Gynecological Cancers

- Endometrial Cancer
- Cervical Cancer
- Ovarian Cancer

Endometrial Cancer
Endometrial cancer is a disease in which malignant (cancer) cells form in the tissues of the endometrium. The endometrium is the lining of the uterus. The uterus is a hollow, pear shaped, muscular organ in a woman's pelvis. The uterus is where a fetus grows. In most nonpregnant women, the uterus is about 3 inches long. Cancer of the endometrium is different from cancer of the muscle of the uterus, which is called sarcoma of the uterus.

Symptoms
Endometrial cancer may develop in breast cancer patients who have been treated with tamoxifen. A patient taking this drug should have a pelvic examination every year and report any vaginal bleeding (other than menstrual bleeding) as soon as possible. Women taking estrogen (a hormone that can affect the growth of some cancers) alone have an increased risk of developing endometrial cancer. Taking estrogen in combination with progesterone (another hormone) does not increase a woman's risk of this cancer.

Possible signs of endometrial cancer include unusual vaginal discharge or pain in the pelvis. A woman should see her doctor if any of the following problems occur:

• Bleeding or discharge not related to menstruation (periods).
• Difficult or painful urination.
• Pain during sexual intercourse.
• Pain in the pelvic area.

Diagnosis
Tests that examine the endometrium are used to detect (find) and diagnose endometrial cancer. Because endometrial cancer begins inside the uterus, it does not usually show up in the results of a Pap test. For this reason, a sample of endometrial tissue must be removed and examined under a microscope to look for cancer cells. One of the following procedures may be used:

• Endometrial biopsy: A procedure in which a thin flexible tube is inserted through the cervix into the uterus. The tube is used to gently scrape small amounts of tissue from the lining of the uterus. The tissue samples of the endometrium are then sucked out through the tube.
• Dilatation and curettage (D&C): A procedure in which the cervix is dilated so that a surgical instrument can be inserted into the uterus to remove larger samples of tissue.

Certain factors affect treatment options and prognosis (chance of recovery).

The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it is in the endometrium only, involves the whole uterus, or has spread to other places in the body), the type of cancer, the size of the tumor, and the patient's general health. The chance of recovery may also depend on how the cancer cells look under a microscope and whether they are affected by progesterone. Endometrial cancer is highly curable.

Stages of Endometrial Cancer
After endometrial cancer has been diagnosed, tests are done to find out if cancer cells have spread within the uterus or to other parts of the body.
The process used to find out whether the cancer has spread within the uterus or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. Certain tests and procedures are used in the staging process. A hysterectomy (an operation in which the uterus is removed) will usually be done to help find out how far the cancer has spread.

Treatment Option Overview
There are different types of treatment for patients with endometrial cancer.

Different types of treatment are available for patients with endometrial cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Three types of standard treatment are used:

Surgery (removing the cancer in an operation) is the most common treatment for endometrial cancer. The following surgical procedures may be used:

Hysterectomy and bilateral salpingo-oophorectomy: This surgery involves removing the uterus, fallopian tubes, and ovaries through an incision in the abdomen. Pelvic lymph nodes may also be removed to see if they contain cancer cells.

Radical hysterectomy: This surgery involves removing the cervix, uterus, fallopian tubes, ovaries, and part of the vagina. Lymph nodes in the area may also be removed.

Even if the doctor removes all the cancer that can be seen at the time of the operation, some patients may be offered radiation therapy or hormone treatment. Treatment given after the surgery to increase the chances of a cure is called adjuvant therapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Endometrial cancer is treated with internal and external radiation therapy. Radiation may be used alone or in addition to surgery, chemotherapy, or both.

Hormone therapy
Hormones are chemicals produced by glands in the body and circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way the hormones work or by surgically removing organs that make hormones, such as the ovaries.

Web sites and Organizations
The NCI's Cancer.gov Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

Cervical Cancer
Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).

Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.

Risk Factors
Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer. Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.

Other possible risk factors include the following:

• Giving birth to many children.
• Having many sexual partners.
• Having first sexual intercourse at a young age.
• Smoking cigarettes.
• A diet lacking in vitamins A and C.
• Oral contraceptive use ("the Pill").
• Weakened immune system.

