Diagnosis and Treatment of Ovarian Cancer

If the disease is detected in its early stages, a woman with ovarian cancer has a nearly 90% chance of surviving for 5 years. But fewer than 25% of ovarian cancers are detected in the early stages. The symptoms, which include abdominal swelling, chronic stomach pain and bloating or gas, unusual vaginal bleeding, pain or pressure in the pelvis, and leg pain are vague and may imitate many other less serious conditions.

Regular pelvic examinations are extremely important in the detection of ovarian cancer. The American Cancer Society recommends a pelvic exam every 1-3 years if you are between 18 and 40 years old, and an annual pelvic exam and gynecological check-up when you are over 40.

If symptoms suggestive of ovarian cancer are observed by the physician, a number of tests may be conducted to further investigate. These include ultrasound, CT scans, MRI, a GI-series or barium enema to examine the colon and rectum for abnormal growths, and a special x-ray of the kidneys and ureters called an intravenous pyelogram.

So far there is no single test that can detect 100% of early stage ovarian cancers. Some newer diagnostic indicators are being studied. The usefulness of blood levels of markers like CA 125, LPA (lysophosphatidic acid), and an epidermal growth factor receptor called sErbB1, are under study. Transvaginal ultrasound has been shown to be effective as a screening test for early stages of ovarian cancer, but it is not yet routinely used for this purpose.

Biopsy and Staging

The only sure way to know if cancer is present is for a pathologist to examine a sample of tissue under the microscope. Removing tissue from the body for this examination is called a biopsy. To obtain the tissue, the surgeon does an operation called a laparotomy. A doctor must cut into the abdomen and carefully look at all the organs to see if they contain cancer. Usually the doctor will remove the cancer and other organs that contain cancer during the laparotomy. The surgeon may also remove nearby lymph nodes, and take samples of tissue from the diaphragm and other organs in the abdomen. Fluid is also collected from the abdomen. All of these samples are examined by a pathologist to check for cancer cells. This process, called surgical staging, is needed to find out whether the cancer has spread. The doctor needs to know the stage of the disease to plan further treatment.

Cancers are designated at a certain stage indicating how far they have spread. Stage I cancer is only in one or both of the ovaries. Stage II cancer in is one or both ovaries and has spread to the uterus or other organs in the pelvis. Stage III cancer is found in the ovaries and has spread to other body parts in the abdomen or to the lymph system at the time of detection. Stage IV cancers have spread to more distant organs like the liver.

The five-year survival rates are highest women whose cancer is discovered and treated at Stage I. Current information from the American Cancer Society indicates that 80-90% of women in this category will live for 5 years or longer after their diagnosis. At stage II the survival rates decline to between 75 and 40% depending on the specific case. For stages III and IV patients the five-year survival rates are 15-20% and 5% or less.

Treatment of Ovarian Cancer

Treatment depends on the type of ovarian cancer (endothelial is the most common), the stage of the disease, and the woman's age and overall condition, but surgery is the primary therapy for ovarian cancer. Surgical intervention allows for the precise staging and accurate diagnosis of the cancer, and removal of as much of the cancer as possible.

How much surgery and what type of operation depends on the stage of the cancer and the general health status of the patient. Typically surgery will involve removal of the uterus (hysterectomy) and of the ovaries and fallopian tubes (called salpingo-oophorectomy), but in women of childbearing age with early stage cancer the effort is made to treat the cancer without removing both ovaries and the uterus.

Depending upon the pathologist's findings of what specific kinds of cells are involved in the tumor and how malignant the tumor appears to be (how likely it is to spread), additional treatment with radiation and /or chemotherapy will be planned after surgery.

Radiation therapy uses high energy x-rays to kill cancer cells and shrink tumors. The x-rays may be administered externally, in much the same way as a diagnostic x-ray, or as an implant of radioactive materials or fluid placed near the tumor or in the abdominal cavity. Radiation is rarely used as the primary treatment for ovarian cancer.

Chemotherapy uses anticancer drugs (often a combination of two or more drugs) to kill cancer cells. Chemotherapy may be administered intravenously or as pills. Because the drugs enter the blood stream and reach all parts of the body, chemotherapy is useful for cancers that have spread from the ovaries to other parts of the body. Chemotherapy is usually scheduled in cycles of 4 to 6 weeks: doses of the drug are given and then there is a rest period.

After surgery and during chemotherapy, the patient is monitored to see whether the level of the tumor-marker CA 125 returns to normal. Imaging studies like CT scans or sonograms are used to track tumor shrinkage. Persistent or recurrent tumors may be treated with additional surgery and chemotherapy. Chances for success in treating these are best when there has been a significant interval of disease free years between the first and subsequent cancers.

Information provided by: National Cancer Institute, American Cancer Society, and National Women's Health Information Center

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.