basic ovarian cancer

8/10/2019 Basic Ovarian Cancer

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Types of Cancer

Types of Cancer> Gynecologic Cancers> OvarianCancer> Overview

Ovarian Cancer: The Basics

Christopher Dolinsky, MSIVThe University of ennsylvania Cancer Centerosting Date! "ove#$er %&, %''%

What is the ovary?

The ovaries are two s#all organs that onlywo#en have( They are in a wo#an)s pelvis, oneach si*e of her uterus+the organ where a $a$ygrows an* *evelops when a wo#an ispregnant( The ovaries are each a$o-t the si.eof a pean-t M/M, an* they can often $e felt $y

yo-r *octor *-ring the bi-manualportion of apelvic e0a#ination( 1 wo#an)s ovaries areresponsi$le for two i#portant f-nctions in her$o*y! they pro*-ce fe#ale hor#ones an* they

pro*-ce eggs( 2very #onth that a wo#an isfertile an* not pregnant, her ovaries release an

egg that travels into her -ter-s an* has thepotential to $eco#e fertili.e*( The ovaries also

pro*-ce the i#portant hor#ones, estrogen an*progesterone,which reg-late a wo#an)s

#enstr-al cycles, infl-ence the *evelop#ent ofa wo#an)s $o*y *-ring p-$erty, an* keep a

wo#an fertile(

What is ovarian cancer?

Ovarian cancer *evelops when cells in theovaries $egin to grow o-t of control an* canthen inva*e near$y tiss-es or sprea*thro-gho-t the $o*y( 3arge collections of thiso-t of control tiss-e are calle* tumors(4owever, so#e t-#ors are not really cancer$eca-se they cannot sprea* or threatenso#eone)s life( These are calle* $enign

t-#ors( The t-#ors that can sprea* thro-gho-tthe $o*y or inva*e near$y tiss-es areconsi*ere* cancer an* are calle* #alignantt-#ors( The *istinction $etween $enign an*#alignant t-#ors is very i#portant in ovariancancer $eca-se #any ovarian t-#ors are$enign( 1lso, so#eti#es wo#en +especiallyyo-ng wo#en can get ovarian cysts, which are
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collections of fl-i* in the ovaries that canoccasionally grow large or $eco#e painf-l(4owever, ovarian cysts are not cancero-s an*sho-l* not $e conf-se* with ovarian cancer(

5o-r *octor #ay s-ggest that yo- have anovarian cyst re#ove* if it is $eco#ing$otherso#e(

Cancers are characteri.e* $y the cells that theyoriginally for# fro#( The #ost co##on type ofovarian cancer is calle* epithelial ovariancancer6 it co#es fro# cells that lie on thes-rface of the ovary known as epithelialcells(2pithelial ovarian cancer co#pro#ises a$o-t7'8 of all ovarian cancers an* -s-ally occ-rs inol*er wo#en( 1$o-t 98 of ovarian cancers are

calle* germ cell ovarian cancers an* arise fro#the ovarian cells that pro*-ce eggs( Ger# cellovarian cancers are #ore likely to affectyo-nger wo#en( 1nother 98 of ovarian

cancers are known as stromal ovarian cancersan* *evelop fro# the cells in the ovary that

hol* the ovary together an* pro*-ce hor#ones(These t-#ors can create sy#pto#s $y

pro*-cing large a#o-nts of e0cess fe#alehor#ones( 2ach of these three types of ovarian

cancer +epithelial, ger# cell, stro#al contains#any *ifferent s-$types of cancer that are

*isting-ishe* $ase* on how the cells look -n*era #icroscope( Disc-ss the e0act category ofovarian cancer that yo- have with yo-rphysician, so that yo- can get a sense of thepartic-lars of yo-r case(

Am I at risk for ovarian cancer?

