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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2024/11/22" /><meta name="citation_author" content="PDQ Adult Treatment Editorial Board" /><meta name="citation_pmid" content="26389163" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65718/" /><meta name="citation_keywords" content="ovarian epithelial cancer" /><meta name="citation_keywords" content="fallopian tube cancer" /><meta name="citation_keywords" content="primary peritoneal cavity cancer" /><meta name="citation_keywords" content="fallopian tube cancer" /><meta name="citation_keywords" content="ovarian epithelial cancer" /><meta name="citation_keywords" content="primary peritoneal cavity cancer" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Adult Treatment Editorial Board" /><meta name="DC.Date" content="2024/11/22" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65718/" /><meta name="description" content="Treatment of ovarian epithelial, fallopian tube, and primary peritoneal cancers depends on the stage. Most patients have surgery to remove as much of the tumor as possible. Learn about the different types of surgery, including hysterectomy and bilateral salpingo-oophorectomy, and other ovarian cancer treatment options." /><meta name="og:title" content="Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Treatment of ovarian epithelial, fallopian tube, and primary peritoneal cancers depends on the stage. Most patients have surgery to remove as much of the tumor as possible. Learn about the different types of surgery, including hysterectomy and bilateral salpingo-oophorectomy, and other ovarian cancer treatment options." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65718/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062963/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65718/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} </style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script>
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65718_"><span class="title" itemprop="name">Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><h4>Authors</h4><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: November 22, 2024.</p></div><div class="body-content whole_rhythm" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062963__321">This PDQ cancer information summary has current information about the treatment of ovarian epithelial, fallopian tube, and primary peritoneal cancers. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000062963__322">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000062963__104"><h2 id="_CDR0000062963__104_">General Information About Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers</h2><div id="CDR0000062963__104.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062963__105">Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer are diseases in which malignant (cancer) cells form in the tissue covering the ovary or lining the fallopian tube or peritoneum.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__313">Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer form in the same type of tissue and are treated the same way.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__109">Women who have a family history of ovarian cancer are at an
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increased risk of ovarian cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__112">Some ovarian, fallopian tube, and primary peritoneal cancers are caused by inherited gene mutations
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(changes).</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__116">Women with an increased risk of ovarian cancer may consider
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surgery to lessen the risk.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__217">Signs and symptoms of ovarian epithelial, fallopian tube, or peritoneal cancer include pain or swelling in the abdomen.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__123">Tests that examine the ovaries and pelvic area are used to diagnose and stage ovarian epithelial, fallopian tube, and peritoneal cancers.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__127">Certain factors affect treatment options and prognosis
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(chance of recovery).</a></div></li></ul></div><div id="CDR0000062963__105"><h3>Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer are diseases in which malignant (cancer) cells form in the tissue covering the ovary or lining the fallopian tube or peritoneum.</h3><p id="CDR0000062963__107">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> are a pair
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of organs in the female <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046564/" class="def">reproductive
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system</a>. They are in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, one on each side of the
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uterus (the hollow, pear-shaped
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organ where a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046400/" class="def">fetus</a> grows). Each
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ovary is about the size and shape of an almond. The ovaries make eggs and
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female <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormones</a> (chemicals that
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control the way certain cells or
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organs work).</p><p id="CDR0000062963__311">The fallopian tubes are a pair of long, slender tubes, one on each side of the uterus. Eggs pass from the ovaries, through the fallopian tubes, to the uterus. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> sometimes begins at the end of the fallopian tube near the ovary and spreads to the ovary.</p><p id="CDR0000062963__312">The peritoneum is the tissue that lines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall and covers organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">Primary peritoneal cancer</a> is cancer that forms in the peritoneum and has not spread there from another part of the body. Cancer sometimes begins in the peritoneum and spreads to the ovary. <div id="CDR0000062963__251" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20female%20reproductive%20system&p=BOOKS&id=609617_CDR0000609921.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000609921.jpg" alt="Anatomy of the female reproductive system; drawing shows the uterus, myometrium (muscular outer layer of the uterus), endometrium (inner lining of the uterus), ovaries, fallopian tubes, cervix, and vagina." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium. </p></div></div></p><p id="CDR0000062963__108"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">Ovarian epithelial cancer</a>
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is one type of cancer that affects the
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ovary. For information about other types of ovarian <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>, see the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a> summaries:</p><ul id="CDR0000062963__264"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000062967/">Ovarian Germ Cell Tumors Treatment</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000062968/">Ovarian Low Malignant Potential Tumors Treatment</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000798961/">Childhood Ovarian Cancer</a>
