which treatment is best for you. This multidisciplinary team (MDT) will include:
The MDT may also include a number of other healthcare professionals such as a:
The government recommends that women with ovarian cancer are treated by a
specialist gynaecological cancer team. These teams are based in larger cancer
centres, so you may have to travel for your treatment.
The MDT will plan your treatment by taking into consideration a number of factors.
This will include your age, general health, how well your kidneys are working, the
type and size of the tumour, what it looks like under the microscope and whether it
has spread beyond the ovary (the stage).
the type and extent of the treatment you are advised to have
the advantages and disadvantages of the treatment
any other treatments that may be available
any significant risks or side effects of the treatment.
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If you don‟t understand what you have been told, let the staff know straight away so
that they can explain it again. Some cancer treatments are complex, so it‟s not
unusual for people to need repeated explanations.
It‟s often a good idea to have a friend or relative with you when the treatment is
explained. This can help you remember the discussion more fully.
Patients often feel that hospital staff are too busy to answer their questions, but it‟s
important for you to be aware of how the treatment is likely to affect you. The staff
should be willing to make time for you to ask questions. You can talk to the specialist
gynaecological nurse at the hospital or to our specialist nurses.
You can always ask for more time to decide about the treatment if you feel that you
can‟t make a decision when it‟s first explained to you.
You are also free to choose not to have the treatment. The staff can explain what
may happen if you don‟t have it. It‟s important to tell a doctor or your nurse if you
decide not to have treatment, so that they can record your decision in your medical
notes. You don‟t have to give a reason for not wanting to have treatment, but it can
be helpful to let the staff know your concerns so that they can give you the best
advice.
Second opinion
Usually a number of cancer specialists work together as a team and they use
national treatment guidelines to decide on the most suitable treatment for a patient.
Even so, you may want to have another medical opinion. Either your specialist, or
your GP, should be willing to refer you to another specialist for a second opinion, if
you feel it will be helpful. Getting a second opinion may cause a delay in the start of
your treatment, so you and your doctor need to be confident that it will give you
useful information.
If you do go for a second opinion, it may be a good idea to take a friend or relative
with you, and have a list of questions ready, so that you can make sure your
concerns are covered during the discussion.
Early menopause
Fertility
In young women with borderline tumours, or low-grade, stage 1a cancer (see staging
and grading) it may be possible to remove only the affected ovary and fallopian tube,
and leave the womb and unaffected ovary. This will mean that you will be able to
have children in the future. Women with stage 1b and 1c cancer, or those who have
had their menopause, or don‟t want any more children, will usually be advised to
have both ovaries and the womb removed.
The surgeon may remove a layer of fatty tissue called the omentum, which is close to
the ovaries (an omentectomy). They will also take samples from other tissues, such
as the lymph glands, to see if the cancer has spread. The surgeon will also put fluid
into your abdomen and send some of it to be tested for cancer cells. This is known as
an abdominal washing.
If it is unclear before surgery what stage the cancer is, the surgeon may remove just
the affected ovary and fallopian tube and take a number of biopsies and abdominal
washings. Depending on the results of the biopsies and washings, further surgery to
remove the womb and remaining ovary and fallopian tube - sometimes called
completion surgery - may be needed.
Chemotherapy is usually given after surgery if it wasn‟t possible to remove all the
tumour, or if there is a risk that some cancer cells may have been left behind.
If the cancer has spread to the bowel, a small piece of bowel may be removed and
the two ends joined together. Rarely the two ends can‟t be rejoined and the upper
end of the bowel will be brought out onto the skin of the abdomen. This is known as a
colostomy and the opening of the bowel is known as a stoma. A bag is worn over
the stoma to collect the stool (bowel motions). Your doctor or specialist nurse will
discuss this with you.
Chemotherapy is usually given after the operation to try and kill any cancer cells that
couldn‟t be removed.
You may have a small tube called a catheter, which is put into the bladder and drains
your urine into a collecting bag. This will be removed after a day or two.
You are also likely to have a drainage tube in your wound to drain excess fluid into a
small bottle. This is usually removed after a few days.
Pain
It is quite normal to have some pain or discomfort for a few days but this can be
controlled with effective painkillers. The anaesthetist will often discuss pain control
with you before your operation. If the pain is not controlled, it is important to let your
doctor or nurse know as soon as possible so that your painkillers can be changed.