Symptoms
There are usually no noticeable signs of early cervical cancer but it can be detected early with yearly check-ups.
Early cervical cancer may not cause noticeable signs or symptoms. Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis (chance of recovery) is better when the cancer is found early.

Possible signs of cervical cancer include vaginal bleeding and pelvic pain.

These and other symptoms may be caused by cervical cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• Vaginal bleeding.
• Unusual vaginal discharge.
• Pelvic pain.
• Pain during sexual intercourse.

Diagnosis
Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.

The following procedures may be used:

• Pap smear: A piece of cotton, a brush, or a small wooden stick is used to collect cells from the cervix and vagina. The cells are viewed under a microscope. Abnormal (precancerous) cells in the tissues of the cervix can usually be found by a Pap smear.
• Colposcopy: The tissues of the vagina and cervix are examined using a lighted magnifying instrument called a colposcope.
• Biopsy: If abnormal cells are found in a Pap smear, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope. A biopsy that removes only a small amount of tissue is usually done in the doctor's office. A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).
• Pelvic exam: A procedure to check the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size.
• Endocervical curettage: A curette (a spoon-shaped instrument) is used to collect cells from the cervical canal. The cells are viewed under a microscope. This procedure is sometimes done at the same time as the colposcopy.

Staging
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the body), the type of cervical cancer, the size of the tumor, and the patient's desire to have children. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.

After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body.
The process used to find out if cancer has spread within the cervix or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:

• Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.
• CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.
• Lymphangiography: An x-ray is made of the lymph system. A dye is injected into a lymph vessel and travels through the lymph system. The dye outlines the lymph vessels and organs on the x-ray. This test helps determine whether cancer has spread to the lymph nodes.
• Pretreatment surgical staging: Surgery (an operation) is done to find out if the cancer has spread within the cervix or to other parts of the body. In some cases, the cervical cancer can be removed at the same time. Pretreatment surgical staging is usually done only as part of a clinical trial.
• Ultrasound: A test that uses sound waves to create images of body tissues.
• MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).
  The results of these tests are viewed together with the results of the original tumor biopsy to determine the cervical cancer stage.

Treatment
Different types of treatment are available for patients with cervical cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Three types of standard treatment are used:
Surgery (removing the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used:

• Conization: Surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal for biopsy. Also called cone biopsy.
• Hysterectomy: The uterus and cervix are removed in a hysterectomy. If the uterus is taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus is taken out through an incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy.
• Bilateral salpingo-oophorectomy: The removal of both ovaries and both fallopian tubes.
• Radical hysterectomy: This surgery involves removing the cervix, uterus, fallopian tubes, ovaries, and part of the vagina. Lymph nodes may also be removed.
• Pelvic exenteration: If the cancer has spread throughout the pelvis, then the lower colon, rectum, or bladder (depending on where the cancer has spread) may be removed along with the cervix, uterus, and vagina. Plastic surgery may be needed to make an artificial vagina after this operation.
• Cryosurgery: An instrument is used to freeze and destroy the abnormal tissue. This procedure is also called cryotherapy. Carcinoma in situ may be treated with cryosurgery.
• Laser surgery : A laser beam (a narrow beam of intense light) is used as a knife to remove the cancer. A laser beam can also be used to kill the cancer cells. This may be called laser therapy.
• Loop electrosurgical excision procedure (LEEP): An electrical current passed through a thin wire loop is used as a knife to remove abnormal tissue.

Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Both external and internal radiation are used for cervical cancer.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

Ovarian Cancer
The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus (the hollow, pear-shaped organ where a baby grows). Each ovary is about the size and shape of an almond. The ovaries have two functions: they produce eggs and female hormones (chemicals that control the way certain cells or organs function). The ovaries are the main source of the female hormones estrogen and progesterone. These hormones influence the development of a woman's breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.