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</div></li></ul></div><div id="CDR0000062963__313"><h3>Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer form in the same type of tissue and are treated the same way.</h3></div><div id="CDR0000062963__109"><h3>Women who have a family history of ovarian cancer are at an
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increased risk of ovarian cancer.</h3><p id="CDR0000062963__sm_CDR0000753334_4"><div class="milestone-start" id="CDR0000062963__sm_CDR0000753334_1"></div>Anything that increases your chance of getting a disease
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is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445074/" class="def">ovarian cancer</a>.</p><p id="CDR0000062963__sm_CDR0000753334_2">Risk factors for ovarian cancer include the following:</p><ul id="CDR0000062963__sm_CDR0000753334_3"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">Family history</a> of ovarian cancer in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000460150/" class="def">first-degree relative</a> (mother, daughter, or sister).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">Inherited</a> changes in the <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046047/" class="def">BRCA1</a></i> or <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046742/" class="def">BRCA2</a></i>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>.</div></li><li class="half_rhythm"><div>Other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045983/" class="def">hereditary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044884/" class="def">hereditary nonpolyposis colorectal cancer</a> (HNPCC; also called Lynch syndrome).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046427/" class="def">Endometriosis</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045269/" class="def">Postmenopausal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045110/" class="def">hormone therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000527371/" class="def">Obesity</a>.</div></li><li class="half_rhythm"><div>Tall height.</div></li></ul><p id="CDR0000062963__sm_CDR0000753334_5">Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.<div class="milestone-end"></div></p></div><div id="CDR0000062963__112"><h3>Some ovarian, fallopian tube, and primary peritoneal cancers are caused by inherited gene mutations
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(changes).</h3><p id="CDR0000062963__114">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a> in cells carry the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045983/" class="def">hereditary</a> information
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that is received from a person’s parents. Hereditary ovarian cancer makes up about
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20% of all cases of ovarian cancer. There are three hereditary patterns: ovarian cancer alone, ovarian and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444971/" class="def">breast cancers</a>, and ovarian and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044237/" class="def">colon cancers</a>.</p><p id="CDR0000062963__315"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000755773/" class="def">Fallopian tube cancer</a> and peritoneal cancer may also be caused by certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">inherited</a> gene <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutations</a>.</p><p id="CDR0000062963__115">There are tests that can detect gene mutations. These
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046128/" class="def">genetic tests</a> are sometimes done for
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members of families with a high risk of cancer. For more information, see the following PDQ summaries:</p><ul id="CDR0000062963__265"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000062822/">Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention</a>
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062855/">Genetics of Breast and Gynecologic Cancers</a> (for health professionals)</div></li></ul></div><div id="CDR0000062963__116"><h3>Women with an increased risk of ovarian cancer may consider
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surgery to lessen the risk.</h3><p id="CDR0000062963__118">Some women who have an increased risk of ovarian
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cancer may choose to have a risk-reducing
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045438/" class="def">oophorectomy</a> (the removal of healthy ovaries so that cancer
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cannot grow in them). In high-risk women, this procedure has been shown to greatly decrease the risk of ovarian cancer. For more information, see <a href="/books/n/pdqcis/CDR0000062822/">Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention</a>.</p></div><div id="CDR0000062963__217"><h3>Signs and symptoms of ovarian epithelial, fallopian tube, or peritoneal cancer include pain or swelling in the abdomen.</h3><p id="CDR0000062963__219">Ovarian epithelial, fallopian tube, or peritoneal cancer may not cause early <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>. When signs or symptoms do appear, the cancer is often <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced</a>. Signs and symptoms may include:</p><ul id="CDR0000062963__220"><li class="half_rhythm"><div>Pain, swelling, or a feeling of pressure in the abdomen or pelvis.</div></li><li class="half_rhythm"><div>Sudden or frequent urge to urinate.</div></li><li class="half_rhythm"><div>Trouble eating or feeling full.</div></li><li class="half_rhythm"><div>A lump in the pelvic area.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045692/" class="def">Gastrointestinal</a> problems, such as gas, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476585/" class="def">bloating</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">constipation</a>.</div></li></ul><p id="CDR0000062963__221">These signs and symptoms also may be caused by other conditions and not by ovarian, fallopian tube, or peritoneal cancer. If the signs or symptoms get worse or do not go away on their own, check with your doctor so that any problem can be diagnosed and treated as early as possible.</p></div><div id="CDR0000062963__123"><h3><div class="milestone-start" id="CDR0000062963__124"></div>Tests that examine the ovaries and pelvic area are used to diagnose and stage ovarian epithelial, fallopian tube, and peritoneal cancers.<div class="milestone-end"></div></h3><p id="CDR0000062963__125"> The following tests and procedures may be used to diagnose and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">stage</a> ovarian epithelial, fallopian tube, and peritoneal cancers:</p><ul id="CDR0000062963__284"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000798522/" class="def">health history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322873/" class="def">Pelvic exam</a></b>: An exam of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046133/" class="def">cervix</a>, uterus, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a>, ovaries, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046588/" class="def">speculum</a> is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045978/" class="def">Pap test</a> of the cervix is usually done. The doctor or nurse also inserts one or two <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046302/" class="def">lubricated</a>, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.