Ovarian Cancer

Ovaries are two round, walnut sized organs in the female reproductive system that produce eggs during a woman’s reproductive years. Ovarian cancer occurs when abnormal cells in the ovaries or fallopian tubes grow and multiply out of control.

The type of cell where the cancer begins determines the type of ovarian cancer you have and helps your doctor determine which treatments are best for you. Ovarian cancer types include:

• Epithelial ovarian cancer: This type is the most common. It includes several subtypes, including serous carcinoma and mucinous carcinoma.
• Stromal tumors: These rare tumors are usually diagnosed at an earlier stage than other ovarian cancers.
• Germ cell tumors: These rare ovarian cancers tend to occur at a younger age.

In the United States, an estimated 19,700 women will receive an ovarian cancer diagnosis each year. While the 11^th most common cancer among women, ovarian cancer is the fifth leading cause of cancer-related death among women. A woman’s risk of developing ovarian cancer during her lifetime is about 1 in 78. This cancer is slightly more common in Native American and white populations than in people who are Black, Hispanic, or Asian. In addition, people of Ashkenazi Jewish descent are more likely to have a BRCA gene mutation, which places them at higher risk for breast and ovarian cancers.

 

Signs & Risk Factors

Symptoms of these cancers can include:

• Pelvic or abdominal pain, discomfort or bloating.
• Changes in eating habits, getting full easily or losing your appetite.
• More frequent urination or urgency.
• Bowel changes such as constipation or diarrhea.
• Vaginal discharge or abnormal bleeding, especially if bleeding occurs outside of a normal menstrual cycle or after menopause.
• Swollen abdomen or back pain.

Risk Factors can include:

• Age: most cases occur over 60.
• Family history: blood relatives who have been diagnosed with ovarian cancer.
• Endometriosis: a disorder in which tissue similar to the lining of the uterus actually grows outside the uterus.
• Inherited gene changes: such as Lynch syndrome and genes BRCA1, BRCA2, BRIP1, RAD51C and RAD51D.
• Obesity: some hormones can be changed to estrogen by fat tissue. The higher the amount of fat tissue, the greater the effect on estrogen levels.
• Long menstruation span: if your period started before age 12 or if menopause occurs after age 50, your uterus has been exposed to estrogen for a longer span of time. However, the number of years menstruating may be more important than your age when periods started and ended.
• Never been pregnant: women who have never been pregnant or had difficulty trying to conceive.
• Hormone replacement therapy (HRT): receiving hormone replacement therapy after menopause.

 

If your physician suspects you may have ovarian cancer after a pelvic exam and imaging, they may recommend additional exams and tests to confirm your diagnosis. This may include a biopsy.

Once you have received your diagnosis, a team of qualified cancer care experts will help you through the treatment process. Your ovarian cancer care team may include a gynecologic oncologist, a radiation oncologist, and a medical oncologist.

• A gynecologic oncologist specializes in cancers of the female reproductive Your gynecologic oncologist may perform surgery to treat your cancer but can also prescribe chemotherapy or other medicines.
• A medical oncologist is a physician who specializes in treating cancer with medicine, like chemotherapy, targeted drug therapy, or immunotherapy.
• A radiation oncologist specializes in treating cancer with radiation This treatment uses high-energy rays to eliminate cancer cells.

Your care team may also include other clinical professionals, such as oncology nurses, social workers, pharmacists, genetic counselors, and dietitians. These clinicians all work together to develop the treatment path that is right for you.

Treatment for ovarian cancer is different for each patient. Your team will work with you to develop a plan tailored to your cancer and your goals for your health. When you meet with your cancer care team, ask any questions you feel will better help you understand your situation and your options. Writing down your questions before your appointment and bringing something to take notes with may be helpful.

Here are a few questions that may help you gain a better understanding of your options:

• What is the stage and grade of my ovarian cancer, and what does that mean for my treatment options?
• What are the risks and side effects of my treatment options? Are these side effects treatable?
• Is the goal of this treatment to eliminate my cancer, manage my symptoms, or both?
• Will treatment affect my ability to become pregnant in the future?
• How will this treatment affect my daily life and normal activities?
• If my cancer is eliminated, what is the chance of recurrence? If my cancer does return, what would our next steps be?

 

Ovarian Cancer Staging

Once you have been diagnosed with ovarian cancer, your physician will determine the stage of your cancer to help guide your treatment plan. To do this, your physician will look at the extent of the primary tumor, any spread to nearby lymph nodes, and whether the cancer has spread to other parts of the body.

Ovarian cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) staging system. The stage of the cancer is determined by examining tissue removed by surgery. If surgery cannot be done right away, staging will be based on the results of a physical exam, biopsy, and imaging tests done before surgery.

Stage I

Ovarian cancers in stage I are located in one or both ovaries.

