Whether in their childbearing years or later, ovarian cancer is always a scary diagnosis. We understand, and our collaborative team is here to guide you through treatment for ovarian cancer.
Ovarian cancer can start anywhere in the ovarian tissue, leading to three types of ovarian cancer:
- Epithelial carcinoma – Tumors in the outermost layer that covers the ovary; makes up nearly 90% of ovarian cancers
- Germ cell tumors – Tumors in the cells that produce eggs
- Stromal tumors – Tumors in the connective tissue that supports the ovary
Ovarian cancer can spread directly to nearby structures in the abdominal cavity, to adjacent lymph nodes or blood vessels and to lymph nodes in other parts of the body, lungs, liver and bones.
Much of the time, there are no symptoms of ovarian cancer until it is advanced, and many of these symptoms can be caused by other, less serious conditions. Be sure to talk to your doctor about any symptoms to get the care you need—early detection and treatment improves outcomes for cancer and other health conditions.
- Abdominal discomfort and pain
- Gas, indigestions, pressure, bloating or cramps
- Nausea, diarrhea or constipation
- Frequent or urgent urination
- Feeling of fullness after eating only a light meal
- Abnormal vaginal bleeding
- Loss of appetite
- Unexplained weight loss
- Abdominal swelling
- Sensation of a mass in the abdomen or in lymph nodes
- Difficulty breathing from fluid build up in lungs
A risk factor is anything that increases your chances of developing ovarian cancer. Although patients can develop ovarian cancer even without any of these risk factors, having them increases the likelihood of developing ovarian cancer, and you can ask your doctor how you might decrease your risk. Risk factors for ovarian cancer include:
- Being over 60 years old
- History of breast, uterine, colon or rectal cancers
- Having never been pregnant
- Early onset of first period
- Later than typical menopause
- Use of hormone replacement therapy
- Polycystic ovary syndrome (PCOS)
- Family history of ovarian cancer
In some cases, breastfeeding recues the risk of breast cancer. For women at high risk because of family history (including a first-degree relative like a mother, sister or daughter with ovarian cancer), genetic testing can help you and your doctor determine the right steps to take.
To determine whether or not you have ovarian cancer, your doctor will start by asking about your symptoms, medical history and family history, as well as completing a pelvic exam, including manual evaluation of the vagina, cervix, uterus, fallopian tubes and ovaries. If your doctor suspects ovarian cancer, you’ll be referred to a doctor who specializes in gynecologic cancers.
There are a number of tests, scans and procedures that can be done to find abnormalities, confirm the presence of cancer and the determine the stage of an ovarian cancer, including:
- Blood tests – Certain substances, called tumor markers, are released in the blood when a tumor develops. Blood tests can measure these levels to determine if a patient has cancer, what stage the cancer is and if a treatment is working.
- Imaging tests – Tests can help assess ovaries and other organs for the presence and location of tumors. These tests include:
- CT scan
- PET scan
- Biopsy – Ovarian cancer diagnosis needs to be confirmed via biopsy, during which suspicious tissue is removed to be examined closely under a microscope. Biopsy options include:
- Surgical removal of the entire tumor
- Needle aspiration (an alternative method where a needle guided by imaging scanning is inserted through the abdominal walls to take a sample of tissue or fluids)
If ovarian cancer is confirmed, the tests outlined above can help determine the stage of cancer, and helps your care team determine your prognosis and the right treatment for you. Factors that play a role in staging include where the tumor is found, how far the original tumor has spread, whether lymph nodes are involved, if cancer has spread to other tissue and microscopic cellular details. Staging can also be completed via surgery, which can also include surgical removal of tumors, tissues or organs.
The stages of ovarian cancer range from 1-4, including:
- Stage 1A-Cancer is in ONE ovary OR fallopian tube.
- Stage 1B-Cancer is in BOTH ovaries OR fallopian tubes.
- Stage 1C-Cancer is found in ONE or BOTH ovaries OR fallopian tubes WITH:
- Cancer on the outside of ONE or BOTH ovaries OR fallopian tubes.
- OR The capsule surround the ovary has ruptured. This can occur before or during surgery.
- OR Cancer cells are in the fluid of the peritoneum and/or peritoneal cavity.
- Stage 2-Cancer is in ONE or BOTH ovaries OR fallopian tubes and has spread to nearby pelvic or abdominal organs.
- Stage 2A-Cancer has spread FROM the ovaries AND/OR fallopian tubes TO the uterus.
- Stage 2B-Cancer has spread TO nearby pelvic organs, including the bladder, rectum or colon.
- Stage 3-Cancer is in ONE or BOTH ovaries OR fallopian tubes WITH spread from the pelvis TO the abdomen AND/OR lymph nodes.
- Stage 3A-Cancer is in the lymph nodes in and around the back of the abdomen, but outside of the peritoneum OR cancer cells are found ON the peritoneal layer OR IN the pelvic lymph nodes.
- Stage 3B-Cancer is outside of the pelvis and in the peritoneum. Tumor is two centimeters (cm) or less. Cancer may be in the lymph nodes in and around the back of the abdomen, but outside of the peritoneum.