<div id="CDR0000062963__285" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Pelvic%20exam&p=BOOKS&id=609617_CDR0000609924.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000609924.jpg" alt="Pelvic exam; drawing shows a side view of the female reproductive anatomy during a pelvic exam. The uterus, left fallopian tube, left ovary, cervix, vagina, bladder, and rectum are shown. Two gloved fingers of one hand of the doctor or nurse are shown inserted into the vagina, while the other hand is shown pressing on the lower abdomen. The inset shows a woman covered by a drape on an exam table with her legs apart and her feet in stirrups." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046490/" class="def">CA-125</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044528/" class="def">assay</a></b>: A test that measures the level of CA-125 in the blood. CA-125 is a substance released by cells into the bloodstream. An increased CA-125 level can be a sign of cancer or another <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046427/" class="def">endometriosis</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs in the abdomen, and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. The picture can be printed to be looked at later.<div id="CDR0000062963__286" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Abdominal%20ultrasound&p=BOOKS&id=609617_CDR0000618022.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000618022.jpg" alt="Abdominal ultrasound; drawing shows a woman on an exam table during an abdominal ultrasound procedure. A diagnostic sonographer (a person trained to perform ultrasound procedures) is shown passing a transducer (a device that makes sound waves that bounce off tissues inside the body) over the surface of the patient’s abdomen. A computer screen shows a sonogram (computer picture)." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Abdominal ultrasound. An ultrasound transducer connected to a computer is passed over the surface of the abdomen. The ultrasound transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).</p></div></div>Some patients may have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046633/" class="def">transvaginal ultrasound</a>.<div id="CDR0000062963__287" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Transvaginal%20ultrasound&p=BOOKS&id=609617_CDR0000618018.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000618018.jpg" alt="Transvaginal ultrasound; drawing shows a side view of the female reproductive anatomy during a transvaginal ultrasound procedure. An ultrasound probe (a device that makes sound waves that bounce off tissues inside the body) is shown inserted into the vagina. The bladder, uterus, right fallopian tube, and right ovary are also shown. The inset shows the diagnostic sonographer (a person trained to perform ultrasound procedures) examining a woman on a table, and a computer screen shows an image of the patient’s internal tissues." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Transvaginal ultrasound. An ultrasound probe connected to a computer is inserted into the vagina and is gently moved to show different organs. The probe bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT
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scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> tumor cells in the body. A very small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of cells or tissues so they can be viewed under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer. The tissue is usually removed during surgery to remove the tumor.</div></li></ul></div><div id="CDR0000062963__127"><h3>Certain factors affect treatment options and prognosis
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(chance of recovery).</h3><p id="CDR0000062963__214">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> and treatment options depend on:</p><ul id="CDR0000062963__333"><li class="half_rhythm"><div>The type of ovarian cancer and how much cancer there is.</div></li><li class="half_rhythm"><div>The
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045702/" class="def">grade</a> of the cancer.</div></li><li class="half_rhythm"><div>Whether the patient has extra fluid in the abdomen that causes swelling.</div></li><li class="half_rhythm"><div>Whether all of the tumor can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div>Whether there are changes in the <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046047/" class="def">BRCA1</a></i> or <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046742/" class="def">BRCA2</a></i>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>.</div></li><li class="half_rhythm"><div>The
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patient’s age and general health.</div></li><li class="half_rhythm"><div>Whether the cancer has just been <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back).</div></li></ul></div></div><div id="CDR0000062963__130"><h2 id="_CDR0000062963__130_">Stages of Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers</h2><div id="CDR0000062963__130.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062963__131">After ovarian epithelial, fallopian tube, or peritoneal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__242">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__288">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__135">The following stages are used for ovarian epithelial, fallopian tube, and primary peritoneal
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cancers:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062963__137">Stage I</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__142">Stage II</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__147">Stage III</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__151">Stage IV</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062963__316">Ovarian epithelial, fallopian tube, and primary peritoneal cancers are grouped for treatment as early or advanced cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__355">Ovarian epithelial, fallopian tube, and primary peritoneal cancers can recur (come back) after treatment.</a></div></li></ul></div><div id="CDR0000062963__131"><h3>After ovarian epithelial, fallopian tube, or peritoneal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the ovaries or to other parts of the body.</h3><p id="CDR0000062963__133">The process used to find out whether cancer has spread within the organ or to other parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the staging process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose cancer are often also used to stage the disease. For a description of tests and procedures used to diagnose and stage <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian epithelial cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000755773/" class="def">fallopian tube cancer</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">peritoneal cancer</a>, see the <a href="#CDR0000062963__124">General Information</a> section.</p></div><div id="CDR0000062963__242"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000062963__242_md_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000062963__242_md_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000062963__288"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000062963__288_md_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer cells break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000062963__288_md_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000062963__290">The metastatic tumor is the same type of cancer as the primary tumor. For example, if ovarian epithelial cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, the cancer cells in the lung are actually ovarian epithelial cancer cells. The disease is metastatic ovarian epithelial cancer, not lung cancer.</p><div id="CDR0000062963__340" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000062963__135"><h3>The following stages are used for ovarian epithelial, fallopian tube, and primary peritoneal