Understanding Ovarian Cancer
A malignant tumor that begins in the ovaries is called ovarian cancer. There are several types of ovarian cancer. Ovarian cancer that begins on the surface of the ovary (epithelial carcinoma) is the most common type. This is the type of cancer discussed here. Ovarian cancer that begins in the egg-producing cells (germ cell tumors) and cancer that begins in the supportive tissue surrounding the ovaries (stromal tumors) are rare and are not discussed here. The Cancer Information Service and the other NCI sources listed under "National Cancer Institute Information Resources" can provide information or suggest resources that deal with these types of ovarian cancer.

Ovarian cancer cells can break away from the ovary and spread to other tissues and organs in a process called shedding. When ovarian cancer sheds, it tends to seed (form new tumors) on the peritoneum (the large membrane that lines the abdomen) and on the diaphragm (the thin muscle that separates the chest from the abdomen). Fluid may collect in the abdomen. This condition is known as ascites. It may make a woman feel bloated, or her abdomen may look swollen. Ovarian cancer cells can also enter the bloodstream or lymphatic system (the tissues and organs that produce and store cells that fight infection and disease). Once in the bloodstream or lymphatic system, the cancer cells can travel and form new tumors in other parts of the body.

Risk Factors
The exact causes of ovarian cancer are not known. However, studies show that the following factors may increase the chance of developing this disease:

• Family history. First-degree relatives (mother, daughter, sister) of a woman who has had ovarian cancer are at increased risk of developing this type of cancer themselves. The likelihood is especially high if two or more first-degree relatives have had the disease. The risk is somewhat less, but still above average, if other relatives (grandmother, aunt, cousin) have had ovarian cancer. A family history of breast or colon cancer is also associated with an increased risk of developing ovarian cancer.
• Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest risk in women over 60.
• Childbearing. Women who have never had children are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.
• Personal history. Women who have had breast or colon cancer may have a greater chance of developing ovarian cancer than women who have not had breast or colon cancer.
• Fertility drugs. Drugs that cause a woman to ovulate may slightly increase a woman's chance of developing ovarian cancer. Researchers are studying this possible association.
• Talc. Some studies suggest that women who have used talc in the genital area for many years may be at increased risk of developing ovarian cancer.
• Hormone replacement therapy (HRT). Some evidence suggests that women who use HRT after menopause may have a slightly increased risk of developing ovarian cancer.
  

About 1 in every 57 women in the United States will develop ovarian cancer. Most cases occur in women over the age of 50, but this disease can also affect younger women.

As we learn more about what causes ovarian cancer, we may also learn how to reduce the chance of getting this disease. Some studies have shown that breast feeding and taking birth control pills (oral contraceptives) may decrease a woman's likelihood of developing ovarian cancer. These factors decrease the number of times a woman ovulates, and studies suggest that reducing the number of ovulations during a woman's lifetime may lower the risk of ovarian cancer.

Women who have had an operation that prevents pregnancy (tubal ligation) or have had their uterus and cervix removed (hysterectomy) also have a lower risk of developing ovarian cancer. In addition, some evidence suggests that reducing the amount of fat in the diet may lower the risk of developing ovarian cancer.

Women who are at high risk for ovarian cancer due to a family history of the disease may consider having their ovaries removed before cancer develops (prophylactic oophorectomy). This procedure usually, but not always, protects women from developing ovarian cancer. The risks associated with this surgery and its side effects should be carefully considered. A woman should discuss the possible benefits and risks with her doctor based on her unique situation.

Having one or more of the risk factors mentioned here does not mean that a woman is sure to develop ovarian cancer, but the chance may be higher than average. Women who are concerned about ovarian cancer may want to talk with a doctor who specializes in treating women with cancer: a gynecologist, a gynecologic oncologist, or a medical oncologist. The doctor may be able to suggest ways to reduce the likelihood of developing ovarian cancer and can plan an appropriate schedule for checkups.

Detecting Ovarian Cancer
The sooner ovarian cancer is found and treated, the better a woman's chance for recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage. In a large-scale study, known as the PLCO 4 (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial, scientists are studying ways to detect ovarian cancer before symptoms develop. They are exploring the usefulness of measuring the level of CA 125, a substance called a tumor marker, which is often found in higher-than-normal amounts in the blood of women with ovarian cancer. They also are evaluating transvaginal ultrasound, a test that may help detect the disease early. The Cancer Information Service 2 can provide information about this research.

