Dear Dr. Gott: My daughter has recently been diagnosed with ovarian cancer. She was so shocked when her doctor told her the news that she was unable to understand completely what he told her. She's frightened, confused and would really like your help.

Reply: I can give only a general answer because you do not mention specifics in your brief note.

According to the American Cancer Society, ovarian cancer ranks fifth in cancer deaths among women. It is estimated about 20,000 new cases will be diagnosed this year, and about 15,000 ovarian cancer patients die each year.

Ovaries are the main source of oestrogen and progesterone, the two main female hormones. There are three kinds of tissue in the ovaries: the germ cells, which produce eggs; the stromal cells, which produce most of the female hormones; and the epithelial cells, which cover the ovary.

Tumours that develop and stay within the ovaries are often benign (harmless). However, malignant tumors can also start in the ovaries and spread quickly to other organs such as the uterus, lymph nodes and other parts of the body.

Benign tumours can usually be treated successfully by removing the part of the ovary that contains the tumour or the whole ovary.

Malignant tumours ovarian are usually treated be removing the affected ovary or ovaries and any surrounding tissues the cancer has spread to, such as the fallopian tubes, uterus and lymph glands.

Radiation and/or chemotherapy are also advised because of the risk of missed cancer cells that can grow and continue to spread.

Most ovarian cancers start in the epithelial cells. Called epithelial ovarian carcinomas, these account for 85 percent to 90 percent of all ovarian cancers. Benign tumours and tumours of low malignant potential have a much better prognosis, but, if caught early, most ovarian cancers can be treated and even cured.

Symptoms include abdominal pressure or fullness, urinary urgency, pelvic pain or discomfort, a change in bowel habits, including constipation and diarrhoea, weight loss or gain, an increase in abdominal girth and low-back pain.

Risk factors include difficulty conceiving, inherited gene mutation, a family history of ovarian cancer and obesity during childhood.

There are two tests used routinely. The first is a transvaginal ultrasound, which gives better images than the usual transabdominal ultrasound.

CA-125 is a marker for cancer in women. Serum concentrations are not elevated in up to 50 percent of women with early disease and can be elevated in numerous other conditions.

Because ovarian cancer is so difficult to detect in its early stages, only about one-fifth of the cancers are found before the tumour has spread beyond the ovaries.

Unfortunately, in most cases, the disease has spread before it is diagnosed.

Early-stage epithelial ovarian cancer is potentially curable, with survival rates up to 90 percent. The key is early detection.

Help your daughter prepare a list of questions for her physician, including recommended treatment and an outlook for the future.

Return to him and make sure all questions are answered to her satisfaction.