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cancers:</h3><div id="CDR0000062963__137"><h4>Stage I</h4><div id="CDR0000062963__356" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=In%20stage%20IA%2C%20cancer%20is%20found%20inside%20a%20single%20ovary%20or%20fallopian%20tube&p=BOOKS&id=609617_CDR0000618025.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000618025.jpg" alt="Three-panel drawing of stage IA, stage IB, and stage IC; each panel shows the ovaries, fallopian tubes, uterus, cervix, and vagina. The first panel (stage IA) shows cancer inside one ovary. The second panel (stage IB) shows cancer inside both ovaries. The third panel (stage IC) shows cancer inside both ovaries and (a) the tumor in the ovary on the left has ruptured (broken open), (b) there is cancer on the surface of the ovary on the right, and (c) there are cancer cells in the pelvic peritoneal fluid (inset)." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>In stage IA, cancer is found inside a single ovary or fallopian tube. In stage IB, cancer is found inside both ovaries or fallopian tubes. In stage IC, cancer is found inside one or both ovaries or fallopian tubes and one of the following is true: (a) either the tumor or the capsule (outer covering) of the ovary has ruptured (broken open), or (b) cancer is also found on the surface of the ovary or fallopian tube, or (c) cancer cells are found in the pelvic peritoneal fluid.</p></div></div><p id="CDR0000062963__139">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045899/" class="def">stage I</a>, cancer is
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found in one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a>. Stage I is divided into stage IA, stage IB, and stage IC.</p><ul id="CDR0000062963__140"><li class="half_rhythm"><div>Stage IA: Cancer is found inside a single ovary or fallopian tube.</div></li><li class="half_rhythm"><div>Stage IB: Cancer is found inside both ovaries or fallopian tubes.</div></li><li class="half_rhythm"><div>Stage IC: Cancer is found inside one or both ovaries or fallopian tubes and one of
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the following is true:
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<dl id="CDR0000062963__141" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">the tumor ruptured (broke open) during surgery; or</p></dd><dt>-</dt><dd><p class="no_top_margin">the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer covering) of the ovary
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ruptured before surgery, or there is cancer on the surface of the ovary or fallopian tube; or</p></dd><dt>-</dt><dd><p class="no_top_margin">cancer cells
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are found in the fluid of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046125/" class="def">peritoneal cavity</a> (the body cavity that contains
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most of the organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>) or in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000700145/" class="def">washings</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> (tissue lining the peritoneal
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cavity).</p></dd></dl></div></li></ul></div><div id="CDR0000062963__142"><h4>Stage II</h4><div id="CDR0000062963__357" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=In%20stage%20IIA%2C%20cancer%20is%20found%20in%20one%20or%20both%20ovaries%20or%20fallopian%20tubes%20and%20has%20spread%20to%20the%20uterus%20and%2For%20the%20fallopian%20tubes%20and%2For%20the%20ovaries&p=BOOKS&id=609617_CDR0000618027.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000618027.jpg" alt="Three-panel drawing of stage IIA, stage IIB, and stage II primary peritoneal cancer; the first panel (stage IIA) shows cancer inside both ovaries that has spread to the fallopian tube and uterus. Also shown are the cervix and vagina. The second panel (stage IIB) shows cancer inside both ovaries that has spread to the colon. The third panel (primary peritoneal cancer) shows cancer in the pelvic peritoneum." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>In stage IIA, cancer is found in one or both ovaries or fallopian tubes and has spread to the uterus and/or the fallopian tubes and/or the ovaries. In stage IIB, cancer is found in one or both ovaries or fallopian tubes and has spread to organs in the peritoneal cavity, such as the colon. In primary peritoneal cancer, cancer is found in the pelvic peritoneum and has not spread there from another part of the body.</p></div></div><p id="CDR0000062963__144">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045900/" class="def">stage II</a>, cancer is
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found in one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a> and has spread into other areas of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a> is found within the pelvis. Stage II is divided
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into stage IIA and stage IIB.</p><ul id="CDR0000062963__145"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045900/" class="def">Stage IIA</a>: Cancer has spread from where it first formed to the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a> and/or the
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fallopian tubes and/or the ovaries.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045900/" class="def">Stage IIB</a>: Cancer has spread from the ovary or fallopian tube to organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046125/" class="def">peritoneal cavity</a> (the body cavity that contains most of the organs in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>).</div></li></ul><div id="CDR0000062963__235" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Tumor%20sizes%20are%20often%20measured%20in%20centimeters%20(cm)%20or%20inches&p=BOOKS&id=609617_CDR0000415526.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000415526.jpg" alt="Drawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).</p></div></div></div><div id="CDR0000062963__147"><h4>Stage III</h4><p id="CDR0000062963__149">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045901/" class="def">stage III</a>, cancer
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is found in one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tubes</a>, or is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a>, and has spread outside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> to other parts of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and/or to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.