1s wo#en get ol*er, their risk of *evelopingovarian cancer increases( In the U(S(, it ise0pecte* that %:,:'' wo#en will *evelopovarian cancer in %''%6 an* ;:,7'' wo#en will

*ie of ovarian cancer in %''%( This p-ts ovariancancer as the


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ca-se any sy#pto#s(

1ltho-gh there are several known risk factorsfor getting ovarian cancer, no one knows e0actly

why one wo#an gets it an* another *oesn)t(The #ost significant risk factor for *evelopingovarian cancer is age6 the ol*er a wo#an$eco#es, the higher her chances are of gettingit( The #a=ority of ovarian cancers are*iagnose* in wo#en after they have gonethro-gh #enopa-se, in their late fifties an*si0ties( The average age for a wo#an to get aspora*ic ovarian cancer is


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can get #ore rigoro-s screening or even-n*ergoprophylactic oophorectomies+preventive re#oval of yo-r ovaries to*ecrease her chances of contracting cancer(

The *ecision to get teste* is a highly personalone that sho-l* $e *isc-sse* with a *octor whois traine* in co-nseling patients a$o-t genetictesting(

The rest of the risk factors for ovarian cancerare not as significant as age an* fa#ilyhistorygenetic syn*ro#es, $-t are #entione*$eca-se so#e of the# can $e controlle*( Itappears that the #ore #enstr-al cycles +an*th-s ov-lations a wo#an has in her lifeti#e,the #ore likely she is to *evelop ovarian

cancer( Th-s wo#en who starte* #enstr-atingearly, go thro-gh #enopa-se late, *on)t haveany chil*ren +or have chil*ren after age :',*on)t -se a for# of $irth control that stops

#enstr-ationov-lation +like $irth control pills,an* *on)t $reastfee* are #ore likely to *evelop

ovarian cancer( It also appears that having at-$al ligation +having yo-r Et-$es tie*F an*or

a hysterecto#y +re#oval of yo-r -ter-s*ecreases yo-r risk of ovarian cancer(

rolonge* -se of the infertility *r-g, clomiphenecitrate, witho-t getting pregnant, slightly

increases a wo#an)s risk for ovarian cancer(inally, it has $een s-ggeste* that a *iet high inani#al fats can increase yo-r risk for ovariancancer( Ae#e#$er that all risk factors are $ase*on pro$a$ilities, an* even so#eone witho-t anyrisk factors can still get ovarian cancer( Talk toyo-r *octor a$o-t yo- risk factors for ovariancancer to -n*erstan* hisher reco##en*ationsfor screening an* prevention(

How can I prevent ovarian cancer?

Unfort-nately, there aren)t very goo* screening#etho*s for ovarian cancer, so preventing it is apartic-larly i#portant challenge( If yo- are awo#an witho-t a fa#ily historygeneticsyn*ro#e, then the $est way to prevent ovariancancer is to alter whatever risk factors yo- havecontrol over( Consi*er -sing #etho*s of $irthcontrol +like OCs oral contraceptive pills, or


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*epo?provera that stop ov-lation#enstr-ationor think a$o-t t-$al ligationhysterecto#y forper#anent sterili.ation when the ti#e is right(If yo- plan to get pregnant, try an* *o so

$efore age :' an* #ake s-re an* $reastfee*(

Bo#en who are carriers of one of the a$ove#entione* genetic syn*ro#es face *ifferent*ecisions( They generally nee* to have #orerigoro-s screening *one for ovarian cancer, an*so#e of the# #ay elect to have their ovariesre#ove* when they are still healthy +calle* aprophylactic oophorecto#y( This sho-l* only$e *one when a wo#an is finishe* havingchil*ren, an* it can *rastically re*-ce awo#an)s chances for *eveloping ovarian cancer

+$-t not re*-ce the risk to .ero( @efore awo#an *eci*es to *o this, she sho-l* havegenetic testing an* a significant a#o-nt ofco-nseling fro# a physician who has e0perience

with genetic *iseases(

Bhile a *iet high in ani#al fats has $eeni#plicate* in ovarian cancer, a *iet rich in fr-itsan* vegeta$les #ay have a s#all preventive

effect( It has $een s-ggeste* thats-pple#entation with vita#ins 1, C, an* 2 #ay

*ecrease yo-r risk, $-t f-rther st-*ies nee* to

$e perfor#e* $efore any n-tritionalreco##en*ations can $e #a*e regar*ingovarian cancer prevention(

What screening tests are available?

