There are three types of ovarian cancer tumors. Malignant ovarian tumors can originate from the surface of the ovary, in the epithelium (these are the cells covering or lining the ovaries), in the germ cells (cells within the ovaries that are destined to become eggs), or sex cord-stromal cells (cells that secrete hormones and connect the different structures of the ovaries). The majority of ovarian cancers develop from cells in the lining of the ovary.
Ovarian cancer is a common malignancy in women in the United States, with about 21,550 new cases diagnosed each year, according to the National Cancer Institute. Ovaries make female hormones and store egg cells, which are released once a month during ovulation. Egg cells are delivered from the ovaries to the uterus by hollow organs called fallopian tubes. Ovarian cysts are common in women throughout the stages of life. Many of these ovarian tumors are benign (not cancerous). There are three types of ovarian cancer tumors. Malignant ovarian tumors can originate from the surface of the ovary, in the epithelium (these are the cells covering or lining the ovaries), in the germ cells (cells within the ovaries that are destined to become eggs), or sex cord-stromal cells (cells that secrete hormones and connect the different structures of the ovaries). The majority of ovarian cancers develop from cells in the lining of the ovary. These are referred to collectively as epithelial ovarian cancers. In this treatment overview, the term ovarian cancer refers to epithelial ovarian cancer.
COMMON EPITHELIAL TUMORS:
Common epithelial cancers that start in the surface epithelium account for the majority of ovarian cancers and include the following types:
- Serous: This is the most common type of ovarian cancer and accounts for about 40 percent of common epithelial cancers. It occurs most often in women between the ages of 40 and 60.
- Endometrioid: This type of ovarian cancer accounts for about 20 percent of common epithelial cancers and is associated with endometriosis in 5 percent of cases and endometrial carcinoma (uterine cancer) in 20 percent of cases. It occurs most often in women between the ages of 50 and 70.
- Mucinous: Mucinous cancers account for six to 10 percent of common epithelial ovarian cancer and most often affect women between 30 and 50 years of age.
- Clear Cell Carcinoma: Clear cell carcinomas account for about five percent of common epithelial tumors and most often affect women between ages 40 and 80.
- Undifferentiated Cancers: The remaining 15 percent of common epithelial cancers are referred to as undifferentiated tumors, because their exact cell of origin cannot be determined under a microscope.
- Borderline Ovarian Tumors: These ovarian tumors of low malignant potential are a subgroup of common epithelial tumors that occur in 10 to 15 percent of cases. These tumors are between cancerous and non-cancerous in nature. They originate on the surface of the ovary, but do not invade deeper tissues of the ovary. They have a better prognosis (prediction about the possible outcome of a disease) and cure rate than invasive ovarian tumors.
Symptoms of ovarian cancer are often vague and are not specific to the disease, and may include:
- Abdominal pain
- Abdominal bloating
- Poor appetite
- Nausea and vomiting
- Increasing abdominal girth
- Abnormal bleeding
HOW IS OVARIAN CANCER DIAGNOSED?
Because epithelial ovarian cancers begin deep in the pelvis, they often do not cause any symptoms until they are at an advanced stage. Furthermore, many of the symptoms of ovarian cancer are hard to differentiate from symptoms experienced by women who do not have ovarian cancer, such as back pain, fatigue, abdominal bloating, constipation, vague abdominal pain, and urinary symptoms. Because the symptoms are vague, many women don’t know they have cancer until the disease is quite advanced. Ovarian cancer is often originally suspected in women when their physician finds an abnormal pelvic or abdominal growth. Unlike some other types of cancer, there is no routine screening protocol for ovarian cancer. This is because no tool has been shown to decrease the chances of dying from the disease.
WHAT ARE THE RISK FACTORS FOR DEVELOPING OVARIAN CANCER?
Women who have a family history of ovarian cancer are at an increased risk of developing ovarian cancer themselves. Women who have one first-degree relative (mother, daughter, or sister) with ovarian cancer are at an increased risk of developing ovarian cancer. This risk is higher in women who have one first-degree relative and one second-degree relative (grandmother or aunt) with ovarian cancer. This risk is even higher in women who have two or more first-degree relatives with ovarian cancer.
While ovarian cancer in the family does increase a woman’s risk of developing ovarian cancer, it is important to note that most women who are diagnosed with ovarian cancer do not have a relative who had the disease. Hereditary ovarian cancer makes up approximately five to 10 percent of all cases of ovarian cancer. There is also a hereditary link between ovarian cancer and certain other cancers. There are currently three hereditary patterns that have been identified: ovarian cancer alone, ovarian and breast cancers, and ovarian and colon cancers. There are tests that can detect the gene mutation involved with these known cancer links. These genetic tests are sometimes done for members of families with a high risk of cancer.
WOMEN WITH AN INCREASED RISK OF OVARIAN CANCER MAY CONSIDER SURGERY TO PREVENT IT.
Some women who have an increased risk of ovarian cancer may choose to have a prophylactic oophorectomy (the removal of healthy ovaries so that cancer cannot grow in them). In high-risk women, this procedure has been shown to greatly decrease the risk of developing ovarian cancer.
WHAT IS CA-125 AND WHAT DO MY RESULTS MEAN?
