What is ovarian cancer?
What are the risk factors for ovarian cancer?
How can the risk of ovarian cancer be reduced?
What are the symptoms of ovarian cancer?
How can ovarian cancer be detected?
Why does ovarian cancer recur?
How is relapsed ovarian cancer treated?
What is the goal of treatment?
How may Hycamtin help me?
What is ovarian cancer?
Ovarian cancer is cancer that begins in the cells of the ovaries, including surface epithelial cells, germ cells, and the sex cord-stromal cells. Cancer cells that originate at other organ sites and travel (metastasize) to the ovary are not considered ovarian cancer.
Many types of tumors affect the ovaries. Some are benign, or noncancerous, and the option may be to surgically remove either the entire affected ovary or the area of the tumor. Some are malignant, or cancerous. Treatment options and the patient outcome depend on the type of cancer and how far it has spread.
Ovarian tumors are identified by the type of cells the tumor started from and whether the tumor is benign or cancerous. The three main types of ovarian tumors are:
- Epithelial Tumors
Epithelial tumors develop from cells on the outer surface of the ovary.
- Germ Cell Tumors
Germ cell tumors develop from cells that produce the ova, or eggs. Many germ cell tumors are benign.
- Stromal Tumors
Stromal tumors develop from cells that hold the ovary together, and those that produce the female hormones estrogen and progesterone. These tumors are quite rare and are less likely to spread.
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What are the risk factors for ovarian cancer?[2]
It is important to remember that risk factors increase the odds of getting a disease but do not guarantee it will occur. Only a small number of women who have risk factors will develop ovarian cancer.
- Family history
About 10% of ovarian cancers result from an inherited tendency to develop the disease. If your mother, sister, or daughter have or have had ovarian cancer, you are more at risk. Some inherited traits include the breast-ovarian cancer syndrome(s) BRCA and hereditary nonpolyposis colorectal cancer (HNPCC). The risk is especially high if 2 or more first-degree relatives have had the disease. The risk is somewhat less, but still above average, if other relatives (grandmother, aunt, cousin) have had ovarian cancer. A woman can inherit these risk factors from relatives on her mother's or father's side of the family.
- Personal history
Women who have had breast cancer have a greater risk of developing ovarian cancer than women who have not had breast or colon cancer.
- Age
The likelihood of developing ovarian cancer increases after a women reaches menopause. Half of all ovarian cancers are found in women over the age of 63.
- Reproductive history
Women who started menstruating before age 12, and/or experienced menopause after age 50 may be more likely to develop ovarian cancer. Women who have never had children (or had their first child after age 30) are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.
- Fertility drugs
In some studies, researchers have found that prolonged use of the fertility drug clomiphene citrate, especially without achieving pregnancy, may increase a woman's risk for developing ovarian tumors. Other researchers question this association. A woman taking this drug should discuss the potential risks with her health care provider.
- Talcum powder
Some studies suggest that women who have used talcum powder in the genital area for many years may be at increased risk of developing ovarian cancer. In the past, talcum powder was sometimes contaminated with asbestos, a known cancer-causing mineral.
- Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT)
Risk surrounding HRT remains highly controversial. Some studies indicated that using estrogens after menopause increase a woman's risk of developing ovarian cancer. However, other studies have not found any effect on ovarian cancer risk. In one recent study, the risk of ovarian cancer among women who used ERT for longer than 10 years was almost double that of those who never used it. The risk among those who used it for 20 years or more was tripled. It's important to remember, however, that the average lifetime risk for ovarian cancer is only about 2%.
- Smoking and alcohol use
While these do not increase the risk for most ovarian cancers, some studies have found an increased risk for the mucinous type.
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How can the risk of ovarian cancer be reduced? [2]
There are several ways to reduce your risk of developing epithelial cancer. Much less is know about ways to lower the risk of developing germ cell and stromal tumors. The following refers to epithelial ovarian cancer only. Please be aware that some of these strategies may reduce the risk only slightly. If you are concerned about your risk of ovarian cancer, you should talk to your health care provider.
- Use of oral contraceptives (birth control pills) for 3 or more years has reduced the possibility of developing ovarian cancer by 30% to 50% compared with women who never used them
- Having your ovaries removed offers some protection, but ovarian cancer may still occur. Ovary removal in premenopausal women will bring on sudden menopause. You should discuss all of your concerns carefully with your doctor
- If a woman has surgery to block the fallopian tube to prevent pregnancy (tubal ligation), her risk may be lowered by up to 67%
- Removal of the uterus (hysterectomy) appears to lower the risk
- Pregnancy and breastfeeding may impact your risk. Having one or more children and prolonged breastfeeding (one year or more) has been shown to reduce a woman's risk of developing ovarian cancer
- Diets high in vegetables have been shown to reduce the rate of ovarian cancer in a number of studies
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What are the symptoms of ovarian cancer? [2]
Ovarian cancer is difficult to recognize in the critical early stages. This is partly due to the fact that the disease originates deep inside the abdominal cavity on two soft, small organs, one on either side of the uterus. These are some of the potential signs and symptoms of ovarian cancer:
- Fatigue
- Bloating
- Constipation
- Abdominal pain
- Urinary urgency
These symptoms tend to happen often and become more severe with time. Most women with ovarian cancer have at least two of these symptoms. However, most of these can also be caused by noncancerous diseases and by cancers of other organs. Because these signs and symptoms of ovarian cancer have been described as vague, only about 19% of ovarian cancer cases are found in the early stages.