1n i*eal screening test for ovarian cancer co-l*save #any lives( The vast #a=ority of ovarian

cancers are fo-n* at a*vance* stages, $eca-seearly, s#all ovarian cancers are asy#pto#atican* cannot -s-ally $e fo-n* $y a physician(atients who are *iagnose* with early ovarian

cancers ten* to respon* to treat#ent $etterthan patients with #ore a*vance* cancers(There are not c-rrently any effectiveapproaches to ovarian cancer screening( Thereare a few tests that are $eing st-*ie*, $-t wenee* f-rther *ata $efore they $eco#e ro-tinefor ovarian cancer screening(


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Aight now, the only screening that isreco##en*e* for the general pop-lation+wo#en witho-t here*itary cancer syn*ro#esis an ann-al pelvic e0a#ination( 5o-r physician

can -s-ally feel yo-r ovaries *-ring the bi-manualportion of the e0a#, an* if anya$nor#alities are felt, yo- can $e referre* forf-rther tests( The #a=or li#itation to this#etho* is that early ovarian cancers aren)t-s-ally appreciate* on e0a#ination, an* areoften #isse*(

There are a few other tests that are c-rrently$eing st-*ie* for ovarian cancer screening( Oneis a $loo* test that looks for a protein na#e*C1?;%9( C1?;%9 is a protein that is she* fro#

*a#age* ovary cells, an* is often elevate* inovarian cancer( The #a=or pro$le# with C1?;%9is that is elevate* in #any other *iseases$esi*es ovarian cancer, an* even co#pletely

healthy wo#en can have elevate* C1?;%9levels( 1nother pro$le# with C1?;%9 is that its

levels nor#ally fl-ct-ate *-ring a wo#an)s#enstr-al cycle( One possi$le way to -se C1?

;%9 for ovarian cancer screening is to check itan* then re?check it < #onths later( If it has a

*rastic increase over ti#e, then there is #ores-ggestion that a wo#an has ovarian cancer(

The #a=or pro$le# with C1?;%9 screening isthat #any patients witho-t ovarian cancer willhave elevate* C1?;%9 levels an* nee* f-rtherwork-p +which often #eans going for s-rgery(It is *angero-s to sen* lots of wo#en fors-rgery -nnecessarily, so we nee* a test that is#ore specific for ovarian cancer $efore it can $ereco##en*e* for screening the generalpop-lation(

1nother investigational #etho* for ovariancancer screening is transvaginal

ultrasonography. Ultraso-n* is an i#agingtechniH-e that -ses so-n* waves that $o-nceoff of tiss-es an* provi*e a pict-re of whateveris $eing investigate*( @y inserting an-ltraso-n* pro$e into a wo#an)s vagina,*octors can get a pretty goo* look at herovaries( If the ovaries look s-spicio-s, thenf-rther tests can $e *one( The $iggest pro$le#with -sing transvaginal -ltraso-n* for ovarian


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cancer screening is the sa#e pro$le# as -singC1?;%9! $oth of these tests ca-se too #anyhealthy wo#en to go for -nnecessaryproce*-res $eca-se they aren)t specific eno-gh

for ovarian cancer( Doctors hope that perhaps aco#$ination of C1?;%9 an* transvaginal-ltraso-n* will $e an effective #etho* forovarian cancer screening, an* large st-*ies arec-rrently -n*erway e0a#ining the feasi$ilityan* -sef-lness of this approach(

C-rrently, the general pop-lation sho-l* only $escreene* for ovarian cancer with a pelvice0a#ination( 4owever, wo#en with a strongfa#ily history or who have a proven here*itarycancer syn*ro#e #ay nee* to get #ore

rigoro-s screening with serial C1?;%9 testsan*or transvaginal -ltraso-n*s( Talk to yo-r*octor a$o-t yo-r ovarian cancer risk, an* whatthe $est way to go a$o-t screening is in yo-r

partic-lar case(

What are the signs of ovarian cancer?

Unfort-nately, the early stages of ovarian

cancer -s-ally *o not ca-se any sy#pto#s(2ven when it *oes pro*-ce sy#pto#s, they are

often very non?specific an* *on)t point towar*s

a *iagnosis of ovarian cancer( 1s the t-#orgrows in si.e, it can pro*-ce a variety ofpro$le#s incl-*ing!

a$*o#inal swelling or a$*o#inal pain

vaginal $lee*ing $etween perio*s or after

#enopa-se $loating, gas, in*igestion or cra#ps

pelvic pain

loss of appetite

feeling f-ll after a s#all #eal, or feeling

f-ll very easily

changes in $owel or $la**er ha$its

weight loss or weight gain

1ll of these sy#pto#s are non?specific, an*co-l* represent a variety of *ifferent con*itions6

however, yo-r *octor nee*s to see yo- if yo-*evelop any of these pro$le#s(


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How is ovarian cancer iagnose an

stage?

