Ovarian Cancer

Clinical Description 

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
  • Bloating
  • 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:

Early stage:
  • 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)

Advanced stage:
  • 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.

Programs + Services

Gynecologic Oncology Program

Our expert physicians at the Gynecologic Oncology program are skilled in the latest minimally invasive approaches such as robotic-assisted surgery. Contact us to learn about treatment for ovarian cancer, malignancies of the uterus, cervix and more at Tufts Medical Center in downtown Boston.
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Doctors + Care Team

John O. Schorge, MD

John O. Schorge, MD

Accepting New Patients

Title(s): Chief, Division of Gynecologic Oncology; Gynecologic Oncologist
Department(s): Obstetrics and Gynecology, Gynecologic Oncology
Appt. Phone: 617-636-6058
Fax #: 617-636-3258

Ovarian cancer, endometrial cancer, minimally invasive gynecologic surgery

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Young Bae Kim, MD

Young Bae Kim, MD

Accepting New Patients

Title(s): Gynecologic Oncologist; Associate Professor, Tufts University School of Medicine
Department(s): Obstetrics and Gynecology, Gynecologic Oncology
Appt. Phone: 617-636-6058
Fax #: 617-636-3258

Ovarian cancer, cervical cancer, uterine cancer, other gynecologic cancers, complex gynecologic surgery, robotic-assisted minimally invasive surgery

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Research + Clinical Trials

Phase 1/2 Clinical Study of Niraparib in Combination with Pembrolizumab in Patients with Advanced or Metastatic Triple-Negative Breast Cancer and in Patients with Recurrent Ovarian Cancer

The purpose of this study is to test the effectiveness of the combination of niraparib and pembrolizumab in patients with triple negative breast cancer or ovarian cancer.
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A Phase III, Multicenter, Randomized, Study of Atezolizumab versus Placebo Administered in Combination with Paclitaxel, Carboplatin, and Bevacizumab to patients with Newly Diagnosed Stage III or Stage IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

In this study, subjects will also receive treatment with paclitaxel, carboplatin, and bevacizumab. These chemotherapy based treatments are standard for patients with ovarian, fallopian tube, or primary peritoneal cancer. In addition to these standard treatments, subjects will receive either atezolizumab or a placebo (in other words, an inactive substance that looks like atezolizumab).
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