Going home
Most women are able to go home 5–10 days after their operation, once the stitches
or clips have been taken out. If you think you might have problems when you go
home (for example, if you live alone or have several flights of stairs to climb), let the
nurse or social worker know when you are admitted to the ward so that help can be
arranged. Your nurse specialist can offer or arrange support or counselling for you
and your family. Social workers are often available to give practical advice. Many are
also trained counsellors.
Before you leave hospital you will be given an appointment to attend an outpatient
clinic for your post-operative check up. This is a good time to discuss any problems
you may have. If you have any problems or worries before this time, you can phone
your ward nurses or hospital doctor.
Physical activity
You will need to avoid strenuous physical activity or heavy lifting for at least three
months. You will also be advised not to drive for about six weeks after your operation
and may find it uncomfortable to wear a seatbelt for some time. It‟s best not to start
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driving until you are comfortable wearing a seatbelt as a passenger first. Some
insurance companies have guidelines about this.
Sex life
One of the common questions women ask after a hysterectomy is whether the
operation will affect their sex life. To allow the wound to heal properly, most women
are advised to wait at least six weeks after their operation before having sexual
intercourse. Many women have no problem in having a sexual relationship after this
time. However, others find that the surgery has shortened their vagina and slightly
changed its angle. This can mean that they have different sensations and responses
during sex. If this occurs it can be upsetting. Women who have this effect may take
time to come to terms with their feelings and any physical effects such as pain. Your
specialist nurse can help you if you are having problems after your surgery.
One common fear is that cancer can be passed on to your partner during intercourse.
This is not true and it is perfectly safe for you to continue to have a sexual
relationship.
Early menopause
In younger women who are still having periods, removing the ovaries will bring on an
early menopause.
hot flushes
dry skin
dryness of the vagina, which can make sexual intercourse uncomfortable
reduced sexual desire.
Fertility
Younger women in particular, often find it difficult to come to terms with the fact that
they can no longer have children after a hysterectomy. They may also be worried that
they have lost a part of their female identity. These are very natural, understandable
emotions to have at this time. It can help to discuss any fears or worries with a
sympathetic friend or with the specialist nurse. Counselling can be arranged either by
the hospital or through your GP. There are also support organisations that can help.
We have information on cancer and fertility which you may find useful.
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Chemotherapy drugs are sometimes given as tablets (orally) or, more usually, by
injection into a vein (intravenously).
Chemotherapy is often recommended after surgery for women with moderate or high-
grade ovarian cancer or those with stage 1b or 1c cancer. Giving chemotherapy after
surgery is known as adjuvant chemotherapy. Generally six sessions of
chemotherapy are given, over 5–6 months.
If the cancer has spread to the liver, or beyond the abdomen, it may not be possible
to remove it and so chemotherapy is the main treatment used. Chemotherapy is also
used if the cancer comes back after surgery.
Other drugs that are less commonly used, or may be used if the cancer comes back,
are topotecan (Hycamtin®), doxorubicin, liposomal doxorubicin (Caelyx®, Myocet®)
and cisplatin.
Chemotherapy can also be given directly into the abdomen through a small tube.
This is known as intraperitoneal chemotherapy. Research has shown that
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Our booklet on chemotherapy discusses the treatment and its side effects in more
detail. Information about individual drugs and their particular side effects are also
available.
Side effects
Chemotherapy can cause unpleasant side effects, but any that occur can often be
well controlled with medicines.
You will have a blood test before having more chemotherapy, to make sure that your
cells have recovered. Occasionally it may be necessary to delay your treatment if
your blood count is still low.
Bruising or bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot.
Let your doctor know if you have any unexplained bruising or bleeding, such as
nosebleeds, blood spots or rashes on the skin, or bleeding gums.
Hair loss
Unfortunately, some chemotherapy drugs used to treat ovarian cancer can make
your hair fall out. You can ask your doctor if the drugs you are having are likely to
cause hair loss. Most patients are entitled to a free wig from the NHS. Your doctor or
nurse will be able to arrange for you to see a wig specialist. You may prefer to wear a
bandana, hat or scarf.
