Drug Uses

Evista is a prescription medicine used by women after menopause to treat or prevent a condition called osteoporosis. You should take calcium and vitamin D along with Evista if you do not get enough calcium and vitamin D in your diet.

How Taken

The recommended dosage is one 60-mg Evista tablet daily, which may be administered any time of day without regard to meals.

Warnings/Precautions

Before taking this medication, tell your doctor if you have a history of blood clots; stroke; cancer; increased triglycerides (a type of fat in the blood); or liver disease. You may not be able to take Evista, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Evista is in the FDA pregnancy category X. This means that Evista is known to cause birth defects in an unborn baby. Do not take Evista if you are pregnant or if you could become pregnant during treatment. It is not known whether Evista passes into breast milk. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

Missed Dose

Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of this medication.

Possible Side Effects

An infrequent but serious side effect of taking Evista is the development of blood clots in the veins. These blood clots can stop blood flow and cause serious medical problems, disability or death. Call your doctor right away if you have or have had any of the following signs of blood clots in the legs, lungs or eyes: leg pain or a feeling of warmth in the calves, swelling of the legs, hands or feet, sudden chest pain, shortness of breath or coughing up blood, sudden change in your vision, such as loss of vision or blurred vision. Most of the side effects of Evista are mild and usually do not cause women to stop taking Evista. The most common side effects of Evista are hot flashes and leg cramps. Hot flashes are more common during the first 6 months after starting treatment. If you have any problems or questions that concern you while taking Evista, ask your doctor or pharmacist for more information.

Storage

Store at controlled room temperature, 20o to 25oC (68o to 77oF); allows excursions between 15o and 30oC (59o and 86oF).

Overdose

Incidents of overdose in humans have not been reported. There is no specific antidote for Evista.