Recognizing Symptoms
Ovarian cancer often shows no obvious signs or symptoms until late in its development. Signs and symptoms of ovarian cancer may include:

• General abdominal discomfort and/or pain (gas, indigestion, pressure, swelling, bloating, cramps)
• Nausea, diarrhea, constipation, or frequent urination
• Loss of appetite
• Feeling of fullness even after a light meal
• Weight gain or loss with no known reason
• Abnormal bleeding from the vagina

These symptoms may be caused by ovarian cancer or by other, less serious conditions. It is important to check with a doctor about any of these symptoms.

Diagnosing Ovarian Cancer
To help find the cause of symptoms, a doctor evaluates a woman's medical history. The doctor also performs a physical exam and orders diagnostic tests. Some exams and tests that may be useful are described below:

• Pelvic exam includes feeling the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size. (A Pap test, a good test for cancer of the cervix, is often done along with the pelvic exam, but it is not a reliable way to find or diagnose ovarian cancer.)
• Ultrasound refers to the use of high-frequency sound waves. These waves, which cannot be heard by humans, are aimed at the ovaries. The pattern of the echoes they produce creates a picture called a sonogram. Healthy tissues, fluid-filled cysts, and tumors look different on this picture.
• CA-125 assay is a blood test used to measure the level of CA-125, a tumor marker that is often found in higher-than-normal amounts in the blood of women with ovarian cancer.
• Lower GI series, or barium enema, is a series of x-rays of the colon and rectum. The pictures are taken after the patient is given an enema with a white, chalky solution containing barium. The barium outlines the colon and rectum on the x-ray, making tumors or other abnormal areas easier to see.
• CT (or CAT) scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine.
• Biopsy is the removal of tissue for examination under a microscope. A pathologist studies the tissue to make a diagnosis. To obtain the tissue, the surgeon performs a laparotomy (an operation to open the abdomen). If cancer is suspected, the surgeon performs an oophorectomy (removal of the entire ovary). This is important because, if cancer is present, removing just a sample of tissue by cutting through the outer layer of the ovary could allow cancer cells to escape and cause the disease to spread.

If the diagnosis is ovarian cancer, the doctor will want to learn the stage (or extent) of disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, to what parts of the body. Staging may involve surgery, x-rays and other imaging procedures, and lab tests. Knowing the stage of the disease helps the doctor plan treatment.

Treatment for Ovarian Cancer
Treatment depends on a number of factors, including the stage of the disease and the general health of the patient. Patients are often treated by a team of specialists. The team may include a gynecologist, a gynecologic oncologist, a medical oncologist, and/or a radiation oncologist. Many different treatments and combinations of treatments are used to treat ovarian cancer.

Surgery is the usual initial treatment for women diagnosed with ovarian cancer. The ovaries, the fallopian tubes, the uterus, and the cervix are usually removed. This operation is called a hysterectomy with bilateral salpingo-oophorectomy. Often, the surgeon also removes the omentum (the thin tissue covering the stomach and large intestine) and lymph nodes (small organs located along the channels of the lymphatic system) in the abdomen.

Staging during surgery (to find out whether the cancer has spread) generally involves removing lymph nodes, samples of tissue from the diaphragm and other organs in the abdomen, and fluid from the abdomen. If the cancer has spread, the surgeon usually removes as much of the cancer as possible in a procedure called tumor debulking. Tumor debulking reduces the amount of cancer that will have to be treated later with chemotherapy or radiation therapy.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be given to destroy any cancerous cells that may remain in the body after surgery, to control tumor growth, or to relieve symptoms of the disease.

Most drugs used to treat ovarian cancer are given by injection into a vein (intravenously, or IV). The drugs can be injected directly into a vein or given through a catheter, a thin tube. The catheter is placed into a large vein and remains there as long as it is needed. Some anticancer drugs are taken by mouth. Whether they are given intravenously or by mouth, the drugs enter the bloodstream and circulate throughout the body.

Another way to give chemotherapy is to put the drug directly into the abdomen through a catheter. With this method, called intraperitoneal chemotherapy, most of the drug remains in the abdomen.