- Stage 3C-Cancer is outside of the pelvis and in the peritoneum. Tumor is more than two centimeters (cm). Cancer may be in the lymph nodes in and around the back of the abdomen, or ON the surface of abdominal organs like the liver or spleen.
- Stage 4A-Cancer is contained to the pelvis and abdomen, but cancer cells are in the pleural fluid that surround the lungs.
- Stage 4B-Cancer has spread to other parts of the body. The most common sites for metastatic ovarian cancer are the lymph nodes in other parts of the body, lungs, liver and bones.
If you need treatment for ovarian cancer, our collaborative team will work with you to develop an individualized treatment plan for your unique situation that takes into account the stage of your disease, your age, your general health and more.
If you are pregnant, think you may be pregnant or plan on having children in the future, make sure to share this information with your doctor so you’re aware of all of your options. Elements of treatment for ovarian cancer include:
Surgery is the main treatment for ovarian cancer in all stages. The goal of surgery is to remove the cancerous tumor and preserve as much ovarian function as possible. Your doctor might choose to do chemotherapy before surgery to shrink the tumor or after surgery to kill any remaining cancer cells. Surgical procedures may include one or more of the following:
- Exploratory laparatomy - used during staging with incisions made in the abdominal wall to gain access to the pelvic and abdominal cavities
- Abdominal hysterectomy – complete removal of the uterus
- Bilateral salpingo-oopherectomy – removal of both ovaries and fallopian tubes
- Omentectomy – removal of the omentum (a large, apron-like structure that covers the organs in the abdominal cavity)
- Debulking – removal of as many tumors as possible when ovarian cancer has spread to other organs in the pelvis or abdomen
Across surgeries, lymph nodes and other suspicious tissues are removed and examined under a microscope for the presence of cancer cells.
Chemotherapy uses drugs to kill ovarian cancer cells. If you receive chemotherapy, you will be seen by a medical oncologist, who will determine how many cycles of chemotherapy you need and what combination of drugs will work best.
How it works
Chemotherapy can be used before surgery (to shrink the tumor and decrease the amount of tissue that needs to be removed), after surgery (to kill any remaining cancer and decrease the risk of recurrence) or to help relieve symptoms of metastatic cancer. Chemotherapy is usually given by IV, but some drugs can be given by mouth.
Chemotherapy is usually delivered in a series of 3-6 cycles over a set period of time. Your medical oncologist will determine how many cycles are needed and what drugs will work best.
Although chemotherapy targets cancer cells, the drugs used can also affect healthy cells. Possible side effects of chemotherapy include:
- Nausea and vomiting
- Loss of appetite
- Memory or cognitive problems
- Low blood cell counts that can lead to infection or bleeding
- Premature menopause
These side effects are usually short-term, and subside after treatment is finished. Your team can help you manage the side effects through medication, lifestyle changes and alternative treatments, or adjust your regimen.
Radiation Therapy Treatment
Radiation therapy uses high energy x-rays to destroy ovarian cancer cells and shrink tumors. There are a number of types of radiation that are used for ovarian cancer, including:
External beam radiation therapyUsing radiation produced by a machine outside the body, short bursts of x-rays are directed at the tumor to affect as much cancer as possible. Generally, this process takes only a few minutes each time, repeated five days a week for 3-5 weeks.
Intraperitoneal radiation therapyA catheter delivers radioactive material directly into abdominal cavity, coating the cancer cells in the abdominal cavity. This can be an option for women whose cancer is not responsive to chemotherapy.
Whole brain radiation therapyCraniospinal radiation treats the whole brain and spinal cord in cases where ovarian cancer has spread to the meninges (layers of tissue that cover the brain and spinal cord) or cerebrospinal fluid.
The side effects of radiation depend on where the treatment is directed. Side effects can include:
- Vaginal irritation
- Vaginal dryness
- Bladder irritation
- Bowel obstruction
- Dry, irritated skin
These side effects are usually short-term and subside after treatment is finished. Your team can help you manage the side effects through medication, lifestyle changes and alternative treatments.
Some of the following therapies are still in experimental stages and may be available by participating in a clinical trial. Talk to your doctor and care team to see if these therapies might be beneficial for you and your situation:
- Targeted Therapy - Targeted therapy uses specific medications to seek out and destroy ovarian cancer cells and the systems that support them.
- Hormonal Therapy - Some ovarian cancers are sensitive to hormones. Hormone therapy works by preventing hormones from binding to cancer cells.
- Immunotherapy - Immunotherapy works by using medication to boost your body’s own immune system to recognize and kill cancer cells.
Most of the treatments for ovarian cancer can affect fertility. If you wish to have children, talk with your doctor and your family about options before treatment. There are many options available, including harvesting and preserving eggs for the future or organ-sparing surgery. Organ-sparing surgery can preserve an ovary, a fallopian tube and the uterus if ovarian cancer is in its earliest stages.
Fertility preservation may not work for everyone. Harvesting an egg may cause cancer cells to spread to nearby structures and organ-sparing surgery may not be an option with advanced stage cancer.