CA-125 is a protein that can be found in the blood, commonly in high levels in patients with certain types of cancer. Elevated levels of this protein have been associated with ovarian cancer. However, the presence of elevated levels of CA-125 in the blood does not always indicate the presence of ovarian cancer, because CA-125 levels can be elevated in a number of other conditions. The normal level of CA-125 is less than 35 units per milliliter in the blood. In general, the higher the level of CA-125 found, the greater the chance of having ovarian cancer, especially for women past menopause. However, not all patients with a high CA-125 level have ovarian cancer. Further diagnostic evaluation is required for women who receive an elevated CA-125 result. Once a diagnosis of ovarian cancer has been established, the level of CA-125 in the blood is a useful indicator of cancer growth during or after treatment.
As with other cancers, treatment for ovarian cancer depends on the stage. Cancer stage is determined surgically and is usually the initial step in treatment followed by chemotherapy and, in some cases, radiation.
WHAT IS THE STAGING SURGERY FOR OVARIAN CANCER?
Accurate surgical evaluation of ovarian cancer is necessary for nearly all patients and can only be accomplished during the surgical procedure to determine the stage of the cancer and to remove as much cancer as possible. Staging is the measurement of how much, if at all, the cancer has spread, and involves node dissection, or removal of the lymph nodes during the procedure. The removal of lymph nodes does not add time or additional complications to the surgical procedure. The uterus and both ovaries are removed during the procedure. In a young patient with early stage ovarian cancer, it is possible to preserve the uterus and the uninvolved ovary for fertility. In patients with early stage ovarian cancer, the staging can be performed laparoscopically, which allows for less pain and faster recovery.
WHY IS CHEMOTHERAPY NECESSARY?
Despite surgical removal of the tumor, many patients with ovarian cancer will already have microscopic cancer cells, called micrometastases, which have spread away from the ovary to other locations in the abdomen and distant parts of the body. These micrometastases often cannot be detected by currently available tests. Surgery is a local therapy and cannot treat micrometastatic cancer. Therefore, additional systemic treatment using chemotherapy is required to treat micrometastatic cancer. Information obtained during surgery and from other tests determines whether additional treatment with chemotherapy is necessary. Because many patients with ovarian cancer have advanced disease at diagnosis, the majority of patients will receive chemotherapy as part of the overall treatment plan.
Often, patients with ovarian cancer are initially treated with surgery aimed at debulking (decreasing the size of) the tumor. This type of surgery, in which the goal is to remove the greatest volume of cancer cells possible, is also called “cytoreductive” surgery. After completion of the surgery, most patients are placed on a chemotherapy regimen.
Over the past several years, there has been increasing interest in administering chemotherapy both before and after surgery. Chemotherapy given before surgery is referred to as neoadjuvant chemotherapy, and the surgery that follows is referred to as “interval” cytoreductive surgery. By administering chemotherapy first, micrometastatic cancer cells may be more easily destroyed and chemotherapy may reduce the amount of cancer, thereby allowing for more complete surgical removal of the cancer.
WHY CIGC FOR OVARIAN CANCER
For ovarian cancer patients, choosing a minimally invasive GYN specialist sets the tone for your overall treatment. When you are confident that your treatment and recovery are managed well, you can focus on healing. CIGC surgeons are focused solely on minimally invasive GYN surgery, using advanced surgical techniques that limit pain and complications. When choosing a treatment option, CIGC surgeons work with patients in choosing the least invasive procedure possible.
Know your options. Our surgeons assess ovarian cancer patients on a case-by-case basis to choose the best treatment options. There are many different types of treatment options, and the type of surgical procedure needed depends on the stage and grade of cancer. We will offer you peace of mind by helping you understand your condition and options. Ovarian cancer stage is determined surgically and is usually the initial step in treatment followed by chemotherapy and, in some cases, radiation.
Learn the benefits of laparoscopic procedures. Patients of laparoscopic procedures have a short hospital stay or none at all, minimal pain, and a fast recovery. Since recovery is so easy and fast, patients feel less sick afterward, which contributes greatly to an optimistic outlook. Feeling better physically and mentally makes the rest of the cancer treatment and recovery process more tolerable. At the end of treatment, patients get to walk away with minimal scarring.
CIGC surgeons do not perform open hysterectomies, including patients with ovarian cancer. Open surgeries are known to be painful, have a relatively high risk of complications, and have an extended recovery period. CIGC surgeons also do not perform robotic surgeries. Surgeries in which robotic technology performs the procedure is extremely expensive and has a high risk of complications. At CIGC, we perform minimally invasive, advanced laparoscopic hysterectomies. This type of hysterectomy is far superior to open or robotic procedures. Laparoscopic surgery leaves you with minimal cosmetic scarring, has a recovery period of only a few days, and has a low risk of complications. Hear why our patients prefer our laparoscopic procedures.
CIGC surgeons are laparoscopic surgical specialists who have dedicated their careers to the performance of minimally invasive GYN surgery. Our commitment to surgery means that we have worked on a higher volume of cases, more difficult cases, and use advanced techniques and procedures learned in extensive training sessions. We strive to complete even the most complex surgeries with low complication rates.
Surgery is the only medicine practiced by our surgical specialists. We partner with OB/GYNs. The focus for OB/GYNs is obstetrics. At CIGC the sole focus of our practice is surgery. Increased surgical volume is important to develop and maintain surgical expertise.
We know that our customers are picky when choosing their surgeons, and we think doing extensive research is important. When you are exploring ovarian cancer treatment options, get to know our surgical specialists and see why they are the best in the industry.
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