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Stage III is divided into stage IIIA, stage IIIB, and stage IIIC.</p><ul id="CDR0000062963__150"><li class="half_rhythm"><div>In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045901/" class="def">stage IIIA</a>, one of the following is true:<dl id="CDR0000062963__307" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Cancer has spread to lymph nodes behind the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> only; or</p></dd><dt>-</dt><dd><p class="no_top_margin">Cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044935/" class="def">omentum</a> (a fold of the peritoneum that surrounds the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the abdomen). Cancer may have spread to nearby lymph nodes. </p></dd></dl><div id="CDR0000062963__358" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=In%20stage%20IIIA%2C%20cancer%20is%20found%20in%20one%20or%20both%20ovaries%20or%20fallopian%20tubes%20and%20(a)%20cancer%20has%20spread%20to%20lymph%20nodes%20behind%20the%20peritoneum%20only%2C%20or%20(b)%20cancer%20cells%20that%20can%20be%20seen%20only%20with%20a%20microscope%20have%20spread%20to%20the%20surface%20of%20the%20peritoneum%20outside%20the%20pelvis%2C%20such%20as%20the%20omentum&p=BOOKS&id=609617_CDR0000618030.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000618030.jpg" alt="Drawing of stage IIIA shows cancer inside both ovaries that has spread to (a) lymph nodes behind the peritoneum and (b) the omentum. The small intestine, colon, fallopian tubes, uterus, and bladder are also shown." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>In stage IIIA, cancer is found in one or both ovaries or fallopian tubes and (a) cancer has spread to lymph nodes behind the peritoneum only, or (b) cancer cells that can be seen only with a microscope have spread to the surface of the peritoneum outside the pelvis, such as the omentum. Cancer may have also spread to nearby lymph nodes.</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045901/" class="def">Stage IIIB</a>: Cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is 2 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or smaller. Cancer may have spread to lymph nodes behind the peritoneum.<div id="CDR0000062963__359" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=In%20stage%20IIIB%2C%20cancer%20is%20found%20in%20one%20or%20both%20ovaries%20or%20fallopian%20tubes%20and%20has%20spread%20to%20the%20peritoneum%20outside%20the%20pelvis%2C%20such%20as%20the%20omentum&p=BOOKS&id=609617_CDR0000655351.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000655351.jpg" alt="Drawing of stage IIIB shows cancer inside both ovaries that has spread to the omentum. The cancer in the omentum is 2 centimeters or smaller. An inset shows 2 centimeters is about the size of a peanut. Also shown are the small intestine, colon, fallopian tubes, uterus, bladder, and lymph nodes behind the peritoneum." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>In stage IIIB, cancer is found in one or both ovaries or fallopian tubes and has spread to the peritoneum outside the pelvis, such as the omentum. The cancer in the omentum is 2 centimeters or smaller. Cancer may have also spread to lymph nodes behind the peritoneum.</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045901/" class="def">Stage IIIC</a>: Cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is
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larger than 2 centimeters. Cancer may have spread to
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lymph nodes behind the peritoneum or to the surface of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.<div id="CDR0000062963__360" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=In%20stage%20IIIC%2C%20cancer%20is%20found%20in%20one%20or%20both%20ovaries%20or%20fallopian%20tubes%20and%20has%20spread%20to%20the%20peritoneum%20outside%20the%20pelvis%2C%20such%20as%20the%20omentum&p=BOOKS&id=609617_CDR0000655353.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000655353.jpg" alt="Drawing of stage IIIC shows cancer inside both ovaries that has spread to the omentum. The cancer in the omentum is larger than 2 centimeters. An inset shows 2 centimeters is about the size of a peanut. Also shown are the small intestine, colon, fallopian tubes, uterus, bladder, and lymph nodes behind the peritoneum." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>In stage IIIC, cancer is found in one or both ovaries or fallopian tubes and has spread to the peritoneum outside the pelvis, such as the omentum. The cancer in the omentum is larger than 2 centimeters. Cancer may have also spread to lymph nodes behind the peritoneum or to the surface of the liver or spleen (not shown).</p></div></div></div></li></ul></div><div id="CDR0000062963__151"><h4>Stage IV</h4><div id="CDR0000062963__361" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=In%20stage%20IV%2C%20cancer%20has%20spread%20beyond%20the%20abdomen%20to%20other%20parts%20of%20the%20body&p=BOOKS&id=609617_CDR0000657667.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000657667.jpg" alt="Drawing of stage IV shows other parts of the body where ovarian cancer may spread, including the lung, liver, and lymph nodes in the groin. An inset on the top shows extra fluid around the lung. An inset on the bottom shows cancer cells spreading through the blood and lymph system to another part of the body where metastatic cancer has formed." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>In stage IV, cancer has spread beyond the abdomen to other parts of the body. In stage IVA, cancer cells are found in extra fluid that builds up around the lungs. In stage IVB, cancer has spread to organs and tissues outside the abdomen, including the lung, liver, and lymph nodes in the groin.</p></div></div><p id="CDR0000062963__153">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045902/" class="def">stage IV</a>, cancer has spread beyond the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> to other
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parts of the body. Stage IV is divided into stage IVA and stage IVB.</p><ul id="CDR0000062963__306"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045902/" class="def">Stage IVA</a>: Cancer cells are found in extra fluid that builds up around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045902/" class="def">Stage IVB</a>: Cancer has spread to organs and tissues outside the abdomen, including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046375/" class="def">groin</a>.</div></li></ul></div></div><div id="CDR0000062963__316"><h3>Ovarian epithelial, fallopian tube, and primary peritoneal cancers are grouped for treatment as early or advanced cancer.</h3><p id="CDR0000062963__318">Stage I ovarian epithelial and fallopian tube cancers are treated as early cancers.</p><p id="CDR0000062963__319">Stages II, III, and IV ovarian epithelial, fallopian tube, and primary peritoneal cancers are treated as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced cancers</a>.</p></div><div id="CDR0000062963__355"><h3>Ovarian epithelial, fallopian tube, and primary peritoneal cancers can recur (come back) after treatment.</h3><p id="CDR0000062963__354">The cancer may come back in the same place or in other parts of the body. Persistent cancer is cancer that does not go away with treatment.</p></div></div><div id="CDR0000062963__156"><h2 id="_CDR0000062963__156_">Treatment Option Overview</h2><div id="CDR0000062963__156.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000062963__157">There are different types of treatment for patients with ovarian epithelial