After chemotherapy is completed, second-look surgery may be performed to examine the abdomen directly. The surgeon may remove fluid and tissue samples to see whether the anticancer drugs have been successful.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation). Some women receive a treatment called intraperitoneal radiation therapy in which radioactive liquid is put directly into the abdomen through a catheter.

Clinical trials (research studies) to evaluate new ways to treat cancer are an important treatment option for many women with ovarian cancer. In some studies, all patients receive the new treatment. In others, doctors compare different therapies by giving the promising new treatment to one group of patients and the usual (standard) therapy to another group. Through research, doctors learn new, more effective ways to treat cancer.

Possible Side Effects of Treatment
The side effects of cancer treatment depend on the type of treatment and may be different for each woman. Doctors and nurses will explain the possible side effects of treatment, and they can suggest ways to help relieve problems that may occur during and after treatment.

• Surgery causes short-term pain and tenderness in the area of the operation. Discomfort or pain after surgery can be controlled with medicine. Patients should feel free to discuss pain relief with their doctor. For several days after surgery, the patient may have difficulty emptying her bladder and having bowel movements.
  
  When both ovaries are removed, a woman loses her ability to become pregnant. Some women may experience feelings of loss that may make intimacy difficult. Counseling or support for both the patient and her partner may be helpful.
  Also, removing the ovaries means that the body's natural source of estrogen and progesterone is lost, and menopause occurs. Symptoms of menopause, such as hot flashes and vaginal dryness, are likely to appear soon after the surgery. Some form of hormone replacement therapy may be used to ease such symptoms. Deciding whether to use it is a personal choice; women with ovarian cancer should discuss with their doctors the possible risks and benefits of using hormone replacement therapy.
  
• Chemotherapy affects normal as well as cancerous cells. Side effects depend largely on the specific drugs and the dose (amount of drug given). Common side effects of chemotherapy include nausea and vomiting, loss of appetite, diarrhea, fatigue, numbness and tingling in hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Certain drugs used in the treatment of ovarian cancer can cause some hearing loss or kidney damage. To help protect the kidneys while taking these drugs, patients may receive extra fluid intravenously.
  
• Radiation therapy, like chemotherapy, affects normal as well as cancerous cells. Side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Common side effects of radiation therapy to the abdomen are fatigue, loss of appetite, nausea, vomiting, urinary discomfort, diarrhea, and skin changes on the abdomen. Intraperitoneal radiation therapy may cause abdominal pain and bowel obstruction (a blockage of the intestine).
  
  Doctors and nurses will explain the possible side effects of treatment, and they can suggest ways to help relieve problems that may occur during and after treatment.

The Importance of Follow-up Care
Follow-up care after treatment for ovarian cancer is important. Regular checkups generally include a physical exam, as well as a pelvic exam and Pap test. The doctor also may perform additional tests such as a chest x-ray, CT scan, urinalysis, complete blood count, and CA-125 assay. In addition to having followup exams to check for the return of ovarian cancer, patients may also want to ask their doctor about checking them for other types of cancer. Women who have had ovarian cancer may be at increased risk of developing breast or colon cancer. In addition, treatment with certain anticancer drugs may increase the risk of second cancers, such as leukemia.

Emotional Support
Living with a serious disease is challenging. Apart from having to cope with the physical and medical challenges, people with cancer face many worries, feelings, and concerns that can make life difficult. They may need help coping with the emotional aspects of their disease. In fact, attention to the emotional burden of having cancer is often a part of a patient's treatment plan. The support of the health care team (doctors, nurses, social workers), support groups, and patient-to-patient networks can help people feel less isolated and distressed and can improve the quality of their lives. Cancer support groups provide an environment where cancer patients can talk about living with cancer with others who may be having similar experiences. Patients may want to speak with their health care team about finding a support group.

Additional resources:
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone
Cancer Information Service (CIS)
Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY (for deaf and hard of hearing callers): 1-800-332-8615

Internet
http://cancer.gov
NCI's Web site contains comprehensive information about cancer causes and prevention, screening and diagnosis, treatment and survivorship; clinical trials; statistics; funding, training, and employment opportunities; and the Institute and its programs.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.