Ovarian cancer (which includes fallopian tube and primary peritoneal cancer) is the most deadly cancer of the female reproductive system. For years, ovarian cancer was known as “the silent killer” because early symptoms are so vague and non-specific that ovarian cancer was usually advanced before it was properly diagnosed.
But research has revealed a cluster of symptoms common to ovarian cancer, and women are encouraged to contact a gynecologic oncologist if they notice any of these symptoms persisting over time. A study by the National Institutes of Health reports that women with ovarian cancer fare better when treated by gynecologic oncologists.
While most cases of ovarian cancer occur in older women, young women are more likely to develop malignant germ cell tumors, a rare form of ovarian cancer.
Symptoms and Diagnosis
The ovaries are two tiny, almond-shaped organs that sit on either side of the uterus. Before menopause, the ovary releases an egg for possible fertilization each month. The ovaries also manufacture estrogen, a female sex hormone.
Because the ovaries are so small and buried deep within the body, the early symptoms of ovarian cancer occur in the abdominal area, leading many general physicians to initially suspect a gastrointestinal or bladder ailment. Early symptoms may include:
- Persistent abdominal bloating
- Feeling full only a few bites into a meal
- Nausea or vomiting
- Changes in bowel habits, especially constipation
- Abdominal pain or pressure
- Sharp pelvic pain
- Distended abdomen
If ovarian cancer is suspected, an ultrasound or computed tomography (CT) scan and blood work may be ordered. Biopsies are not usually taken until the time of surgery.
Women with a family history of breast or ovarian cancer have an increased risk of ovarian cancer. Our Cancer Genetics Screening Program can help high-risk women accurately assess their risk and determine appropriate prevention strategies.
The Gynecologic Cancer Program is a team of gynecologic oncologists, radiation oncologists, radiologists and pathologists who specialize in gynecologic cancers. This team constructs a treatment plan based on your symptoms and health status. Surgery is the mainstay of ovarian cancer treatment, but chemotherapy may occasionally be ordered prior to surgery.
Ovarian cancer surgery has two main goals: to determine the extent of the cancer and to remove as much cancer as possible. A gynecologic oncologist will remove and examine the uterus, fallopian tubes, ovaries, lymph nodes and some tissue from the inside of the abdomen. A specially trained pathologist then examines the organs and tissue for microscopic disease. This step is crucial because ovarian cancer is frequently found in other organs, even though it appears confined to the ovaries. Appropriate surgical staging sets the stage for proper treatment.
The gynecologic oncologist also performs “surgical debulking,” which is the physical removal of all tumors greater than a centimeter in size. According to the National Institutes of Health, a woman’s chance of survival is substantially increased when a gynecologic oncologist performs her ovarian cancer operation.
Intravenous (IV) chemotherapy is most often given in conjunction with intraperitoneal (IP) chemotherapy. For some women, treatment with both forms of chemotherapy can lead to significantly improved outcomes.
IP chemotherapy is the instillation of anti-cancer drugs directly into the abdominal cavity. The idea is that the drugs bathe the inside of the abdomen, the site of ovarian cancer, killing as many cancer cells as possible while sparing the rest of the body. IP chemotherapy takes place in the outpatient setting, and no general anesthesia is required. The procedure requires the patient’s co-operation (patients must alternate positions during treatment), and treatment takes place over several sessions.
Our gynecologic oncologists have extensive experience with IP chemotherapy. They help patients select the best chemotherapy approach based on their cancer and their specific situation.
Some women with ovarian cancer may benefit from HIPEC, a surgical procedure that combines surgical debulking with IP chemotherapy. During this procedure, surgeons remove as much visible cancer as possible, and then circulate a heated chemotherapy solution throughout the abdominal cavity.
Physicians and researchers are currently evaluating HIPEC to determine how best to use it to treat ovarian cancer. This therapy may be appropriate in specific situations, such as for patients who have experienced several recurrences. A gynecologic oncologist is best suited to weigh this option against others and work with patients and their physicians to determine the most appropriate treatment plan.
Although not a first-line treatment for ovarian cancer, radiation therapy may be used for disease recurrence in select patients.
As part of an academic medical center, the Gynecologic Cancer Program offers its patients the opportunity to participate in clinical trials. Ovarian cancer patients who are eligible for a clinical trial may choose to try new cancer drugs or different combinations of existing treatments. Clinical trials are available for new cancers and recurrent disease.