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cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__161">The following types of treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062963__163">Surgery </a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__171">Chemotherapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__293">Targeted therapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062963__174">New types of treatment are being tested in clinical
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trials. </a></div><ul><li class="half_rhythm"><div><a href="#CDR0000062963__335">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__176">Immunotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000062963__341">Treatment for ovarian epithelial, fallopian tube, and primary peritoneal cancers may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__244">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000062963__248">Follow-up care may be needed.</a></div></li></ul></div><div id="CDR0000062963__157"><h3>There are different types of treatment for patients with ovarian epithelial
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cancer.</h3><p id="CDR0000062963__159">Different types of treatment are available for patients with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian epithelial cancer</a>. Some
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treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a>, and some are being tested in
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A
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treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current
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treatments or obtain information on new treatments for patients with cancer.
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When clinical trials show that a new treatment is better than the treatment
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currently used as standard
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treatment, the new treatment may become the standard treatment.
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Patients with any <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of ovarian cancer may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.</p></div><div id="CDR0000062963__161"><h3>The following types of treatment are used:</h3><div id="CDR0000062963__163"><h4>Surgery </h4><p id="CDR0000062963__165">Most patients have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove as much of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> as possible. Different types
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of surgery may include:</p><ul id="CDR0000062963__166"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045718/" class="def">Hysterectomy</a>: Surgery to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a> and, sometimes, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046133/" class="def">cervix</a>. When only the uterus is removed, it is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000410676/" class="def">partial hysterectomy</a>. When both the uterus and the cervix are removed, it is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045929/" class="def">total hysterectomy</a>. If the uterus and cervix are taken out through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046646/" class="def">vagina</a>, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the operation is called a total <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> hysterectomy. If the uterus and cervix are taken out through a small incision (cut) in the abdomen using a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044360/" class="def">laparoscope</a>, the operation is called a total laparoscopic hysterectomy.<div id="CDR0000062963__255" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Hysterectomy&p=BOOKS&id=609617_CDR0000612116.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65718/bin/CDR0000612116.jpg" alt="Hysterectomy; drawing shows the female reproductive anatomy, including the ovaries, uterus, vagina, fallopian tubes, and cervix. Dotted lines show which organs and tissues are removed in a total hysterectomy, a total hysterectomy with salpingo-oophorectomy, and a radical hysterectomy. An inset shows the location of two possible incisions on the abdomen: a low transverse incision is just above the pubic area and a vertical incision is between the navel and the pubic area." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.</p></div></div></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322894/" class="def">Unilateral salpingo-oophorectomy</a>: A surgical procedure to remove one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovary</a> and one <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045687/" class="def">fallopian tube</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322852/" class="def">Bilateral salpingo-oophorectomy</a>: A surgical procedure to remove both ovaries and both fallopian tubes.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045053/" class="def">Omentectomy</a>: A surgical procedure to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044935/" class="def">omentum</a> (tissue in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045829/" class="def">peritoneum</a> that contains <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerves</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000793499/" class="def">Lymph node biopsy</a>: The removal of all or part of a lymph node. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> views the lymph node tissue under a microscope to check for cancer cells.</div></li></ul></div><div id="CDR0000062963__171"><h4>Chemotherapy</h4><p id="CDR0000062963__173"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>).</p><p id="CDR0000062963__226">A type of regional chemotherapy used to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian cancer</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046331/" class="def">intraperitoneal (IP) chemotherapy</a>. In IP chemotherapy, the anticancer drugs are carried directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046125/" class="def">peritoneal cavity</a> (the space that contains the abdominal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>) through a thin tube.