About Ovarian Cancer

Since there is NO DIAGNOSTIC TEST, all women need to know the facts about Ovarian Cancer and be educated as to the symptoms. When Ovarian Cancer is diagnosed at its early stages it is most often treated successfully. Please take the time to educate yourself and share the information with others. Please continue to information about Ovarian Cancer detection, symptoms, preliminary testing, medical care and stages.

Ovarian Cancer Symptoms

In June 2007, the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists, and the American Cancer Society, with significant support from the Ovarian Cancer National Alliance, formed a consensus statement on ovarian cancer, agreeing that the disease has specific symptoms.

These symptoms include:

  • Bloating
  • Pelvic or abdominal pain
  • Difficulty eating or feeling full quickly
  • Urinary symptoms (urgency or frequency)

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.

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. Consult a gynecologist if any symptoms persist or feel abnormal. Keep a diary of your symptoms, and the frequency at which they occur and take it with you when you see your specialist. (See Symptom Diary)

  • A women with persistent symptoms should undergo:
  • Vaginal -rectal pelvic exam
  • Transvaginal ultrasound
  • CA 125 blood test.

If abnormal findings, consider a consultation with a gynecologic oncologist.

Prior to any Surgery, ask to be referred to a Gynecologic Oncologist, a specialist in cancer of the reproductive tract.

What is a Gynecologic Oncologist?

A gynecologic oncologist is a physician, who after completing a four-year residency in obstetrics and gynecology completes an additional three-year fellowship in precancerous and cancerous conditions of the reproductive tract. They learn the specifics of radiation and chemotherapy, plus the surgical skills required to stage and remove the majority of cancer tissue.

According to numerous studies published world-wide, seeing a gynecologic oncologist is a top factor in increasing survival rates and decreasing recurrence.

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

Staging Ovarian Cancer

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)

Screening and Early Detection

Early detection of ovarian cancer saves women’s lives. No screening test exists that can test all women for ovarian cancer. The Pap test does not test for ovarian cancer; it screens for cervical cancer.

Not only do researchers need to develop an early detection test for ovarian cancer, like mammograms for breast cancer and Pap tests for cervical cancer, but also women and medical professionals need to become more aware of ovarian cancer symptoms.

While no early detection tool exists for all women, several tests exist for women who are at a high risk. If a woman has ovarian cancer symptoms, a strong family history, or a genetic predisposition such as a BRCA mutation, doctors may monitor her with one of three tests or a combination of them:

Blood Test

  • The protein CA-125 exists in greater concentration in cancerous cells. Though a high count of this protein may help doctors identify ovarian cancer, premenopausal women may have an elevated CA-125 due to benign conditions unrelated to ovarian cancer. Uterine fibroids, liver disease, inflammation of the fallopian tubes, and other types of cancer can raise a woman’s CA-125 level, often causing a false positive test for ovarian cancer.
  • Although the CA-125 blood test is more accurate in postmenopausal women, it is not a reliable early detection test for ovarian cancer. In about 20 percent of advanced stage ovarian cancer cases and 50 percent of early stage cases, the CA-125 is not elevated even though ovarian cancer is present. As a result, doctors generally use the CA-125 blood test in combination with a transvaginal ultrasound.
  • The CA-125 blood test can be an important tool for evaluating the disease’s progress and tumors’ response to treatment. Additionally, this test can monitor a woman’s CA-125 level for evidence of recurrence.
  • OVA1 has also been approved by the Food and Drug Administration (FDA).

Transvaginal Ultrasound

  • A transvaginal ultrasound is a test used to examine a woman’s reproductive organs and bladder.
  • To administer the test, the doctor inserts a probe into the woman’s vagina. The probe sends off sound waves which reflect off body structures. The waves are then received by a computer that turns them into a picture.

Pelvic Exam

  • A pelvic exam should be a part of a woman’s regular female health exam.
  • This exam requires the doctor to place one or two fingers into a woman’s vagina and another over her abdomen to feel the size, shape, and position of the ovaries and uterus. Ovarian cancer is rarely detected in a pelvic exam and usually in an advanced stage if it is.