Share on facebook Share on Twitter Share on Google Plus Share This

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.

Doctors + Care Team

Rachel Soffer, RN, MSN, ANP-BC

Rachel Soffer, RN, MSN, ANP-BC

Title(s): Nurse Practitioner
Department(s): Obstetrics and Gynecology, Gynecologic Oncology
Appt. Phone: 617-636-6058
Fax #: 617-636-3258

Gynecologic oncology, women's health

More Info

Young Bae Kim, MD

Young Bae Kim, MD

Title(s): Chief, Division of Gynecologic Oncology; 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

More Info

Research + Clinical Trials

A Phase III study comparing single-agent olaparib or the combination of cediranib and olaparib to standard platinum-based chemotherapy in women with recurrent platinum-sensitive ovarian, fallopian tube, or primary peritoneal cancer

The purpose of this study is to compare the effect on ovarian cancer of using either olaparib by itself or the combination of cediranib and olaparib to the usual chemotherapy given for ovarian cancer.
More information about research and clinical trials

Can diet and physical activity modulate ovarian, fallopian tube and primary peritoneal cancer progression-free survival?

The purpose of this study is to find out if a change in diet and exercise in women with ovarian, fallopian tube, or primary peritoneal cancer has an effect on the length of time someone is cancer free following initial treatment. Some studies suggest diet and exercise may improve survival for cancer patients, but no studies have been done to show if changes in diet and exercise can have an effect on cancer returning in women treated for ovarian, fallopian tube, or primary peritoneal cancer. Other goals include finding out if the changes in diet and exercise will improve your overall quality of life and your ability to be physically active. In addition, you may be asked if researchers can test some of your blood to measure carotenoid levels, which will tell them about the kind of foods you are eating, and examine your genes (DNA).
More information about research and clinical trials

A Randomized, Double-blind, Placebo-Controlled, Phase 2 Study to Assess the Efficacy and Safety of Farletuzumab (MORAb-003) in Combination with Carboplatin plus Paclitaxel or Carboplatin plus Pegylated Liposomal Doxorubicin (PLD) in Subjects with Low CA125 Platinum-Sensitive Ovarian Cancer

This research is being done to find out if carboplatin plus paclitaxel or carboplatin plus Pegylated Liposomal Doxorubicin (PLD), chemotherapies (anticancer drugs) that are used to treat ovarian cancer, work better alone or when given with an investigational drug called farletuzumab.
More information about research and clinical trials

Tufts Medical Center and Floating Hospital for Children have high quality care.

Quality + Safety

A world-class teaching hospital shouldn’t make you feel small.  At Tufts Medical Center the patient is at the center of everything that we do.  This means we’re committed to providing the highest quality of care in a safe, friendly environment.

Learn more
The City of Boston.

200 Years of Caring for the Community

Tufts Medical Center has been taking care of Boston and the surrounding community for more than 200 years.

Read about our enduring history