What Every Woman Needs to Know about Ovarian Cancer
*All information obtained from the Ovarian Cancer National Alliance*

Ovarian Cancer Facts

Ovarian cancer is the deadliest of the gynecologic cancers and is the fifth leading cause of cancer death among U.S. women. 

      -Ovarian cancer occurs in 1 out of 67 women.

      -More than 21,600 women in the United States. are diagnosed with the disease each year.

      -Over 15,500 women in the United States die from ovarian cancer each year.

      -Currently, 55 percent of the women diagnosed with ovarian cancer die from it within five years;    

      -Among African American women, only 40 percent survive five years or more.

      -Ovarian Cancer strikes women of ALL AGES.      

Ovarian Cancer Can be Treated if Detected Early

       -The vast majority of cases are not diagnosed until the cancer has spread beyond the ovaries.

       -In cases where ovarian cancer detection ha than five years.

       -Yet early stage diagnosis occurs in only 20 percent of ovarian cancer cases in the U.S.

       -When diagnosed in the advanced stages, the chance of five-year survival drops to about 30 percent.

       -Ovarian cancer is difficult to diagnose because symptoms are easily confused with other diseases
        and there is no reliable, easy-to-administer screening tool that can be administered to all women.

Symptoms

Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:
 

       Bloating

       Pelvic or abdominal pain

       Difficulty eating or feeling full quickly

       Urinary symptoms (urgency or frequency)

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms.

Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

Several other symptoms have been commonly reported by women with ovarian cancer. These symptoms include fatigue, indigestion, back pain, pain with intercourse, constipation and menstrual irregularities. However, these other symptoms are not as useful in identifying ovarian cancer because they are also found in equal frequency in women in the general population who do not have ovarian cancer.

Consult a health care professional if any symptoms persist or feel abnormal.

Experts recommend a complete pelvic/rectal exam, a transvaginal ultrasound, and a CA 125 blood test. Pap tests do not detect ovarian cancer.

According to numerous studies published world-wide, seeing a gynecologic oncologist is a top factor in increasing survival rates and decreasing recurrence.  We encourage all women who are newly diagnosed to do whatever it takes to get to a specialist. 

In Brevard County we are lucky to have a gynecologic oncologist, Dr. John Bomalaski.   In other areas you may consult Find a Doctor www.wcn.org

Diagnosis & Staging

Diagnostic Tools

Several diagnostic tests exist that can be used to detect ovarian cancer. The three most common tools are:

            Vaginal-rectal pelvic exam

           Transvaginal ultrasound

           CA-125 blood test

Because of the margin of error associated with each of the tests, they are most effective when used in combination with each other.

Other diagnostic tools include:

             Transvaginal color flow doppler

             CT (or CAT) Scan

             Lower GI series or barium enema (occasionally)

Surgical Biopsy

The only way to confirm a diagnosis of ovarian cancer suggested by the above tests is through examining a sample of the tumor tissue under a microscope. Several surgical techniques can be used to obtain a sample tissue. The procedure used will depend on many factors and will ultimately be decided by the surgeon.
 

Ovarian cancer is staged at surgery. Staging is based on classifications devised by FIGO (International Federation of Gynecology and Obstetrics - http://www.figo.org
 

Stage I

Cancer is limited to one or both ovaries.

IA - Cancer is limited to one ovary and the tumor is confined to the inside of the ovary. (No cancer exists on the outer surface of the ovary.) There is no ascites present containing malignant cells. The surface of the tumor is unruptured.

IB - Cancer is limited to both ovaries without any tumor on their outer surfaces. There is no ascites present containing malignant cells. The surface of the tumor is unruptured.

IC - The tumor is classified as either Stage 1A or 1B and one or more of the following conditions exist: (1) tumor is present on the outer surface of one or both ovaries; (2) at least one of the tumors has ruptured; and (3) there is ascites present or abdominal (peritoneal) washings containing malignant cells.

Stage II

The tumor involves one or both ovaries with extension to other pelvic structures.

IIA - The cancer has extended to and/or involves the uterus or the fallopian tubes or both.

IIB - The cancer has extended to the bladder or rectum.

IIC - The tumor is classified as either Stage IIA or IIB and one or more of the following are present: (1) tumor is present on the outer surface of one or both ovaries; (2) at least one of the tumors has ruptured; and (3) there is ascites containing malignant cells or with abdominal (peritoneal) washings containing malignant cells.

Stage III

The tumor involves one or both ovaries, and one or both of the following are present: (1) the cancer has spread beyond the pelvis to the lining of the abdomen; and (2) the cancer has spread to the lymph nodes. The tumor is limited to the true pelvis but with histologically-proven malignant extension to the small bowel or omentum.

IIIA - During the staging operation, the practitioner can see cancer involving one or both of the ovaries, but no cancer is grossly visible in the abdomen and it has not spread to the lymph nodes. However, biopsies checked under a microscope show tiny deposits of cancer in the abdominal (peritoneal) surfaces.

IIIB - The tumor is in one or both ovaries, and deposits of cancer are present in the abdomen that are large enough for the surgeon to see but not exceeding 2 cm in diameter. The cancer has not spread to the lymph nodes.

IIIC - The tumor can be seen in one or both ovaries, and one or both of the following is present: (1) the cancer has spread to lymph nodes; (2) the deposits of cancer exceed 2 cm in diameter and are found in the abdomen.

Stage IV

          Growth of the cancer involves one or both ovaries and distant metastases to the liver or lungs have
          occurred. Finding ovarian cancer cells in the excess fluid accumulated around the lungs (pleural fluid) also
          shows evidence of stage IV disease.

          The stage of ovarian cancer at diagnosis is also the most important indicator of prognosis (prediction of
          duration, course and outcome of the disease)