More Information

Before having any surgery, tell your doctor that you are taking Evista. Treatment with Evista may need to be stopped temporarily if you require an extended period of bed rest. Avoid sitting still for long periods of time during travel while taking Evista. Alcohol and cigarette smoking may cause increased bone loss. Discuss with your doctor the use of these products.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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Ovarian Cancer Ovarian cancer usually happens in women over age 50, but it can also affect younger women. Ovarian cancer causes more deaths than any other cancer of the female reproductive system. The sooner ovarian cancer is found and treated, the better your 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 and hard to treat. Symptoms may include: * Heavy feeling in pelvis * Pain in lower abdomen * Bleeding from the vagina * Weight gain or loss * Abnormal periods * Unexplained back pain that gets worse * Gas, nausea, vomiting, or loss of appetite Treatment is usually surgery followed by treatment with medicines called chemotherapy. Types of Ovarian Tumors Many types of tumors can start growing in the ovaries. Some are benign (non-cancerous) and never spread beyond the ovary. Women with these types of tumors can be treated successfully by removing one ovary or the part of the ovary that contains the tumor. Other types of ovarian tumors are malignant (cancerous) and can spread to other parts of the body. Their treatment is more complex and is discussed later in this document. In general, ovarian tumors are named according to the kind of cells the tumor started from and whether the tumor is benign or cancerous. There are 3 main types of ovarian tumors: * Germ cell tumors start from the cells that produce the ova (eggs). * Stromal tumors start from connective tissue cells that hold the ovary together and produce the female hormones estrogen and progesterone. * Epithelial tumors start from the cells that cover the outer surface of the ovary. Epithelial Ovarian Tumors Benign epithelial ovarian tumors: Most epithelial ovarian tumors are benign, do not spread, and usually do not lead to serious illness. There are several types of benign epithelial tumors including serous adenomas, mucinous adenomas, and Brenner tumors. Tumors of low malignant potential: When looked at under the microscope, some ovarian epithelial tumors do not clearly appear to be cancerous. These are called tumors of low malignant potential (LMP tumors). They are also known as borderline epithelial ovarian cancer. These differ from typical ovarian cancers in that they do not grow into the supporting tissue of the ovary (called the ovarian stroma). Likewise, if they spread outside the ovary, for example, into the abdominal cavity, they do not usually grow into the lining of the abdomen. These cancers affect women at a younger age than the typical ovarian cancers. LMP tumors grow slowly and are also a less life-threatening disease than most ovarian cancers. Although they can be fatal, this is not common. Epithelial ovarian cancers: Cancerous epithelial tumors are called carcinomas. About 85% to 90% of ovarian cancers are epithelial ovarian carcinomas. Epithelial ovarian carcinoma cells have several features that can be seen under the microscope. These features are used to classify epithelial ovarian carcinomas into serous, mucinous, endometrioid, and clear cell types. The serous type is by far the most common. Undifferentiated epithelial ovarian carcinomas don't look like any of these 4 subtypes, and they also tend to grow and spread more quickly. Epithelial ovarian carcinomas are classified by cell type and are also given a grade and a stage. The grade is on a scale of 1, 2, or 3. Grade 1 epithelial ovarian carcinomas look more like normal tissue and tend to have a better prognosis (outlook). Grade 3 epithelial ovarian carcinomas look less like normal tissue and usually have a worse outlook. The tumor stage describes how far the tumor has spread from where it started in the ovary. Staging is explained in detail in a later section. Primary Peritoneal Carcinoma Primary peritoneal carcinoma is a cancer closely related to epithelial ovarian cancer. It is also sometimes called also called extra-ovarian (meaning outside the ovary) primary peritoneal carcinoma (EOPPC) or serous surface papillary carcinoma. It develops in cells from the peritoneum, which is the membrane that lines the walls and organs of the pelvis and abdomen. These cells are very similar to epithelial cells on the surface of the ovaries. Because EOPPC tends to spread along the surfaces of the pelvis and abdomen, it is often difficult to tell exactly where the cancer first started. Under a microscope, EOPPC looks just like epithelial ovarian cancer. Women who have had their ovaries removed can still develop this type of cancer. Symptoms of EOPPC are similar to those of ovarian cancer, including abdominal pain or bloating, nausea, vomiting, indigestion, and a change in bowel habits. Also, like ovarian cancer, EOPPC may cause an elevation in the amount of CA-125 in the blood. This is a tumor marker for ovarian cancer (discussed later in this document). Treatment for women with EOPPC usually includes surgery to remove as much of the cancer as possible, followed by chemotherapy like that given for ovarian cancer. Its outlook is similar to widespread ovarian cancer. Germ Cell Tumors About 5% of ovarian cancers are germ cell tumors. Germ cells are the cells that usually form the ova or eggs. There are several subtypes of germ cell tumors. Most germ cell tumors are benign, although some are cancerous and may be life threatening. The most common germ cell tumors are teratoma, dysgerminoma, endodermal sinus tumor, and choriocarcinoma. Teratoma: This germ cell tumor has a benign form called mature teratoma and a cancerous form called immature teratoma. The mature teratoma is by far the most common ovarian germ cell tumor and usually affects women of reproductive age (teens through forties). It is often called a dermoid cyst because its lining resembles skin. These tumors or cysts also contain a variety of other benign tissues that may resemble adult respiratory passages, bone, nervous tissue, teeth, and other tissues. The patient is cured by surgically removing the cyst. Immature teratomas occur in girls and young women, usually younger than 18. These are rare cancers that resemble embryonic or fetal tissues such as connective tissue, respiratory passages, and brain. Tumors that are not very immature (grade 1 immature teratoma) and have not spread beyond the ovary are cured by surgical removal of the ovary. When they have spread beyond the ovary and/or much of the tumor has a very immature appearance (grade 2 or 3 immature teratomas), chemotherapy is recommended in addition to surgical removal of the ovary. Dysgerminoma: This is the most common ovarian cancer of germ cells. However, it is a rare cancer. It usually affects women in their teens and twenties. Although dysgerminomas are considered malignant (cancerous), most do not grow or spread very rapidly. When they are limited to the ovary, more than 75% of patients are cured surgically removing the ovary, without any further treatment. Even when the tumor has spread further (or if it recurs, or comes back) surgery and/or chemotherapy is effective in controlling or curing the disease in about 90% of patients. Endodermal sinus tumor (yolk sac tumor) and choriocarcinoma: These very rare tumors typically affect girls and young women. They tend to grow and spread rapidly but are usually very sensitive to chemotherapy. Choriocarcinomas more commonly start in the placenta (during pregnancy) rather than in the ovary. Placental choriocarcinomas usually respond even more to chemotherapy than ovarian choriocarcinomas. Stromal Tumors More than half of stromal tumors are found in women over age 50, but some occur in young girls. Some, but not all, of these tumors produce female hormones or, less often, male hormones. They can cause vaginal bleeding to start again after menopause, or can cause menstrual periods and breast development in young girls. If male hormones are produced, the tumors can disrupt normal periods and cause facial and body hair to grow. Types of malignant (cancerous) stromal tumors include granulosa cell tumors, granulosa-theca tumors, and Sertoli-Leydig cell tumors, which are usually considered low-grade cancers. Thecomas and fibromas are benign stromal tumors. Ovarian Cysts An ovarian cyst is a collection of fluid inside an ovary. Many cysts are completely normal. These are called functional cysts and occur as a normal part of ovulation. The fluid will usually be absorbed and over a few months, the cyst will disappear without any treatment. If you develop a cyst, your doctor may want to check it again after a period of time to see if it has gotten smaller. If, however, the mass is large, occurs in childhood or after menopause, or does not go away, your doctor will usually recommend that you have more tests, since a small number of these cysts may be cancer. Benign cysts are treated by observation (follow-up with physical exams and imaging tests), medications, or surgical removal. Fallopian Tube Cancer This is an extremely rare cancer. It begins in the fallopian tube, The symptoms are similar to those in women with ovarian cancer, except that there may be more pelvic pain. Treatment and outlook is similar to that for ovarian cancer. There are no reliable statistics for this cancer because it is so rare.

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