Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Nell Suby

Nell Suby, MD

Gyn Oncology

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Sacramento Medical Center
Appt/Advice: 916-614-4055

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Most tumors in the ovaries are noncancerous and don’t spread outside the ovary. A cancerous (malignant) tumor in an ovary can damage it and nearby tissues. If the cancer spreads (metastasizes), it can damage other parts of the body.

Women have 2 ovaries, 1 on each side of the womb (uterus). These small, almond-shaped glands:

  • Make and release eggs (ova) during women’s childbearing years.
  • Are the main source of the hormones estrogen and progesterone.
  • Stop releasing eggs and decrease hormone production during menopause.

Most women who develop ovarian cancer have no risk factors. Women who inherited certain genes or are obese can be at higher risk for ovarian cancer.

Your risk may be lower if you have:

  • Used birth control for several years.
  • Been pregnant.
  • Breastfed.
  • Had a tubal ligation (“tubes tied”).
  • Had your uterus or ovaries removed.

Treatment options for ovarian cancer include surgery and chemotherapy.

Additional References:


Depending on where ovarian cancer starts, the tumors are classified as one of three types:

  • Epithelial tumors form in the cells on the surface of the ovary (the epithelium).This is the most common form of ovarian cancer, making up 85 to 90 percent of cases. It is more likely to develop after menopause.
  • Germ cell tumors begin in the cells that produce the eggs. This is a rare cancer. It occurs most often in women younger than age 30.
  • Stromal tumors start in the connective tissue cells. These tissues hold the ovary together and also produce the female hormones.

Risk Factors

Your risk of developing ovarian cancer depends on certain factors, including:

Family history.

  • Your risk is increased if your mother, daughter, or sister had ovarian cancer.
  • The increase in risk is small if only one family member had it, and she was older than 60 when diagnosed. 


  • If you inherited abnormalities (mutations) in the BRCA1 or BRCA2 genes, or Lynch syndrome genes, you are at higher risk for ovarian and breast cancer.
  • If genetic testing shows you’ve inherited these genes, ask your Ob/Gyn practitioner about ways to reduce your risk. 

Obesity. This raises both the risk of developing ovarian cancer and of dying from it. 

Estrogen use. Some studies link using estrogen (hormone therapy) for many years after menopause with increased risk. More research is needed to confirm this.


Ovarian cancer symptoms are often vague. Some are similar to symptoms of other, less serious conditions. Symptoms include:

  • Pelvic or abdominal pain or discomfort.
  • Bloating or abdominal swelling.
  • Difficulty eating or feeling full quickly.
  • Having to urinate urgently or frequently.

Many women have these symptoms from time to time. If they last a few days or less, they are usually nothing to worry about.

Be sure to contact us if you have one or more symptoms almost every day for longer than 4 to 6 weeks. 


There is no approved screening test for ovarian cancer.

If women in your family have had ovarian or breast cancer, talk with a genetic counselor about whether genetic testing is right for you. A blood test would be used to check for abnormalities (mutations) of the BRCA1 gene, BRCA2 gene, or Lynch syndrome genes. 

Women with high genetic risk for ovarian cancer may decide to:

  • Have both ovaries and fallopian tubes removed to reduce their risk of cancer, or
  • Take a “watch and wait” approach (no immediate treatment). These women should have regular ultrasound exams or CA-125 (cancer antigen 125) blood tests to check for signs of cancer. 

Often, women who choose to “watch and wait” are younger and may want to have children someday. “Watching and waiting” is riskier than having the ovaries surgically removed. Women can get ovarian cancer even though they are checked regularly.


If you have symptoms that concern you, schedule a checkup. Your doctor will ask about your symptoms and medical history and do a physical exam.

One or more tests may be ordered to help decide whether you need surgery:

  • CA-125 blood test. Most women with ovarian cancer have above-normal levels of a protein called CA-125. This test is not always reliable. Conditions other than cancer can cause high CA-125 levels.
  • Pelvic ultrasound. An ultrasound device is placed on your abdomen and/or inside your vagina to check for a mass in the ovary.
  • CT (computed tomography) scan. A scanner linked to a computer creates a detailed series of X-ray images.
  • Biopsy. We may use a method called interventional radiology to remove a small amount of tissue. Or we may remove fluid from your abdomen (paracentesis). A laboratory checks the tissue or fluid for cancer.


If ovarian cancer is found, we will determine its stage. This is based on how much the cancer has spread. Knowing the cancer’s stage is important for creating the best treatment plan for you.

Stage I means the cancer is contained in the ovaries. Cancer that has spread (metastasized) to other parts of the body is classified as stage II, III, or IV, depending on the degree of spread.


After we have confirmed the type and stage of the cancer, we’ll talk with you about treatment options. Surgery and chemotherapy are the most common treatments. 

Together we’ll make a plan that is right for you.

Additional References:

Your Care with Me

If you suspect that you might have ovarian cancer, your first contact will typically be with your personal gynecologist, who will evaluate your health and symptoms. If specialty care is needed, your personal gynecologist will place a referral for an appointment in my department.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

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If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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