Ovarian Cancers
The ovaries are the part of the female reproductive organs, which produce hormones (estrogen and progesterone) and egg cells every month during a woman’s reproductive cycle. The ovaries are located on either side of the uterus in the lower abdomen/pelvis and are approximately the size of almonds. In young thin women, the ovaries can usually be easily felt on physical examination. After going through menopause (the change of life), the ovaries usually shrink to about half their normal size.
Signs and symptoms:
- Some tumors that grow in the ovaries are benign, or noncancerous, and never spread beyond the ovary.
- Some younger women may develop cysts on the ovary, which can be felt on exam. A cyst is a small fluid filled growth that is rarely cancerous, especially in pre-menopausal women.
- Some cysts may be followed by ultrasound (U/S) and may go away on their own. Others will require surgical removal.
Statistics:
About one in 70 women, or 1.4%, will develop ovarian cancer. 70% of ovarian cancers are not diagnosed until the cancer has spread from the ovary to other parts of the body because the symptoms of early disease are vague and tend to mimic other medical problems. The average age of developing ovarian cancer is 61 years old.
About one in 70 women, or 1.4%, will develop ovarian cancer. 70% of ovarian cancers are not diagnosed until the cancer has spread from the ovary to other parts of the body because the symptoms of early disease are vague and tend to mimic other medical problems. The average age of developing ovarian cancer is 61 years old.
Pathology:
Ovarian carcinoma occurs when the cells in the ovary grow and divide uncontrollably. These cells accumulate and form tumors that may invade or destroy normal tissues. These cells can break away and spread (metastasize) to other organs in the abdomen to form new tumors or spread to other parts of the body through lymphatic system or blood stream. The most common type of ovarian cancer cell is epithelial.
Ovarian carcinoma occurs when the cells in the ovary grow and divide uncontrollably. These cells accumulate and form tumors that may invade or destroy normal tissues. These cells can break away and spread (metastasize) to other organs in the abdomen to form new tumors or spread to other parts of the body through lymphatic system or blood stream. The most common type of ovarian cancer cell is epithelial.
There are five major types of epithelial ovarian cancers:
- Serous
- Mucinous
- Endometrioid
- Undifferentiated
- Clear Cell
Epithelial ovarian cancers arise from cells in the ovary and are divided into grade according to how atypical the cell looks under the microscope.
Grade: what the cell looks like under the microscope; well-differentiated tumors have a better prognosis than poorly differentiated tumors.
- Grade 1 well-differentiated
- Grade 2 moderately-differentiated
- Grade 3 poorly-differentiated
Stage: There are four stages of ovarian cancer depending on where the disease has spread.
- Stage I Disease is limited to one or both ovaries
- Stage II Cancer has spread beyond the ovaries, but is limited to the surrounding pelvic organs.
- Stage III Cancer has spread beyond the ovary and pelvis to the upper abdominal cavity, excluding the liver or to the lymph nodes.
- Stage IV Cancer has metastasized or spread outside the ovary and abdomen, to the liver, lungs or other organs located outside of the abdominal area.
Low Malignant Potential Tumors of the Ovary, also known as Borderline tumors, are the most well differentiated types of ovarian cancers (Grade 0). They account for up to 15% of all epithelial carcinomas of the ovary.
Symptoms associated with ovarian cancer:
- Bloating (clothes don’t fit right)
- Vague abdominal discomfort or low back pain
- Gastrointestinal discomfort
- Unexplained fatigue
- Unexplained weight loss
- Loss of Appetite
- Early satiety (feel full quickly when eating)
- Urinary Frequency
- Diarrhea or Constipation
- Shortness of Breath
Diagnosis: The diagnosis of ovarian carcinoma is made by pathologic (laboratory) review of tissue under a microscope. Tests pre-operatively can help determine if surgery is needed. A careful pelvic exam is done on your visit with your doctor to feel the uterus, tubes/ovaries. An ultrasound can sometimes help identify a solid vs. cystic or simple vs. complex mass. A CT or PET scan may help determine the extent or spread of disease. A CA 125 tumor marker is a blood test that is elevated in eight out of ten women with advanced ovarian cancer but can be falsely elevated in benign conditions and, therefore, is not a good screening tool for ovarian cancer.
Surgery: Surgical exploration and appropriate staging procedures are required including removal of the ovaries, tubes and uterus along with removal of abnormal tissues which may include a section of bowel, appendix, omentum, and lymph nodes. Fluid within the abdomen may be removed and is called peritoneal washings or cytology to look for malignant cells. This process is called staging and is used to determine if the cancer has spread, which is important in treatment planning, and follow-up. In women with advanced cancer, removal of as much tumor as possible is the ultimate goal. Optimal tumor debulking is defined as leaving behind no tumor implant greater than 5mm. A colostomy may be necessary in some advanced cases of ovarian cancer.
2nd Look surgery: For those who have completed the recommended course of chemotherapy and have no evidence of disease (NED) by physical exam, CA 125 tumor marker, and CT scan, may wish to return to surgery for a laparoscopic 2nd Look. This surgery does not improve survival rates but is the most reliable way to determine whether any cancer remains after treatment. This consists of exploration of the abdomen with washings and multiple biopsies taken throughout the abdomen and pelvis. Typically, if the second-look procedure is negative, no further treatment is required. It is still a poor predictor of survival and as high as 50% of patients will still recur with cancer even if the second look surgery is negative.
In advanced recurrent cancer, surgery is sometimes required to remove the cancerous growth or relieve obstruction of the bowels.
Surgery: Surgical exploration and appropriate staging procedures are required including removal of the ovaries, tubes and uterus along with removal of abnormal tissues which may include a section of bowel, appendix, omentum, and lymph nodes. Fluid within the abdomen may be removed and is called peritoneal washings or cytology to look for malignant cells. This process is called staging and is used to determine if the cancer has spread, which is important in treatment planning, and follow-up. In women with advanced cancer, removal of as much tumor as possible is the ultimate goal. Optimal tumor debulking is defined as leaving behind no tumor implant greater than 5mm. A colostomy may be necessary in some advanced cases of ovarian cancer.
2nd Look surgery: For those who have completed the recommended course of chemotherapy and have no evidence of disease (NED) by physical exam, CA 125 tumor marker, and CT scan, may wish to return to surgery for a laparoscopic 2nd Look. This surgery does not improve survival rates but is the most reliable way to determine whether any cancer remains after treatment. This consists of exploration of the abdomen with washings and multiple biopsies taken throughout the abdomen and pelvis. Typically, if the second-look procedure is negative, no further treatment is required. It is still a poor predictor of survival and as high as 50% of patients will still recur with cancer even if the second look surgery is negative.
In advanced recurrent cancer, surgery is sometimes required to remove the cancerous growth or relieve obstruction of the bowels.
Treatment:
- For those who will need chemotherapy, the current first line therapy is Taxol® and platinum which is usually begun 2-4 weeks after surgery. This treatment can be given intravenous or in combination with intraperitoneal chemotherapy. A treatment cycle consists of one or two chemotherapy dayse every three weeks for six time over a total of 18 weeks.
- Upon completion of the initial course of chemotherapy, if there remains evidence of disease, a 2nd line therapy may be administered.
Recommended Followup Schedule: *Physical examination, CA 125 are recommended on the following schedule
- Every 3-4 months for the first 2 years
- Every 6 months for years 3-5
- Yearly thereafter
- Scans and X-rays at the discretion of the doctor