Other symptoms, such as prolonged swelling in the abdomen, abdominal pain and cramping, pelvic pressure, vaginal bleeding, and leg pain, tend to occur later in the course of the disease.
If you think you might have ovarian cancer, talk to your health care provider immediately.
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How can ovarian cancer be detected?
The sooner ovarian cancer is found and treated, the better a woman's chance for recovery. When the cancer is found before it spreads past the ovaries, about 90% of patients live longer than 5 years after diagnosis. [2] Some of the more common methods used to screen for ovarian cancer include the following:
- Pelvic examination
The pelvic examination includes feeling the uterus and ovaries to determine any abnormality in their shape or size.
- Ultrasound
Ultrasound uses high-frequency sound waves to create pictures of the area being examined. Healthy tissues, fluid-filled cysts, and tumors look different on this picture. Ultrasound may be performed vaginally or abdominally.
- Computed tomography (CT)
A CT scan is an X-ray procedure that produces detailed cross-sectional images of your body. A CT scanner takes multiple pictures as it rotates around you, combining these pictures into an image of a slice of your body. CT scans can be useful in showing how large a tumor is and what other organs may be affected.
- CA125 blood test
High blood levels of CA125 are often detected in women with ovarian cancer. More than 50% of women in the early stages of ovarian cancer will have an elevated CA125 level. [3] Unfortunately, CA125 is even less reliable for detecting cancer in premenopausal women because levels are frequently elevated by noncancerous conditions.
If any of these tests suggest the presence of ovarian cancer, surgery may be advised to examine the cells and check for malignancy.
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Why does ovarian cancer recur?
Recurrence (relapse) means a reappearance of the signs and symptoms of cancer. Ovarian cancer is usually very responsive to initial (first-line) chemotherapy, and most patients achieve a complete remission of their disease. Unfortunately, ovarian cancer cells can remain undetected in the body, and the majority will experience a recurrence of their disease months or years after initial therapy. [3]
A recurrence of ovarian cancer is not the same thing as a new cancer, even if it is found in a new place in your body. So if ovarian cancer cells appear on the liver, it is a recurrence of ovarian cancer and not a new case of liver cancer. What matters is the type of cells that are found in a reappearance of cancer. If they are the same cells as the original tumor, it is a recurrence of the disease. Recurrent cancers are classified by location: local, regional, or distant. [4]
- Local recurrence occurs when the cancer comes back in or very close to the same place as the original ovarian cancer but does not appear in the nearby lymph nodes or other tissues
- Regional recurrence happens when a new tumor is detected in the lymph nodes or tissues near the original site but is not detected in other tissues far from the original site
- Distant recurrence is when the ovarian cancer spreads (metastasizes) to other tissues or organs far from the site of the original cancer
While it is possible to develop a second, entirely new tumor that is not related to ovarian cancer, the situation is more unusual than a recurrence.
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How is relapsed ovarian cancer treated?
Many of the same issues that affected treatment during your initial cancer therapy will be considered again when planning treatment for relapsed disease. Doctors may recommend second-line chemotherapy or additional surgery. Second-line chemotherapy may include drugs such as Hycamtin that were not used in the initial treatment plan. Some patients are re-treated with the same drugs they received during first-line chemotherapy. And for some patients, participation in clinical trials (where new drugs are tested) may be an option.
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What is the goal of treatment?
The main goal of therapy in relapsed ovarian cancer is usually to extend survival by stabilizing the disease, slowing its progression, and minimizing treatment-related side effects, although in some cases, a complete remission can be achieved. Hycamtin is approved for the treatment of metastatic carcinoma of the ovary after failure of initial or subsequent chemotherapies have stopped being effective. However, for patients who are too ill to receive chemotherapy, the best plan may be to provide supportive care for symptoms and help maintain a satisfactory quality of life. Be sure to discuss the goal of your treatment with your health care team.
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How may Hycamtin help me?
Although the battle against ovarian cancer may seem overwhelming, Hycamtin may help you fight back. In scientific studies, Hycamtin has been shown to be effective against recurrent ovarian cancer. In fact, in a randomized clinical study, Hycamtin was found to be as effective as Taxol® (paclitaxel).* And in some clinical studies of recurrent ovarian cancer, Hycamtin was able to achieve results in some patients who did not respond to previous platinum-based chemotherapy.[1]
Although Hycamtin does not often lead to remission, it may at least stabilize the disease and slow its progression. [1] Of course, it's important to remember that all patients respond differently to therapy. Individual results may vary, so it is important to discuss with your doctor whether Hycamtin is right for you. For information about the side effects of Hycamtin, see side effects.
*Taxol is a registered trademark of Bristol-Myers Squibb Oncology Division, a Bristol-Myers Squibb Company.
Remember, no one source can answer all your questions or replace the information provided by your doctors and nurses. This Web site is not intended to replace ongoing communication between you and your health care team.
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Important Safety Information
Use of Hycamtin
Hycamtin is used for the treatment of recurrent ovarian cancer.
Reasons Not to Use Hycamtin
Do not use if you have had an allergic reaction to Hycamtin, if you are pregnant, if you are breast-feeding, or if you have low blood counts.
Side Effects
Hycamtin can interfere with your body’s ability to make white and red blood cells. Your doctor may prescribe a supportive therapy to help your body make more blood cells.
Side effects often associated with Hycamtin included nausea (64%), vomiting (45%), diarrhea (32%), hair loss (49%), fatigue (29%), and shortness of breath (22%). Most of these side effects were mild to moderate.
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