CT scan (CAT scan)

A CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Learn more about Computed Tomography (CT) Scans and Cancer.

Computed tomography (CT) scan. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body.

Magnetic resonance imaging (MRI)

MRI uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the pelvis or abdomen. This procedure is also called nuclear magnetic resonance imaging.

Magnetic resonance imaging (MRI) scan. The child lies on a table that slides into the MRI machine, which takes a series of detailed pictures of areas inside the body. The positioning of the child on the table depends on the part of the body being imaged.

Ultrasound exam

An ultrasound exam uses high-energy sound waves (ultrasound) that bounce off internal tissues or organs in the abdomen or pelvis and make echoes. The echoes form a picture of body tissues called a sonogram.

Biopsy

Biopsy is a procedure in which a sample of tissue is removed from the tumor so that a pathologist can view it under a microscope to check for signs of cancer.

Serum tumor marker test

A serum tumor marker test examines a sample of blood to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers. The tumor markers alpha-fetoprotein, beta-human chorionic gonadotropin (beta-hCG), CEA, CA-125, and others are used to diagnose ovarian cancer.

DICER1 genetic testing

DICER1 genetic testing examines a sample of blood or saliva for changes in the DICER1 gene. This test may be done for children with a Sertoli-Leydig cell tumor.

Molecular testing

A molecular test checks for certain genes, proteins, or other molecules in a sample of tissue, blood, or bone marrow. Molecular tests also check for certain changes in a gene or chromosome that may cause or affect the chance of developing an ovarian tumor. A molecular test may be used to help plan treatment, find out how well treatment is working, or make a prognosis.

The Molecular Characterization Initiative offers free molecular testing to children, adolescents, and young adults with certain types of newly diagnosed cancer. The program is offered through NCI's Childhood Cancer Data Initiative. To learn more, visit About the Molecular Characterization Initiative.

Stage I (also called stage 1) ovarian cancer

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.

In stage I, ovarian cancer has formed and is found in one or both ovaries or fallopian tubes. Stage I is divided into stages IA, IB, and IC.

• Stage IA: Cancer is found inside a single ovary or fallopian tube.
• Stage IB: Cancer is found inside both ovaries or fallopian tubes.
• Stage IC: Cancer is found inside one or both ovaries or fallopian tubes. Stage IC is further divided based on whether the cancer is found outside the ovary.

  • Stage IC1: The tumor ruptured (broke open) during surgery.
  • Stage IC2: The capsule (outer covering) of the ovary ruptured before surgery, or there is cancer on the surface of the ovary or fallopian tube.
  • Stage IC3: Cancer cells are found in the fluid of the peritoneal cavity (the body cavity that contains most of the organs in the abdomen) or in washings of the peritoneum (tissue lining the peritoneal cavity).

Stage II (also called stage 2) ovarian cancer

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.

In stage II, cancer is found in one or both ovaries or fallopian tubes and has spread into other areas of the pelvis, or primary peritoneal cancer is found within the pelvis.

Stage II is subdivided based on whether the cancer has spread to other tissue.

• Stage IIA: The cancer has spread from where it first formed to the uterus and/or the fallopian tubes and/or the ovaries.
• Stage IIB: The cancer has spread from the ovary or fallopian tube to organs in the peritoneal cavity (the body cavity that contains most of the organs in the abdomen).

Stage III (also called stage 3) ovarian cancer

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).

In stage III, cancer is found in one or both ovaries or fallopian tubes, or is primary peritoneal cancer, and has spread outside the pelvis to other parts of the abdomen and/or to nearby lymph nodes.

Stage III is subdivided based on how far the cancer has spread.

• Stage IIIA1: The cancer has spread to lymph nodes behind the peritoneum only.
• Stage IIIA2: The 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 (a fold of the peritoneum that surrounds the stomach and other organs in the abdomen). Cancer may have spread to nearby lymph nodes.

  

  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.

• Stage IIIB: The cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is 2 centimeters or smaller. Cancer may have spread to lymph nodes behind the peritoneum.

  

  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.