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If your hair does fall out, it will grow back over a period of 3–6 months once the
chemotherapy has finished.
Tiredness
Chemotherapy affects people in different ways. Some people find they are able to
lead a fairly normal life during their treatment, but many find they become very tired
and have to take things much more slowly. Just do as much as you feel like and try
not to overdo it.
Although they may be difficult to cope with, most of these side effects will disappear
once your treatment is over.
Chemotherapy can‟t guarantee that the cancer will not come back, but it can reduce
the chance that it will. The risk of the cancer coming back varies according to each
woman‟s situation. Your doctor can usually give you an idea of whether your cancer
is likely to come back or not. They can also give you information about the likely side
effects of chemotherapy for you.
If the chance of your cancer coming back is small, chemotherapy may only slightly
reduce the risk of the cancer coming back. The additional benefit of the
chemotherapy would be small and the chance of doing well without it would still be
good. However, if the risk of the cancer coming back is higher, chemotherapy may
greatly reduce the chance of recurrence, and increase the chance of cure.
This information can help you decide whether the benefit of the chemotherapy is
worth the side effects of the treatment.
chemotherapy will have little or no effect on the cancer and they will have the side
effects of the treatment with little benefit. The fitter you are the more likely you are to
benefit and the less likely to have side effects.
Making decisions about treatment in these circumstances is always difficult, and you
may need to discuss in detail with your doctor whether you want to have
chemotherapy. If you choose not to have chemotherapy, you can still be given
medicines to control any symptoms that you have. This is known as supportive care
(or palliative care).
Radiotherapy is rarely used to treat cancer of the ovary. It may occasionally be used
to treat an area of cancer that has come back after surgery and chemotherapy, when
other treatment options are no longer appropriate. It may also be used to reduce
bleeding or feelings of pain and discomfort. This is known as palliative
radiotherapy.
Our radiotherapy booklet gives more details about this treatment and its side effects.
A trial has been done to see whether regular testing of blood levels of CA125 is
helpful in detecting a recurrence of ovarian cancer. The data from that trial is
currently being analysed. At the time of writing (September 2008) it is not known
whether regular testing of CA125 can improve survival for women who have been
treated for ovarian cancer. Some women may be offered regular CA125 testing, and
other women may only have CA125 testing if they have signs or symptoms that could
be due to a recurrence of the cancer.
For women whose treatment is over apart from regular check-ups, our booklet on life
after cancer gives useful advice on how to keep healthy and adjust to life after
treatment.
Trials are the only reliable way to find out if a different operation, type of
chemotherapy, radiotherapy, or other treatment is better than what is already
available.
If you decide not to take part in a trial your decision will be respected and you don‟t
have to give a reason. There will be no change in the way that you‟re treated by the
hospital staff and you will be offered the best standard treatment for your situation.
The research may be carried out at the hospital where you are treated, or it may be
at another hospital. This type of research takes a long time, and results may not be
available for many years. The samples will, however, be used to increase knowledge
about the causes of cancer and its treatment. This research will, hopefully, improve
the outlook for future patients.
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CHORUS
Women who are newly diagnosed with ovarian cancer may be asked to take part in a
trial called CHORUS. The trial is looking to see if giving chemotherapy before as well
as after surgery helps to improve survival.
ICON 7
You may be asked to take part in a trial using a biological therapy alongside
chemotherapy. Two biological therapies - called angiogenesis inhibitors - that can
stop cancer from developing new blood vessels, are currently being tested.
ICON 6
Another trial, called ICON 6, is testing a newer angiogenesis inhibitor called
cediranib, which is a tablet. The trial is for women whose cancer has come back six
months or more after they had chemotherapy. Women will be given one of the
following treatments:
Decitabine
A drug that can make cancer cells sensitive to chemotherapy is being tested for
women whose ovarian cancer has come back after initial chemotherapy. The drug,
called decitabine, which is given as a drip (infusion), is being given alongside
carboplatin chemotherapy.
All the above treatments are in the early stages of research and are not widely
available. You can talk to your doctor about any that you think may be appropriate for
you.
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You can fill this in before you see the doctor or surgeon, and then use it to remind
yourself of the questions you want to ask, and the answers you receive.
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Answer _______________________________________
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3. _______________________________________
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Information Services in many ways.
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