(pills), which a woman can take at home, and
others are available only in intravenous injectable
forms, which require administration at a
chemotherapy center.
CHEMOTHERAPY AGENTS TO TREAT OVARIAN CANCERcisplatin doxorubicin
etoposide ifosfamide
melphalan paclitaxel
topotecan
High-dose chemotherapy with autologous BONE
MARROWtherapy, also called STEM CELLsupport, is
often effective in providing short-term REMISSION
in stage 4 ovarian cancer. However, many cancer
experts question whether the high risk and cost of
this treatment ultimately improves a woman’s
QUALITY OF LIFE and LIFE EXPECTANCY. For many
women, investigational treatments provide equal
or better results with significantly less severe side
effects and complications.
Because the spread of ovarian cancer within
the abdominal cavity is so diffuse, early detection
and treatment are particularly essential. Surgery is
most effective when the tumor remains confined
to the ovary; treatment is most effective when the
surgeon is able to remove all of the cancer. The
outlook for remission with early treatment is very
good. Later stage ovarian cancer is difficult to con-
trol because the surgeon cannot remove all of the
cancer. Chemotherapy provides highly effective
treatment though side effects can be significant.
Later stage ovarian cancer has a tendency to recur
after remission, though each period of remission
may last three to five years.
Risk Factors and Preventive Measures
The primary risk factors for ovarian cancer are age
greater than 60 years and family history of ovar-
ian cancer, especially among first-degree relatives
(mother, daughter, sister). Women who carry the
BRCA- 1 /BRCA- 2 GENEmutations have especially high
risk, though not the certainty, to develop ovarian
cancer. Some women who have such high risk
choose prophylactic oophorectomy (surgery to
remove the ovaries) when they reach the end of
their childbearing years or menopause as a means
for reducing their risk.
The causes of ovarian cancer are unclear,
though there appear to be hormonal correlations.
Women who carry at least one pregnancy to deliv-
ery, breastfeed, or take oral contraceptives (birth
control pills) for longer than three years, or have a
TUBAL LIGATIONor a total hysterectomy (surgery to
remove the uterus and cervix) for reasons other
than cancer appear significantly less likely to
develop ovarian cancer. Lifestyle factors such as
the fat content of the diet and the frequency of
physical exercise also correlate to the risk for ovar-
ian cancer, with the risk much lower in women
who eat a low-fat diet and get daily physical exer-
cise (minimum 30 to 60 minutes). Cigarette smok-
ing raises the risk for ovarian cancer, as it does for
many cancers.
Though many ovarian tumors are difficult to
palpate (feel), health experts recommend routine
pelvic examination as a means of possible early
detection of ovarian cancer. However, the PAP TEST
that often accompanies a pelvic examination,
while very effective for detecting early CERVICAL
CANCER, does not detect ovarian cancer. The sched-
ule of examination varies with age and health sta-
tus, though women at high risk for ovarian cancer
should have annual pelvic examinations.
See also BREAST CANCER; CANCER TREATMENT
OPTIONS AND DECISIONS; COLORECTAL CANCER; ENDOME-
TRIAL CANCER; ENDOSCOPY; SURGERY BENEFIT AND RISK
ASSESSMENT.ovarian cyst A noncancerous, fluid-filled growth
that forms within an ovary. Ovarian cysts are
common and many are transient (come and go).
The most common type of ovarian cyst is a follicu-
lar cyst, which develops in an ovarian follicle. Typ-
ically the follicle fills with fluid. Over time the
fluid reabsorbs into the follicle and the cyst goes
away. Sometimes a follicular cyst ruptures, caus-
ing sudden PAIN. Cysts may also form in the corpus
luteum, the structure of endocrine tissue that sup-
ports a ripened ovum. Such a cyst, called a luteal
cyst, typically goes away when the corpus luteum
involutes (turns in on itself) and becomes
absorbed into the ovarian follicle immediately pre-
ceding MENSTRUATION. Follicular cysts and luteal
cysts are usually functional—that is, they come
and go with the hormonal shifts of the MENSTRUAL312 The Reproductive System