Ovarian cancer is the seventh-most common cancer among women in the United States. It most commonly affects women between the ages of 40 and 65, with most patients being over sixty at diagnosis. Unfortunately, about 68% of patients are diagnosed with advanced disease as the symptoms of early disease are vague and there is no screening test available.
Symptoms of Ovarian Cancer
· Pelvic or abdominal discomfort
· Difficulty eating or feeling full
· Increased abdominal size
· Change in bowel habits
· Urinary symptoms (urgency and frequency)
Occasionally, an abdominal mass is found on physical examination or radiological examination that leads to work up.
How Ovarian Cancer is Diagnosed
Initial imaging such as ultrasound or computed tomography (CT) may be suggestive, but surgical biopsy is needed to confirm the diagnosis. Usually, an exploratory surgery is done by a specialist, a gynecologic oncologist, to confirm the diagnosis and to remove as much tumor as possible. This is called “debulking” and it is an important first step in the treatment of ovarian cancer, as optimal “debulking” is thought to improve outcomes.
Prior to surgery, the doctor may check a blood test called CA-125. This is a protein tumor marker which is elevated in 80% of women with advanced ovarian cancer. This test can be useful not only to support a suspicion of cancer, but more importantly to assess response during treatment and follow-up.
Based on the findings of the surgery, and the extent of involvement of the cancer, it is staged according to the size, extent and location of the cancer. There are four stages, with stage IV being the most advanced and with the poorest prognosis:
· Stage IA and IB: Limited to one or both ovaries, and the capsule covering the ovaries has not been broken by the cancer's growth
· Stage IC: Cancer spreading through the capsule of the ovary
· Stage II: Cancer involves other pelvic organs (uterus, fallopian tubes)
· Stage III: Cancer is widespread in the abdomen and abdominal lymph nodes
· Stage IV: Cancer has spread to distant sites such as the liver or lungs
Patients with early stage have a good overall prognosis, with 5 year survival rates of about 90%. Unfortunately, as the disease becomes more widespread, the prognosis worsens.
Treatment Options for Ovarian Cancer at Tufts Medical Center
Treatment usually includes a combination of surgery and chemotherapy. Some patients with very early disease, Stage IA and IB, may be managed with surgery alone, but for most other patients chemotherapy is recommended after surgery. Patients with advanced ovarian cancer generally receive six cycles of chemotherapy. The most common agents used are carboplatin and paclitaxel. This chemotherapy is usually given every three weeks, starting 2-6 weeks after surgery. Additional treatments, such as intraperitoneal chemotherapy, are an option for patients with Stage III disease after optimal debulking surgery. Intraperitoneal chemotherapy has the advantage of providing higher doses of the drugs directly into the abdominal cavity, where there is the highest risk of recurrence.
Once treatment is completed, the gynecologic oncologist will continue to monitor the patient. Even when a complete response is achieved, there is still the possibility of recurrence, especially for patients with higher stage disease. Treatment after recurrence usually includes chemotherapy, either with the same agents as before or different agents. In some cases, additional surgery may be recommended. For each patient, the gynecologic oncologist will offer the best treatment options that are available.
Clinical Trials Available for Patients
Our patients have access to novel therapies through participation in both Tufts Medical Center clinical trials and national clinical trials.
More information about Tufts Medical Center’s Gynecology Oncology Program and our expert medical resources