Ovarian Cancer

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Overview

Women have two ovaries, one on each side of the uterus. The ovaries produce eggs as well as the female sex hormones estrogen and progesterone. Ovarian cancer is a disease in which normal ovarian cells begin to grow in an uncontrolled, abnormal manner and produce tumors in one or both ovaries.

According to the American Cancer Society, ovarian cancer ranks fifth in cancer deaths among women. It’s estimated that about 20,000 women in the United States will develop ovarian cancer this year. About 15,000 deaths from ovarian cancer will occur in American women during that same time frame.

The chances of surviving ovarian cancer are better if the cancer is found early. But because the disease is difficult to detect in its early stage, only about 20 percent of ovarian cancers are found before tumor growth has spread into adjacent tissues and organs beyond the ovaries. Most of the time, the disease has already advanced before it’s diagnosed.

Until recently, doctors thought that early-stage ovarian cancer rarely produced any symptoms. But new evidence has shown that most women may have signs and symptoms even in the early stages of the disease. Being aware of them may lead to earlier detection.

Symptoms

Symptoms of ovarian cancer are nonspecific and mimic those of many other more common conditions, including digestive and bladder disorders. It isn’t unusual for a woman with ovarian cancer to be diagnosed with another condition before finally learning she has cancer. The key seems to be persistent or worsening signs and symptoms. With most digestive disorders, symptoms tend to come and go, or they occur in certain situations or after eating certain foods. With ovarian cancer, there’s typically little fluctuation — symptoms are constant and gradually worsen.

Recent studies have shown that women with ovarian cancer are more likely than other women to consistently experience the following symptoms:

  • Abdominal pressure, fullness, swelling or bloating
  • Urinary urgency
  • Pelvic discomfort or pain

Additional signs and symptoms that women with ovarian cancer may experience include:

  • Persistent indigestion, gas or nausea
  • Unexplained changes in bowel habits, including diarrhea or constipation
  • Changes in bladder habits, including a frequent need to urinate Loss of appetite
  • Unexplained weight loss or gain Increased abdominal girth or clothes fitting tighter around the waist
  • Pain during intercourse (dyspareunia)
  • A persistent lack of energy
  • Low back pain

Doctors can usually diagnose ovarian cancer within three months of women first noticing symptoms, but sometimes it may take six months or longer before a diagnosis can be made.

Screening

No standardized screening test exists to reliably detect ovarian cancer. Researchers haven’t yet found a screening tool that’s sensitive enough to detect ovarian cancer in its early stages and specific enough to distinguish ovarian cancer from other, noncancerous conditions. Doctors don’t recommend routine screening for women at average risk of ovarian cancer.

If a woman is at high risk of ovarian cancer, she needs to have a careful discussion with her doctor about the risks and benefits of undergoing screening tests.

Diagnosis

If a doctor suspects that symptoms suggest the presence of ovarian cancer, he or she may recommend one or more of the following tests:

Pelvic examination. A doctor examines the vagina, uterus, rectum and pelvis, including the ovaries, for masses or growths. If the patient has had her uterus removed (hysterectomy) but still has her ovaries, she should continue getting regular pelvic exams.

Ultrasound. Pelvic ultrasound provides a safe, noninvasive way to evaluate the size, shape and configuration of the ovaries. Ultrasound can also detect fluid in the abdominal cavity (ascites), a possible sign of ovarian cancer. Because ascites develops in many conditions other than ovarian cancer, however, its presence necessitates more testing.

Other diagnostic tests may include computerized tomography (CT) and magnetic resonance imaging (MRI), which both provide detailed, cross-sectional images of the inside of the body. A doctor also may order a chest X-ray to determine if cancer has spread to the lungs.

If the above tests suggest ovarian cancer, an operation will be needed to confirm the diagnosis. In a surgical procedure called laparotomy, a gynecologic oncologist makes an incision in the abdomen and explores the abdominal cavity to determine whether cancer is present. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist.

In certain cases, a less invasive surgical procedure called laparoscopy may be used. Laparoscopy requires only a couple of small incisions. This procedure may be used if a surgeon wants to remove a tissue mass to determine whether it’s cancerous before proceeding with a more invasive operation.

If ovarian cancer is confirmed, the surgeon and pathologist identify the type of tumor and determine whether the cancer has spread. This will help determine the stage of the disease. The surgeon may then need to extend the incision so that he or she can perform a more extensive operation to remove as much of the cancer as possible. It is important that this type of surgery be performed by a doctor specifically trained to treat gynecologic cancers.

Stages of ovarian cancer

Ovarian cancer is classified in stages I through IV, with stage I being the earliest and stage IV, the most advanced. Staging is determined at the time of surgical evaluation of the disease:
Stage I. Ovarian cancer is confined to one or both ovaries.
Stage II. Ovarian cancer has spread to other locations in the pelvis such as the uterus or fallopian tubes.
Stage III. Ovarian cancer has spread to the lining of the abdomen or to the lymph nodes within the abdomen. This is the most common stage of disease identified at the time of diagnosis.
Stage IV. Ovarian cancer has spread to organs beyond the abdomen.

Treatment

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Surgery

If a tumor is discovered early and the patient would like to preserve the option to have children, the surgeon may remove only the involved ovary and its fallopian tube.

The vast majority of women with ovarian cancer require a more extensive operation that includes removing both ovaries, fallopian tubes, and the uterus as well as nearby lymph nodes and a fold of fatty abdominal tissue known as the omentum, where ovarian cancer often spreads.

During this procedure, a surgeon also removes as much cancer as possible from the abdomen. This may involve removing part of the intestines.

In addition, a surgeon will take samples of tissue and fluid from the abdomen to examine for cancer cells. This evaluation is critical in identifying the stage of the disease and determining if additional therapy is needed.

Chemotherapy

After surgery, most women will likely be treated with chemotherapy — drugs designed to kill any remaining cancer cells. The initial regimen for ovarian cancer includes the combination of carboplatin (Paraplatin) and paclitaxel (Taxol) injected into the bloodstream.

A more intensive regimen has recently been shown to improve survival in women with advanced ovarian cancer by combining standard intravenous chemotherapy with chemotherapy injected directly into the abdominal cavity through a catheter placed at the time of the initial operation. This intra-abdominal infusion exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.

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