What is ovarian cancer: Cancer that forms in tissues of the ovary. Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in the cells on the surface of the ovary) or malignant germ cell tumors (cancer that begins in egg cells).

How many people are affected by ovarian cancer: In 2008 there were over 21,000 new cases of ovarian cancer in the United States. 15,520 women died of ovarian cancer in the U.S. in 2008.

Why is ovarian cancer called "the Silent Killer": Ovarian cancer is often called the "silent" killer because many times there are no symptoms until the disease has progressed to an advanced stage. Early symptoms of ovarian cancer are often mild, making this disease difficult to detect. Early detection of ovarian cancer offers a 90% cure rate. Sadly, a lack of symptoms from this silent disease means that about 75% of ovarian cancer cases will have spread to the abdomen by the time they are detected and, unfortunately, most patients die within five years.

What are the risk factors for ovarian cancer : 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 ovarian cancer:

• Family history of cancer: Women who have a mother, daughter, or sister with ovarian cancer have an increased risk of the disease. Also, women with a family history of cancer of the breast, uterus, colon, or rectum may also have an increased risk of ovarian cancer.If several women in a family have ovarian or breast cancer, especially at a young age, this is considered a strong family history. If you have a strong family history of ovarian or breast cancer, you may wish to talk to a genetic counselor. The counselor may suggest genetic testing for you and the women in your family. Genetic tests can sometimes show the presence of specific gene changes that increase the risk of ovarian cancer.
• Personal history of cancer: Women who have had cancer of the breast, uterus, colon, or rectum have a higher risk of ovarian cancer.
• Age over 55: Most women are over age 55 when diagnosed with ovarian cancer.
• Never pregnant: Older women who have never been pregnant have an increased risk of ovarian cancer.
• Menopausal hormone therapy: Some studies have suggested that women who take estrogen by itself (estrogen without progesterone) for 10 or more years may have an increased risk of ovarian cancer.

Scientists have also studied whether taking certain 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.

What are the symptoms of ovarian cancer : 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

• Shortness of breath
• Feeling the need to urinate often
• Unusual vaginal bleeding (heavy periods, or bleeding after menopause)

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.

What treatment options are available for ovarian cancer: 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 just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.

Your doctor may refer you to a gynecologic oncologist, a surgeon who specializes in treating ovarian cancer. Or you may ask for a referral. Other types of doctors who help treat women with ovarian cancer include gynecologists, medical oncologists, and radiation oncologists. You may have a team of doctors and nurses.

Your doctor can describe your treatment choices and the expected results. Most women have surgery and chemotherapy. Rarely, radiation therapy is used.

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 be given directly into the abdomen and pelvis through a thin tube. The drugs destroy or control cancer in the abdomen and pelvis.
• Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and destroy or control cancer throughout the body.

You may want to know how treatment may change your normal activities. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women with all stages of ovarian cancer.

What is being done to find a prevention or cure for ovarian cancer: Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new and better ways to prevent, detect, and treat ovarian cancer.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances, and researchers continue to search for more effective methods.

Women who join clinical trials may be among the first to benefit if a new approach is effective. And even if the women in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about ovarian cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

Researchers are conducting studies with women across the country:

• Prevention studies: For women who have a family history of ovarian cancer, the risk of developing the disease may be reduced by removing the ovaries before cancer is detected. This surgery is called prophylactic oophorectomy. Women who are at high risk of ovarian cancer are taking part in trials to study the benefits and harms of this surgery. Other doctors are studying whether certain drugs can help prevent ovarian cancer in women at high risk.
• Screening studies: Researchers are studying ways to find ovarian cancer in women who do not have symptoms.
• Treatment studies: Doctors are testing novel drugs and new combinations. They are studying biological therapies, such as monoclonal antibodies. Monoclonal antibodies can bind to cancer cells. They interfere with cancer cell growth and the spread of cancer.

If you are interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It explains how clinical trials are carried out and explains their possible benefits and risks.

NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of ovarian cancer. NCI's Information Specialists at 1-800-4-CANCER or at LiveHelp at http://www.cancer.gov/help can answer questions and provide information about clinical trials.