UofL Health – Brown Cancer Center is dedicated to the best diagnosis and treatment of ovarian cancer. Our Multidisciplinary Gynecologic Oncology Team delivers the most advanced ovarian cancer therapies tailored to you with a team of gynecologic oncologists, radiation oncologists, surgical oncologists, colorectal surgeons, pathologists and radiologists.
We are dedicated to providing you with cutting-edge treatment. Your treatment will be personalized, and involve cutting-edge technologies, techniques, surgical procedures, chemotherapy and targeted treatments. We also offer treatment for benign tumors of the ovaries.
Approximately 22,000 women are diagnosed with ovarian cancer in the United States each year. Ovarian cancer is the ninth most common cancer in women in the United States, but it is the fifth leading cause of cancer-related death. The average age of women with ovarian cancer is 60 years old.
The ovaries are organs in women that produce and release eggs (ova) with each menstrual cycle. The eggs travel through the fallopian tube to the uterus. The eggs may be fertilized by sperm and develop into a fetus. Ovaries also make hormones such as estrogen and progesterone.
Ovarian cancer may start in the ovaries or it may spread from the fallopian tube to the ovary. Sometimes cancer that acts very similar to ovarian cancer starts in the cells that line the abdomen, called the peritoneum. This is called primary peritoneal cancer. Ovarian, fallopian tube, and primary peritoneal cancer behave similarly. They are treated similarly.
Types of ovarian cancer
Some tumors of the ovaries are not cancer, benign. Some tumors of the ovaries are malignant, or cancer. Some tumors are in between benign and malignant tumors and are called borderline tumors. These may develop into cancer if not treated.
There are many types of ovarian cancer. The type of ovarian cancer depends on what cells in the ovary lead to cancer. These include:
Epithelial ovarian cancer: More than 90 percent of all ovarian cancers are epithelial ovarian cancers. These start in the cells that line the outside of the ovary or from the fallopian tube. This type includes serous, mucinous, endometrioid, clear cell, transitional cell and undifferentiated types.
Germ cell tumors: Only 5 percent of ovarian cancers are this type. They begin in cells that produce eggs. These are more common in women under 30 years old. These include malignant teratomas, dysgerminomas, endodermal sinus tumors and choriocarcinoma.
Sex cord stromal tumors: Only 5 percent of ovarian cancer are of this type. They begin in the cells that produce hormones in the ovaries. They are more common in older women. These include granulosa cell tumors, Sertoli-Leydig cell tumors and theca cell tumors.
Not everyone with risk factors will get ovarian cancer. Risk factors include:
- Age: The risk of ovarian cancer increases with age
- Family history of ovarian cancer
- Genetic syndrome that increases risk of ovarian cancer
- Never having children
- Early menses
- Late menopause
The symptoms of ovarian cancer are vague. Symptoms may vary from woman to woman, but often include:
- General abdominal pain or discomfort (indigestion, pressure, swelling, bloating or cramps)
- Bloating and/or feeling of fullness after a light meal
- Nausea, diarrhea, constipation or frequent urination
- Unexplained weight loss or gain
- Loss of appetite
- Abnormal vaginal bleeding
- Unusual fatigue
- Back pain
- Pain with sex
- Menstrual changes
These symptoms do not always mean you have ovarian cancer. Discuss these with your health care provider if any of these symptoms are new, last for more than a few weeks or occur more than 12 times a month.
Diagnosis of ovarian cancer is made with a physical exam, laboratory testing, imaging and sometimes surgery. If cancer is diagnosed early, treatment may be more successful. The following tests may be used to diagnose ovarian cancer.
Pelvic exam: A pelvic exam helps to feel if a mass is present on the uterus or ovary.
CA 125 blood test: This is a test for a protein that can be made by cancer cells. It is called a tumor marker. This may be used to follow your cancer over time and to determine if treatment is working. It is often elevated prior to treatment. However, it cannot diagnose ovarian cancer alone. Other conditions can cause CA 125 to be high.
Biopsy: This may be done with surgery, laparoscopy (surgery with small incisions) or with image-guided biopsies.
Imaging studies: This may be used to help with the diagnosis and determine if cancer has spread. The following imaging studies may be used:
- CT or CAT (computed axial tomography) scan
- MRI (magnetic resonance imaging)
- PET (positron emission tomography)
- Chest X-rays
- Transvaginal ultrasound
Treatment of ovarian cancer involves surgery, chemotherapy, hormone therapy, targeted therapy and radiation therapy. Treatment depends on your type of cancer and the stage of cancer. Our team communicates and collaborates to offer you the best treatment possible.
Surgery is one of the main treatments for ovarian cancer. Surgery may be done first to diagnose cancer, remove a mass or perform a debulking surgery where all visible cancer is removed. Cancer staging may be done to determine if cancer has spread. Surgery often involves removal of the uterus and cervix (hysterectomy), removal of ovaries and fallopian tubes (salpingo-oophorectomy), removal of the omentum (fatty tissue in the abdomen), and any other visible tumors. Surgery may involve the removal of portions of the intestines, the spleen, lymph nodes or liver. Some patients require an ostomy after surgery. Sometimes surgery is done after chemotherapy if cancer has spread to many organs or the patient is not healthy to go through surgery. Surgery can be tailored to women who still want to have children.
Most women will require chemotherapy after surgery to destroy any remaining cancer cells in the body. Some women will require chemotherapy before surgery to shrink cancer so it may be removed safely. Chemotherapy can be given in several ways. These include:
Intravenous chemotherapy: Chemotherapy is given through the veins. Chemotherapy may be given weekly or every few weeks.
Intraperitoneal chemotherapy: Chemotherapy is delivered through a small catheter directly into the abdomen. This may be done after all visible cancer is removed.
Oral chemotherapy: Some chemotherapy and targeted cancer treatments are available in pill form. You and your doctor will determine if this is right for you.
Radiation therapy may be used to treat any cancer left in the pelvis or when cancer returns. The goals of this treatment are to control the growth and spread of cancer.
Genetic testing and counseling in ovarian cancer
About 10 to 15 percent of ovarian cancers are passed from one generation to the next. Certain genetic mutations increase your risk of ovarian cancer. Patients with high-grade ovarian cancer will be offered genetic counseling and testing. Genetic mutations that make patients high risk for ovarian cancer include:
- BRCA 1 and BRCA 2 genes
- Hereditary breast and ovarian cancer syndrome
- Lynch Syndrome, or Hereditary non-polyposis colorectal cancer (HNPCC)
- BRIP1, RAP51C, or RAD51D genes
Women with these mutations may be offered screening for ovarian cancer with exams, ultrasounds and testing CA 125.
If you have a family history of breast cancer, colon cancer, ovarian cancer, pancreatic cancer or prostate cancer discuss your risk with your doctor.