• Stage IA cancers are confined to one ovary and have no tumors on the external surface of the
• Stage IB cancers are in both ovaries but have no tumors on the external surface of the
• Stage IC cancers can be in one or both ovaries but do have tumors located on the external surface of the ovaries.

Stage II

Cancer in this stage has spread beyond the ovaries to the uterus, fallopian tubes, or other nearby organs. It has not spread to the lymph nodes or distant parts of the body.

• Stage IIA cancers have spread to the uterus, the fallopian tubes, or
• Stage IIB cancers have spread to other nearby organs in the pelvic

Stage III

Stage III ovarian cancer has spread to the lymph nodes or the abdominal lining but has not spread to distant parts of the body.

• Stage IIIA1 cancers are in the lymph nodes found at the back of the The areas of spread can be any size.
• Stage IIIA2 cancers have grown from the pelvis to the The cancer in the abdomen is small and can only be seen under a microscope. It may or may not have spread to the lymph nodes in the back of the abdomen.
• Stage IIIB cancers have spread to the abdomen and are visible but are smaller than two centimeters. The cancer may or may not have spread to the lymph nodes in the back of the
• Stage IIIC cancers have spread to the abdomen and are larger than two The cancer may or may not have spread to the lymph nodes in the back of the abdomen.

Stage IV

Stage IV describes cancers that have spread outside of the abdomen to distant parts of the body.

• Stage IVA cancers have spread to the fluid around the lungs but have not spread to other distant
• Stage IVB cancers have spread to the spleen, liver, lymph nodes outside of the abdomen, and/or other organs or tissues, including the lungs and bones.

 

Ovarian Cancer Treatment

Your cancer care team at Southern Cancer Center will work with you to develop a treatment plan that best fits your cancer and overall needs. The treatment your physician recommends may depend on a variety of factors, including the stage of your cancer, any potential side effects, and your personal preferences. It’s important to speak to your physician about your needs, goals for your health and lifestyle, and any other concerns you may have about treatment.

Surgery

Surgery is usually the main treatment for ovarian cancer. Because imaging cannot always detect the extent of ovarian cancer, minimally invasive surgery is often used during diagnosis to accurately stage the cancer. For some patients, surgery may be followed up with chemotherapy. There are several surgical options for ovarian cancer, and the type of surgery your physician recommends will depend on the stage of your cancer. Two or more procedures may be performed during the same surgery.

Types of surgery for ovarian cancer include:

• Salpingo-oophorectomy is a surgery that removes the ovaries and fallopian tubes. It may be possible to remove only one ovary and one fallopian tube if the cancer is isolated to one
• Hysterectomy is a surgery that removes the uterus and sometimes surrounding A partial hysterectomy removes just the uterus, while a total hysterectomy removes the uterus and the cervix.
• Omentectomy removes the thin layer of fatty tissue covering the
• Lymphadenectomy (lymph node dissection) removes lymph nodes in the pelvis or abdomen to see if the cancer has spread from the ovary.
• Debulking is a procedure used to remove as much of the tumor as

Chemotherapy

Chemotherapy uses anti-cancer drugs that travel through the bloodstream to reach cancer cells wherever they are in the body. Chemotherapy may be used to treat ovarian cancer after surgery. Usually, ovarian cancer is treated with a combination of two types of anti-cancer drugs that are given intravenously every three to four weeks in three to six cycles. If these drugs shrink or eliminate the cancer cells, but the cancer later returns, your physician may recommend additional rounds of chemotherapy using the same or different medications.

Radiation Therapy

Radiation therapy treats cancer by using high energy rays to target and eliminate cancer cells. Radiation therapy is not commonly used as a main treatment for ovarian cancer, but it may be used to treat ovarian cancer that has spread to other parts of the body.

The type of radiation therapy used to treat ovarian cancer is usually external beam radiation therapy. External beam radiation therapy uses a machine to deliver radiation to the area of the body affected by cancer. This procedure is painless and only lasts a few minutes, though set up for the treatment takes longer. Treatment is usually given five days a week over the course of several weeks.

Targeted Therapy

Targeted therapy uses medicine to target cancer cells and stop or slow their growth. These medicines target the proteins that cause ovarian cancer cells to grow and spread. These drugs may be used to treat ovarian cancer patients with a mutation in one of the BRCA genes or other genetic mutations. They may be used alongside other treatments, like chemotherapy. Some targeted therapies may be used as a maintenance treatment for advanced ovarian cancers in patients with or without a gene mutation.

Immunotherapy

Immunotherapy uses medicine to boost your immune system so it can recognize and target cancer cells. For example, the immunotherapy drug pembrolizumab (Keytruda®) can be used to treat certain types of ovarian cancer that have grown following chemotherapy.

 

It is important to feel confident in your diagnosis and the physician leading your treatment. The physicians at Southern Cancer Center provide second opinions for all types of cancer diagnoses and treatment plans. To schedule a second opinion, please call our office to make an appointment with one of our medical oncologists.