The #ost co##on reason for a physician to

s-spect ovarian cancer is if heshe feels a #ass*-ring a pelvic e0a#ination( Bhen a pelvic#ass is fo-n* in either a post#enopa-salwo#an, or a girl or teenager than hasn)t yet$eg-n #enstr-ating, then they will nee* to-n*ergo s-rgery to #ake the final *iagnosis(

Chances are very high that a pelvic #ass in ayo-ng girl or teenager that hasn)t $eg-n

#enstr-ating is a cancer +-s-ally a ger# cellovarian cancer( 4owever, only 98 of #asses

felt on pelvic e0a# in #enstr-ating wo#en are#alignancies, an* certain characteristics of the

#ass #ake it #ore or less likely to $e a cancer(If the #ass is soli*, irreg-lar or fi0e*, it is #orelikely to $e a cancer( Often, if yo- are a#enstr-ating wo#an, yo-r physician will havethe #ass f-rther characteri.e* $y transvaginal-ltraso-n*( If the #ass is s#all, has holes +iscystic, is in only one ovary, is freely #ova$le,an* has reg-lar conto-rs, then it is -nlikely to$e a cancer( Masses with these H-alities can $efollowe* $y clinical e0a# $eca-se there is agoo* chance that they represent ovarian cystsan* will *isappear on their own( 4owever, if

these #asses persist or enlarge, then they nee*to $e s-rgically e0plore*( Bo#en with a pelvic#ass an* an increase* C1?;%9 level will gostraight to s-rgery, an* wo#en with a pelvic#ass an* other sy#pto#s s-ggestive of cancer+like having fl-i* collect in their a$*o#en #ay

also go *irectly to s-rgery(

Ovarian cancer is a type of cancer that nee*s to$e *iagnose* an* stage* *-ring a s-rgery(Often, the cancer is *iagnose* an* treate*

*-ring the sa#e proce*-re( S-rgeries for

ovarian cancer *iagnosis an* treat#ent sho-l*$e *one $y a s-rgeon speciali.e* in gynecologic#alignancies( S-rgery is *one so that sa#ples

of the #ass an* s-rro-n*ing tiss-e can $e$iopsie* an* analy.e*( 1 $iopsy is the only way

to know for s-re if yo- have cancer, $eca-se itallows yo-r *octors to get cells that can $ee0a#ine* -n*er a #icroscope( Once the tiss-e


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is re#ove*, a *octor known as a pathologist willreview the speci#en( The pathologist can tell ifit is cancer or not6 an* if it is cancero-s, thenthe pathologist will characteri.e it $y what type

of tiss-e it arose fro# an* what s-$type ofovarian cancer it is, how a$nor#al it looks+known as the gra*e, whether or not it isinva*ing s-rro-n*ing tiss-es(

In or*er to g-i*e treat#ent an* offer so#einsight into prognosis, ovarian cancer is stage*into fo-r *ifferent gro-ps at the ti#e of thes-rgery( S-rgeons who speciali.e ingynecologic #alignancies go thro-gh a caref-linspection an* sa#pling of a wo#an)s pelvis*-ring this proce*-re, an* $iopsy speci#ens are

sent to a pathologist while the s-rgeon is stillworking( The staging syste# -se* for ovariancancer is the IGO syste# +Internationale*eration of Gynecologists an* O$stetricians(

The staging syste# is so#ewhat co#ple0, $-there is a si#plifie* version of it!

!tage I ovarian cancer confine* to the ovaryor ovaries

!tage II ovarian cancer that has sprea*$eyon* the ovaries, $-t is confine* to the pelvis

+can $e in the -ter-s, $la**er or rect-#

!tage IIIovarian cancer that has sprea* to theperitoneum+the lining of the a$*o#en an*orly#ph no*es

