Ovarian cancer usually occurs in post-menopausal women but can affect women of all ages. The most common type of ovarian cancer is epithelial ovarian cancer, meaning the tumor starts in the epithelial covering of the ovary. Younger women are more likely to develop ovarian germ cell tumors (which start in young cells similar to the eggs contained within the ovary), and older women may develop ovarian stromal cell tumors, which start in the supporting tissue (stroma) contained within the ovary. Each type of ovarian cancer requires a different type of treatment.
Ovarian Cancer Symptoms and Diagnosis
Unfortunately, many patients with ovarian cancer experience no early warning signs or symptoms. This is because the tumor may spread beyond the ovary to involve other areas within the pelvis and abdomen at a time when it is too small to be detected by pelvic examination. However, when ovarian cancer symptoms arise, they usually include pelvic pain or abdominal discomfort and bloating.
Ovarian cancer diagnosis
Once a pelvic mass is discovered, your physician may order special tests such as a pelvic ultrasound to further evaluate the mass. If the ultrasound confirms the possibility of an ovarian tumor, a surgical procedure (oftentimes an exploratory laparotomy) is often performed to remove the mass for examination by a pathologist. During the biopsy procedure, the surgeon may take small amounts of tissue from many different areas of the abdomen and pelvis (biopsies) in order to determine the exact locations of the tumor. This will help to determine your tumor stage and guide further treatment decisions.
Patients may be diagnosed with one of four different stages of ovarian cancer:
- Stage I - Tumor confined to the ovary or ovaries.
- Stage II - Tumor involving other sites in the pelvis.
- Stage III - Tumor involving the upper abdominal cavity or lymph nodes within the abdomen or pelvis.
- Stage IV - Tumor that has spread beyond the abdominal cavity, or involves the insides of organs such as the liver or spleen.
Approximately 30 percent of ovarian cancer patients will be diagnosed with stage I or II tumors, and 70 percent of ovarian cancer patients will have stages III or IV disease.
Ovarian Cancer Treatment
If the ovarian tumor removed during biopsy is malignant (cancerous), it may be necessary to perform removal of the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) and removal of the uterus (hysterectomy). If the tumor has extended beyond the ovary to involve other sites in the pelvis and abdomen, an attempt is made to remove as much of the tumor as possible (called "debulking"). This is done because patients who have only small amounts of tumor remaining tend to respond more favorably to post-operative treatments such as chemotherapy.
Most patients with epithelial ovarian cancer have tumors that cannot be completely removed by surgery alone. Even in situations where all of the obvious tumor has been removed, microscopic areas of tumor often remain and can grow back again if not treated. That is why the majority of patients with ovarian cancer will require some form of chemotherapy after surgery in an attempt to destroy any remaining tumor cells.
More than 70 percent of ovarian cancer patients who receive chemotherapy will experience a beneficial reduction in the size of residual tumor, oftentimes associated with a drop in the level of a blood test known as CA-125. CA-125 is a substance made by ovarian cancer cells, and its blood level drops as the tumor is destroyed. Unfortunately, many (but not all) patients experience regrowth of their tumor at some point in the future. At that time, retreatment with additional chemotherapy is often required, although obtaining good control of the tumor may be more difficult. This is due to the fact that recurrent tumors develop a certain amount of resistance to the effects of chemotherapy (a condition known as "drug resistance").
Several options are available for managing recurrent ovarian cancer, including retreatment with taxanes or platinum agents, or the use of different agents such as tamoxifen, topotecan, Doxil™, or etoposide. Your oncologist is in the best position to decide which of these agents would be most appropriate for your situation.
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