</p><p id="CDR0000062963__346"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000809547/" class="def">Hyperthermic intraperitoneal chemotherapy</a> (HIPEC) is a treatment used during surgery that is being studied for ovarian cancer. After the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044306/" class="def">surgeon</a> has removed as much tumor tissue as possible, warmed chemotherapy is sent directly into the peritoneal cavity.</p><p id="CDR0000062963__231">Treatment with more than one anticancer drug is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a>.</p><p id="CDR0000062963__227">The way the chemotherapy is given depends on the type and stage of the cancer being treated.</p><p id="CDR0000062963__267">For more information, see <a href="https://www.cancer.gov/about-cancer/treatment/drugs/ovarian" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer</a>.</p></div><div id="CDR0000062963__293"><h4>Targeted therapy</h4><p id="CDR0000062963__295"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.</p><p id="CDR0000062963__351"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046066/" class="def">Monoclonal antibodies</a> are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">proteins</a> made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045738/" class="def">infusion</a>. They may be used alone or to carry drugs, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046622/" class="def">toxins</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</p><p id="CDR0000062963__297"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">Bevacizumab</a> is a monoclonal antibody and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046739/" class="def">angiogenesis inhibitor</a> that may be used with chemotherapy to treat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian epithelial cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000755773/" class="def">fallopian tube cancer</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a> that has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). It binds to a protein called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044222/" class="def">vascular endothelial growth factor</a> (VEGF) and may prevent the growth of new blood vessels that tumors need to grow. Other angiogenesis inhibitors are being studied in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478743/" class="def">advanced</a> or recurrent ovarian cancer.</p><div id="CDR0000062963__352" class="box"><h3><span class="title">monoclonal antibodies: how monoclonal antibodies treat cancer</span></h3><div class="caption"><p>How do monoclonal antibodies work to treat cancer? This video shows how monoclonal antibodies, such as trastuzumab, pembrolizumab, and rituximab, block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful substances to cancer cells. </p></div><p><a href="https://www.youtube.com/watch?v=dxnjAc-rqz8" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div><p id="CDR0000062963__301"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658053/" class="def">Poly (ADP-ribose) polymerase inhibitors</a> (PARP inhibitors) are targeted therapy drugs that block <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> repair and may cause cancer cells to die. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000657862/" class="def">Olaparib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000785881/" class="def">rucaparib</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000788165/" class="def">niraparib</a> are PARP inhibitors that may be used as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045768/" class="def">maintenance therapy</a> to treat certain types of ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that have recurred. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000674055/" class="def">Veliparib</a> is a PARP inhibitor that is being studied in combination with chemotherapy to treat advanced ovarian cancer.</p><p id="CDR0000062963__308">For more information, see <a href="https://www.cancer.gov/about-cancer/treatment/drugs/ovarian" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer</a>.</p></div></div><div id="CDR0000062963__174"><h3>New types of treatment are being tested in clinical
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trials. </h3><p id="CDR0000062963__241">This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000062963__335"><h4>Radiation therapy</h4><p id="CDR0000062963__339">Radiation therapy is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer cells or keep them from growing. Some women receive a treatment called
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044942/" class="def">intraperitoneal radiation therapy</a>,
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in which radioactive liquid is put directly in the abdomen through a catheter. Intraperitoneal radiation therapy is being studied to treat advanced ovarian cancer.</p></div><div id="CDR0000062963__176"><h4>Immunotherapy</h4><p id="CDR0000062963__178"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.</p><p id="CDR0000062963__334"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386223/" class="def">Vaccine therapy</a> is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it. Vaccine therapy is being studied to treat advanced ovarian cancer.</p></div></div><div id="CDR0000062963__341"><h3>Treatment for ovarian epithelial, fallopian tube, and primary peritoneal cancers may cause side effects.</h3><p id="CDR0000062963__341_md_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, visit our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000062963__244"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000062963__244_md_3">For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.</p><p id="CDR0000062963__244_md_4">You can use the <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p><p id="CDR0000062963__244_md_5">Learn more about clinical trials, including how to find and join one, at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Clinical Trials Information for Patients and Caregivers</a>.</p></div><div id="CDR0000062963__248"><h3>Follow-up care may be needed.</h3><p id="CDR0000062963__248_md_33">As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000062963__248_md_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). </p></div></div><div id="CDR0000062963__347"><h2 id="_CDR0000062963__347_">Treatment of Early Ovarian Epithelial and Fallopian Tube Cancers</h2><p id="CDR0000062963__348">For information about the treatments listed below, see the <a href="#CDR0000062963__161">Treatment Option Overview</a> section.</p><p id="CDR0000062963__186">Treatment of early <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian epithelial
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cancer</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000755773/" class="def">fallopian tube cancer</a> may include:</p><ul id="CDR0000062963__187"><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045718/" class="def">Hysterectomy</a>,
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322852/" class="def">bilateral
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salpingo-oophorectomy</a>, and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045053/" class="def">omentectomy</a>.