!tage I"ovarian cancer that has *istantsprea* +#etastasis to other organs

Generally, the higher the stage, the #oreserio-s the cancer( 1ltho-gh s-rgery is reH-ire*for staging, yo-r physicians #ay want to or*er

so#e other tests to $etter characteri.e the#ass#asses an* look for *istant sprea*( Testslike CT scans +a :?D 0?ray or MAIs +like a CTscan $-t *one with #agnets can e0a#ine thepelvis an* locali.e* ly#ph no*es( So#e

patients with $ony pain are referre* for a $onescan, which is a test -sing a ra*ioactive tracer

to look for #etastasis to any of yo-r $ones( 5o-


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#ay get also get a colonoscopy, which -ses alighte* scope to e0a#ine yo-r rect-# an*colon, or a barium enemain which *ye isinserte* into yo-r rect-# an* an 0?ray is

taken( These tests are to look for sprea* of thet-#or to yo-r colon( 2ach patient is anin*ivi*-al so the specific tests people get willvary6 $-t overall, yo-r *octors want to know as#-ch a$o-t yo-r partic-lar t-#or as possi$le sothat they can plan the $est availa$letreat#ents(

What are the treatments for ovarian

cancer?

Surgery

1l#ost all wo#en with ovarian cancer will haveso#e type of s-rgery in the co-rse of their

treat#ent( The p-rpose of s-rgery is first to*iagnose an* stage the cancer, an* then to

re#ove as #-ch of the cancer as possi$le( Inearly stage cancers +stage I an* II, s-rgeonscan often re#ove all of the visi$le cancer(Generally, wo#en with ovarian cancer will havea hysterectomy +re#oval of the -ter-s an*bilateral salpingo-ooporectomy +re#oval of $othovaries an* fallopian t-$es) as part of their

operation( This is $eca-se there is always a riskof #icroscopic *isease in $oth of the ovariesan* the -ter-s( The only circ-#stance in whicha wo#an #ay not have this entire operation is ifshe has a very early stage cancer +I1 thatlooks favora$le -n*er the #icroscope +gra*e;( This is often the case with germ cell ovariant-#ors( If a wo#an)s t-#or has thesecharacteristics an* she *esires to #aintain thea$ility to have chil*ren, then the s-rgeons canre#ove only her *isease* ovary an* t-$e( Then

after she is *one having chil*ren, she will nee*

to have her -ter-s an* the other t-$e an* ovaryre#ove*( Bith any other stage or gra*e oft-#or, or in patients finishe* with chil*$earing,

the entire operation sho-l* $e perfor#e* inor*er to provi*e the $est possi$le chance for a

c-re(

Bo#en who have #ore a*vance* *isease


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+stage III or IV will often have debulkings-rgeries, which #eans that their s-rgeon willatte#pt to re#ove as #-ch *isease aspossi$le( Data collecte* in #any st-*ies has

*e#onstrate* that the #ore t-#or that it*e$-lke*, the $etter the long ter# o-tco#e forthe patient( So#eti#es ovarian cancer is*iff-sely sprea* thro-gho-t the entire pelvisan* a$*o#en, an* it can take a s-rgeon H-iteso#e ti#e to get it a*eH-ately *e$-lke*(Operations for ovarian cancer sho-l* $eperfor#e* $y s-rgeons who are traine* in*ealing with gynecologic #alignancies $eca-sethere are special skills an* techniH-es necessaryto *eal with these t-#ors( So#eti#es, a

patient will have *e$-lking s-rgery an* then

later her cancer will co#e $ack( It #ay $e-sef-l to *e$-lk s-ch a patient a secon* ti#e,partic-larly if she has ha* at least a year

$etween her initial s-rgery an* the rec-rrence(In patients with very a*vance* ovarian cancer,

s-rgery #ay $e -se* forpalliation #eaningthat patients are operate* on with the intent ofeasing their pain or sy#pto#s, rather thantrying to c-re their *isease(

1nother way that s-rgery is occasionally -se* inovarian cancer is to closely #onitor a patient for

signs of rec-rrent *isease( This is a calle* asecond looks-rgery, an* can $e *one with ana$*o#inal incision +a laparotomy or -singfi$eroptic scopes an* long, narrow tools whichallow s-rgeons to operate less invasively+laparoscopically( This -se* to $e a #oreco##on proce*-re in the past, $eca-se c-rrent*ata has faile* to show a strong $enefit fro#perfor#ing secon* look s-rgeries( 4owever, it#ay $e -sef-l in so#e cases, partic-larly inpatients with no other in*ication of a rec-rrence*-ring follow?-p i#aging an* la$oratory

testing( If a secon*?look proce*-re showsrec-rrent t-#or, then f-rther s-rgery can $eperfor#e* or other treat#ent #o*alities #ay$e a**e* or change*( Talk to yo-r s-rgeons

