Ovarian Cancer

Each year more than 22,000 women in the United States learn that they have ovarian cancer. In the female body, two ovaries are located on the left and right sides of the uterus in the pelvic region. Ovaries produce hormones and hold egg cells, which when fertilized, can develop into a fetus (new baby). When cancer cells are found in the lining of the ovary, the condition is called epithelial ovarian cancer. When malignant cells or tumors are found in the egg-producing cells, the condition is called germ cell ovarian cancer.

Genetic screening can help determine if a woman is a carrier of a mutated (changed) gene and, therefore, at greater risk for developing the disease. The GenRISKŽ Adult Genetics Program at Cedars-Sinai can assess a woman's risk of developing ovarian cancer.

The Division of Gynecologic Oncology of the Department of Obstetrics and Gynecology at Cedars-Sinai specializes in the treatment of ovarian cancer. The Gilda Radner Cancer Detection Program at Cedars-Sinai, a component of the Women's Cancer Research Institute, is a research program that follows women who are at high risk for ovarian cancer. Founded in 1991, the Gilda Radner Cancer Detection Program results have helped to shape the current National Institutes of Health recommendations for ovarian cancer screening.

Risk Factors

Family history of the disease, especially in a mother, daughter or sister
Family history of breast or colon cancer
Women who have had breast or colon cancer
Women over age 50
Women who have never borne children
Women who have taken certain fertility drugs

Signs and Symptoms

Often no symptoms are evident in the early stages of the disease, but symptoms may include:

Gastrointestinal complaints, such as gas, nausea and indigestion, that do not go away
Frequent urination
Unexplained change in bowel habits
Abnormal postmenopausal bleeding
Weight gain or loss
Pain during intercourse
Abdominal swelling and/or pain, bloating or a feeling of fullness (Ovarian cancer may spread to the sac inside the abdomen that holds the intestines, uterus and ovaries, causing fluid to accumulate and the abdomen to swell.)
Shortness of breath caused by the spread of the disease to the muscle under the lung. (Fluid build-up in the area makes it difficult for the patient to breathe.)

If symptoms continue for longer than four to six weeks, patients should insist on a thorough pelvic examination by their doctor.

Diagnosis

A comprehensive medical history and physical exam, including a pelvic examination, are performed. The doctor inserts one gloved finger in the rectum and one in the vagina at the same time, and the vagina, rectum and lower abdomen are probed for masses and growths. Taking a mild laxative or enema before the pelvic exam can be helpful. A Pap smear (a common test for cancer of the cervix) is often part of the pelvic exam, although it does not offer a reliable way to diagnose ovarian cancer. Every woman should undergo regular rectal and vaginal pelvic examinations.
Transvaginal sonography and tumor markers are alternative ways of diagnosing ovarian cancer. The most common tumor marker is a blood test called the CA-125.
Ultrasonography aims high frequency sound waves at the ovaries. The echo pattern produced creates a picture called a sonogram. Healthy tissues, fluid-filled cysts and tumors produce different echoes.
CT or CAT scans, a series of computerized X-rays, allow doctors to see cancer cells.
A lower GI series, or barium enema, is a series of X-rays of the colon and rectum. Pictures are taken after the patient is given an enema with a white chalky solution containing barium. The barium outlines the colon and the rectum on the X-ray, which helps the doctor see tumors or other abnormal areas.
An intravenous pyelogram (IVP) is an X-ray of the kidneys and uterus taken when dye is injected into the body.
Blood tests measure a substance in the blood called CA-125. Ovarian cancer cells can produce this tumor marker. CA-125 is not always present in women with ovarian cancer, although it may be present in women who have benign ovarian conditions. This blood test cannot be used alone to diagnose cancer.
A biopsy, removing and examining tissue from the ovaries, is the only way to know if cancer is present. To get a sample tissue, the surgeon does a laparotomy. If cancer is suspected, the surgeon removes the entire ovary (oophorectomy). This is important because if cancer is present, infected cells could escape and spread when cutting through the outer layer of the ovary. During surgery, the surgeon also removes nearby lymph nodes, samples of tissue from the diaphragm and other organs and fluid from the abdomen. A pathologist examines these cells to identify cancer. This process, called surgical staging, is needed to find out whether the cancer has spread and to determine a course of treatment.

Treatment

Treating ovarian cancer depends on a number of factors, including the stage of the disease and the woman's age and general health. Oncologists who specialize in this disease can best determine the treatment plan. Because treatment decisions are complex, more than one doctor's advice can be helpful.
When talking about choices, the patient may want to ask about taking part in a research study or clinical trial. These scientific studies are designed to find new and better ways to treat cancer. Ovarian cancer treatment options include:

Removing the uterus, both ovaries and the fallopian tubes is usually the first treatment given to women with ovarian cancer. If the cancer has spread, the surgeon removes as much of the cancer as possible (tumor debulking). Tumor debulking reduces the amount of cancer to be treated later with chemotherapy or radiation therapy.
Chemotherapy (anti-cancer drugs) may be injected into a vein or taken orally so that they can travel through the bloodstream and destroy cancer cells. Chemotherapy is usually given in cycles, one treatment after another, each followed by a recovery period. Treatments may be given in the hospital on an outpatient basis, at the doctor's office or at the patient's home. Depending on the drugs given, the method of delivery and the woman's general health, a patient may need to stay in the hospital while receiving chemotherapy. Doctors are studying intra-peritoneal chemotherapy, a new way to treat the disease, in which anti-cancer drugs are put into the abdomen through a catheter so that they can reach the cancer directly. This treatment is given in the hospital.
Radiation therapy (also called radiotherapy) uses high-energy X-rays to damage cancer cells and stop their spread. Radiation therapy effects cancer cells only in the treated area. External radiation comes from a special X-ray machine. For external radiation therapy, the patient goes to the hospital or clinic each weekday for about five weeks. For internal radiation, radioactive material is placed into or near the tumor. Some women receive a type of internal radiation called intra-peritoneal irradiation, in which radioactive liquid is put into the abdomen through a catheter. A short hospital stay may be necessary for this treatment.

Some forms of ovarian cancer run in families. A genetic risk assessment done through Cedars-Sinai's GenRISK Adult Genetics Program can help establish whether a woman is at higher than normal risk for getting ovarian cancer.