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph nodes</a> and other
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> are removed and checked
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under a microscope for cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> may be given after surgery.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322894/" class="def">Unilateral salpingo-oophorectomy</a> may be done in certain women who wish to have children. Chemotherapy may be given after surgery.</div></li></ul><p id="CDR0000062963__TrialSearch_347_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062963__195"><h2 id="_CDR0000062963__195_">Treatment of Advanced Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers</h2><p id="CDR0000062963__349">For information about the treatments listed below, see the <a href="#CDR0000062963__161">Treatment Option Overview</a> section.</p><p id="CDR0000062963__196">Treatment of advanced <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian
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epithelial cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000755773/" class="def">fallopian tube cancer</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a> may include:</p><ul id="CDR0000062963__309"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045718/" class="def">Hysterectomy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322852/" class="def">bilateral salpingo-oophorectomy</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045053/" class="def">omentectomy</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph nodes</a> and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> are removed and checked under a microscope to look for cancer cells. Surgery is followed by one of the following:<ul id="CDR0000062963__332"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000776353/" class="def">Intravenous chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046331/" class="def">Intraperitoneal chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">bevacizumab</a>).</div></li><li class="half_rhythm"><div>Chemotherapy and targeted therapy with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658053/" class="def">poly (ADP-ribose) polymerase (PARP) inhibitor</a>.</div></li></ul></div></li><li class="half_rhythm"><div>Chemotherapy and targeted therapy followed by surgery (possibly followed by intraperitoneal chemotherapy).</div></li><li class="half_rhythm"><div>Chemotherapy and hyperthermic peritoneal chemotherapy (HIPEC) followed by surgery.</div></li><li class="half_rhythm"><div>Chemotherapy alone for patients who cannot have surgery.</div></li><li class="half_rhythm"><div>Targeted therapy with a PARP inhibitor (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000657862/" class="def">olaparib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000785881/" class="def">rucaparib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000788165/" class="def">niraparib</a>).</div></li></ul><p id="CDR0000062963__TrialSearch_195_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062963__203"><h2 id="_CDR0000062963__203_">Treatment of Recurrent or Persistent Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers</h2><p id="CDR0000062963__344">For information about the treatments listed below, see the <a href="#CDR0000062963__161">Treatment Option Overview</a> section.</p><p id="CDR0000062963__204">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046768/" class="def">ovarian epithelial cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000755773/" class="def">fallopian tube cancer</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386215/" class="def">primary peritoneal cancer</a> may include:</p><ul id="CDR0000062963__205"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> using one or more anticancer drugs.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658053/" class="def">poly (ADP-ribose) polymerase (PARP) inhibitor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000657862/" class="def">olaparib</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000785881/" class="def">rucaparib</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000788165/" class="def">niraparib</a>) with or without chemotherapy.</div></li><li class="half_rhythm"><div>Chemotherapy and/or targeted therapy (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046115/" class="def">bevacizumab</a>).</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000809547/" class="def">hyperthermic intraperitoneal chemotherapy</a> (HIPEC) during surgery.</div></li></ul><p id="CDR0000062963__TrialSearch_203_19">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062963__236"><h2 id="_CDR0000062963__236_">To Learn More About Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers</h2><p id="CDR0000062963__237">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about ovarian epithelial, fallopian tube, and primary peritoneal cancers, see:</p><ul id="CDR0000062963__238"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/types/ovarian" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
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Home Page</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000062822/">Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Prevention</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000258027/">Ovarian, Fallopian Tube, and Primary Peritoneal Cancers Screening</a>
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</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/CDR0000798961/">Childhood Ovarian Cancer Treatment</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/drugs/ovarian" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Drugs Approved for Ovarian, Fallopian Tube, or Primary Peritoneal Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Targeted Therapy to Treat Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">BRCA Gene Changes: Cancer Risk and Genetic Testing</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Genetic Testing for Inherited Cancer Risk</a>
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</div></li></ul><p id="CDR0000062963__236_md_40">For general cancer information and other resources from the National Cancer Institute, visit:</p><ul id="CDR0000062963__236_md_41"><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a>
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</div></li><li class="half_rhythm"><div>
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<a href="https://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors, Caregivers, and Advocates</a>
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</div></li></ul></div><div id="CDR0000062963__AboutThis_1"><h2 id="_CDR0000062963__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062963__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000062963__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="https://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000062963__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000062963__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000062963__AboutThis_6">This PDQ cancer information summary has current information about the treatment of ovarian epithelial, fallopian tube, and primary peritoneal cancers. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000062963__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000062963__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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</p><p id="CDR0000062963__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000062963__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000062963__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000062963__AboutThis_12">Clinical trials can be found online at <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000062963__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000062963__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000062963__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000062963__AboutThis_21">PDQ® Adult Treatment Editorial Board. PDQ Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancers Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/ovarian/patient/ovarian-epithelial-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389163]</p><p id="CDR0000062963__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 scientific images.
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</p></div><div id="CDR0000062963__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062963__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062963__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000062963__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65718</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389163" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389163</a></span></div></div></div>
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