a$o-t e0actly which type of operation yo- aregoing to -n*ergo(


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Chemotherapy

Despite the fact that the t-#ors are re#ove**-ring s-rgery, there is always a risk of

rec-rrence $eca-se there #ay $e #icroscopiccancer cells left that the s-rgeon cannotre#ove( In or*er to *ecrease a patient)s risk ofrec-rrence, they are offere* che#otherapy(Che#otherapyis the -se of anti?cancer *r-gsthat go thro-gho-t the entire $o*y( The vast#a=ority of patients with ovarian cancer sho-l*$e offere* che#otherapy after their s-rgery(The higher the stage of cancer yo- have, the#ore i#portant it is that yo- receiveche#otherapy( Generally, only very early stage

cancers +early stage I that look favora$le -n*er

the #icroscope +gra*e ; or % can $e treate*with s-rgery alone( 1ny wo#an with a #orea*vance* stage or gra*e cancer sho-l* $e

offere* che#otherapy(

There are #any *ifferent che#otherapy *r-gs,

an* they are often given in co#$inations(atients will -s-ally have to go to a clinic to get

the che#otherapy $eca-se #any of the *r-gshave to $e given thro-gh a vein( Different

che#otherapy regi#ens are -se* for *ifferentp-rposes( The #ost co##on co#$ination

c-rrently -se* for epithelial ovarian cancer isaclita0el pl-s either Cisplatin or Car$oplatin+platin-# containing *r-gs( There are other*r-gs that can $e -se*, like Ge#cita$ine an*Do0or-$icin, an* so#eti#es new co#$inationsare trie* if there isn)t a response to the originalco#$ination( There are a*vantages an**isa*vantages to each of the *ifferent regi#ensthat yo-r #e*ical oncologist will *isc-ss withyo-( @ase* on yo-r own health, yo-r personalval-es an* wishes, an* si*e effects yo- #aywish to avoi*, yo- can work with yo-r *octors to

co#e -p with the $est regi#en for yo-r canceran* yo-r lifestyle(

Radiotherapy

Ovarian cancer *oes not co##only receivera*iation therapy in the Unite* States(Aa*iation therapy-ses high energy rays +si#ilar
http://www.oncolink.com/treatment/treatment.cfm?c=2http://www.oncolink.com/treatment/treatment.cfm?c=5http://www.oncolink.com/treatment/treatment.cfm?c=2http://www.oncolink.com/treatment/treatment.cfm?c=5


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to 0?rays to kill cancer cells( It co#es fro# ane0ternal so-rce, an* it reH-ires patients toco#e in 9 *ays a week for -p to


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a$o-t participating in clinical trials in yo-r area(

This article is #eant to give yo- a $etter-n*erstan*ing of ovarian cancer( Use this

knowle*ge when #eeting with yo-r physician,#aking treat#ent *ecisions, an* contin-ingyo-r search for infor#ation( 5o- can learn#ore a$o-t ovarian cancer on Onco3ink thro-ghthe relate* links to the left(

#eferences

The 1#erican Cancer SocietyAll About OvarianCancer Overviewhttp!www(cancer(org(

4ensler, M( +%''% Epithelial Ovarian Cancer(

C-rrent Treat#ent Options in Oncology(:+%!;:;?;

Je#al, 1( et( al +%''%( Cancer Statistics, !!(Ca! a Cancer Jo-rnal for Clinicians 9% +;!%:?&

"ational Cancer Instit-te( "hat #ou $eed %o&now About Ovarian Cancer.http!www(cancer(gov(

artri*ge 2( an* @arnes M( +;777 Epithelial

Ovarian Cancer'(revention, iagnosis and

%reatment.Ca! a Cancer Jo-rnal for Clinicians7 +9!%7&?:%'

A-$in, ( an* Billia#s, J((, +2*s! Clinical

Oncology' A *ultidisciplinary Approach +or(hysicians and Students thed( +%'';( B(@(Sa-n*ers Co#pany, hila*elphia, ennsylvania(
http://www.cancer.org/http://www.cancer.gov/http://www.oncolink.com/custom_tags/print_article.cfm?Page=2&id=8589&Section=Cancer_Typeshttp://www.cancer.org/http://www.cancer.gov/

basic ovarian cancer

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