• Stage IIIC: The cancer has spread to the peritoneum outside the pelvis, such as the omentum, and the cancer in the peritoneum is larger than 2 centimeters. Cancer may have spread to lymph nodes behind the peritoneum or to the surface of the liver or spleen.

  

  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).

Stage IV (also called stage 4) ovarian cancer

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.

In stage IV, cancer has spread beyond the abdomen to other parts of the body. Stage IV is divided into stage IVA and stage IVB.

• Stage IVA: Cancer cells are found in extra fluid that builds up around the lungs.
• Stage IVB: Cancer has spread to organs and tissues outside the abdomen, including lymph nodes in the groin.

Stage IV ovarian cancer is also called metastatic ovarian cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if ovarian cancer spreads to the lung, the cancer cells in the lung are actually ovarian cancer cells. The disease is called metastatic ovarian cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Recurrent ovarian cancer

Recurrent ovarian cancer is cancer that has come back after it has been treated. The cancer may come back in the ovary or as metastatic tumors in other parts of the body. Tests will be done to help determine where the cancer has returned in the body, if it has spread, and how far. The type of treatment that your child will have for recurrent ovarian cancer will depend on how far it has spread.

To learn more, see Recurrent Cancer: When Cancer Comes Back.

Surgery

Surgery is used to remove a tumor in the ovary. Sometimes the ovary and/or fallopian tube are also removed. During surgery to remove the tumor, fluid in the abdomen will be checked for signs of cancer.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells. Chemotherapy either kills the cancer cells or stops them from dividing.

Chemotherapy may be given in different ways. For ovarian cancer, chemotherapy is injected into a vein. When given this way, the drugs enter the bloodstream and can affect cancer cells throughout the body. Chemotherapy drugs used alone or in combination to treat ovarian cancer in children include:

• bleomycin
• carboplatin
• cisplatin
• cyclophosphamide
• etoposide
• ifosfamide
• vinblastine

Other chemotherapy drugs not listed here may also be used.

To learn more about how chemotherapy works, how it is given, common side effects, and more, see Chemotherapy to Treat Cancer.

Stem cell transplant

High doses of chemotherapy are given to kill cancer cells. This cancer treatment destroys healthy cells, including blood-forming cells. Stem cell transplant (also called stem cell rescue) is a treatment to replace the blood-forming cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient and are frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells.

Tazemetostat is used to treat ovarian cancer.

Targeted therapy is also being studied for the treatment of childhood ovarian cancer that has recurred (come back).

Learn more about Targeted Therapy to Treat Cancer.

Clinical trials

Joining a clinical trial may be an option. There are different types of clinical trials for childhood cancer. For example, a treatment trial tests new treatments or new ways of using existing 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.

You can use the clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. The search allows you to filter trials based on the type of cancer, your child's age, and where the trials are being done.

To learn more, see Clinical Trials Information for Patients and Caregivers.

Treatment of benign childhood ovarian tumors

Treatment of newly diagnosed benign ovarian tumors in children may include surgery.

Treatment of childhood ovarian epithelial cancer

Treatment of newly diagnosed ovarian epithelial cancer in children may include:

• surgery
• chemotherapy

Treatment of childhood ovarian stromal tumors

Treatment of newly diagnosed ovarian stromal tumors, including juvenile granulosa cell tumors and Sertoli-Leydig cell tumors, in children may include:

• surgery to remove one ovary and one fallopian tube for early cancer
• surgery followed by chemotherapy for advanced cancer
• chemotherapy for cancer that has recurred (come back)

Treatment of childhood small cell carcinoma of the ovary

Treatment of newly diagnosed small cell carcinoma of the ovary in children may include:

• surgery followed by chemotherapy and high-dose chemotherapy with stem cell rescue
• targeted therapy (tazemetostat)

Treatment of recurrent ovarian cancer

Treatment of recurrent ovarian cancer in children may include a clinical trial of targeted therapy.

To learn more about clinical trials, see the section on Types of treatment.

About PDQ

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 Spanish.

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Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of childhood ovarian cancer. 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.

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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.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

Clinical Trial Information

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.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Ovarian Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/ovarian/patient/child-ovarian-treatment-pdq. Accessed <MM/DD/YYYY>.

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