Ovarian Cancer

Ovarian cancers are those affecting the ovaries, the two organs attached to the sides of the uterus that produce the eggs and hormones needed for reproduction.

The most common type of ovarian cancer, approximately70-80%, involves the surface covering of the ovary, with the less common types arising from the structural or hormone producing components.

Risk factors for ovarian cancer include advancing age, family history, failure to bear children or a delay in doing so, infertility, early onset of menstrual cycles or late menopause and a history of endometrial or breast cancer.

Symptoms are very non-specific and include irregular menstrual cycles, frequent urination, constipation, pelvic pressure, bloating, nausea/vomiting, weight loss, decrease or loss of appetite and distention or swelling of the abdomen.

Your doctor can often times feel a mass in your abdomen or in your pelvis on examination and will order x-rays and lab tests to help make the diagnosis. He or she should then refer you to a gynecologic oncologist who will perform surgical staging, similar, although more extensive than that for endometrial cancer. In addition to completing the necessary staging, the additional goal of surgery is to remove as much of the cancer as possible. Studies have shown that removing all visible disease will significantly improve survival over leaving any visible disease behind. It is also very important to have your surgery performed by a gynecologic oncologist as studies have shown a decrease in survival when this type of surgery is performed by  those without specialty training.

In addition, staging should be performed when  an  ovary with cancer was removed by a surgeon who was not expecting to find a cancer, as a third of these patients are found to have a higher stage  than was presumed.

Equally important is to have your surgery performed prior to the administration of chemotherapy, with the exception of patients with cancer that has spread outside the abdomen or pelvis (within the liver, brain, lung, etc.) or in a patient who is too high a risk for surgery due to heart, lung or other severe medical conditions. In those cases, chemotherapy may be given first (neoadjuvant chemotherapy).

Disease limited to one or both ovaries is stage I, local spread to the pelvis is stage II, spread of disease to the abdomen is stage III and distant spread is stage IV.

Once the surgery is completed and the stage is known, intravenous chemotherapy is often given, most commonly in the form of a two drug combination, although single agent and oral regimens are sometimes used.

Radiation is rarely used for primary treatment and is most commonly used to treat some recurrences.

Chemotherapy should not be used as a substitute for surgical tumor removal in an otherwise healthy patient.