What is the treatment for ovarian cancer?

Treatment for ovarian cancer consists of surgery, chemotherapy, a combination of surgery with chemotherapy, and sometimes radiotherapy. The kind of treatment depends on many factors, including the type of ovarian cancer, its stage and grade, as well as the general health of the patient.
Some studies have indicated that specialized hospitals tend to have better survival rates for ovarian cancer patients, compared to general hospitals

Surgery

The surgical removal of the cancer is performed in the vast majority of ovarian cancer cases, and is often the first treatment the patient will undergo.

Unless the ovarian cancer is very low grade, the patient will require an extensive operation that includes the removal of both ovaries, the fallopian tubes, the uterus, nearby lymph nodes, and the omentum (a fold of fatty abdominal tissue). Cancer often spreads into the omentum. In most cases the operation will be carried out by a gynecologic oncologist surgeon - a specialist in surgery for women with cancer of the reproductive organs. This operation, sometimes referred to as a total hysterectomy, will mean that the woman will begin her menopause immediately. Recent research by Canadian scientists found that premature removal of the ovaries increases the risk of lung cancer.

If the cancer is confined to just one of the ovaries the surgeon may just remove the affected ovary and the adjoining fallopian tube. The woman will have a chance of being able to conceive. If both ovaries are removed it will not be possible to conceive.

Surgery for ovarian cancer will require a hospital stay of up to two weeks, plus a recovery period of at least six weeks when the patient gets back home.

Chemotherapy

Chemotherapy is the use of chemicals (medication) to treat any disease - more specifically in this text, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing. When health care professionals talk about chemotherapy today, they generally tend to refer more to cytotoxic medication than others. Chemotherapy for ovarian cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove.

Patients will typically receive a combination of carboplatin (Paraplatin) and paclitaxel (Taxol) intravenously (injected into the bloodstream). As it is injected into the bloodstream it can target cancer cells in the reproductive system, as well as any cancer cells that may have reached elsewhere in the body.

Treatment usually involves 6 to 12 chemotherapy sessions which will be given three to four weeks apart so that the body has time to recover. One session usually consists of a 3-hour gradual injection of the medicine into the body; sometimes it may be extended to 24 hours. Extended injections require an overnight stay in hospital.

Radiotherapy

Radiation is not the mainstay of ovarian cancer treatment - it is not generally considered effective for ovarian cancer. It may be used if there are small traces of cancer in the reproductive system, or to treat the symptoms of advanced cancer. External radiotherapy may be used to clear traces of cancer left after chemotherapy, while internal radiotherapy may be used for advanced cancer. Radiotherapy may cause the following symptoms; some symptoms may not appear until a long time after treatment is over:

The 4 stages of ovarian cancer

Ovarian cancer is classified into four stages, with stage 4 being the most advanced.

• Stage 1 - the cancer is confined to one or both ovaries. This is subdivided into three groups:
  
  
  • Stage 1a - the cancer is confined to just one ovary (contained inside it).
  • Stage 1b - the cancer is confined to both ovaries (contained inside them).
  • Stage 1c - either 1a or 1b, but there is come cancer on the surface of one or both ovaries, cancer cells are found in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.


• Stage 2 - the cancer has spread to the uterus, fallopian tubes or some other areas in the pelvis (tummy area). This is subdivided into 3 groups:
  
  
  • 2a - the cancer has spread into the uterus (womb) or the fallopian tubes.
  • 2b - the cancer has spread into other tissues in the pelvis, such as the rectum or bladder.
  • 2c - 2a and 2b, and there is cancer on the surface of one or both ovaries, or cancer cells are identified in fluid extracted from inside the abdomen during surgery, or the ovary bursts during or before surgery.


• Stage 3 - the cancer has spread into the peritoneum (the lining of the abdomen), or to the lymph nodes in the upper abdomen, groin or behind the uterus. Most ovarian cancers are diagnosed at this stage. This stage is divided into three subgroups:
  
  
  • 3a - an examination with a microscope of tissue taken from the peritoneum (lining of the abdomen) or the omentum (fatty layer over the top of the intestines) detects cancer cells.
  • 3b - tumor growths are identified in the peritoneum 2cm or smaller.
  • 3c - tumor growths larger than 2cm are identified in the peritoneum. Cancer is found in the lymph nodes in the groin, behind the womb or the upper abdomen.


• Stage 4 - the cancer has spread beyond the abdomen to other parts of the body, including such organs as the lungs or the liver. If cancer is just found on the surface of the liver, but not inside it, it is still stage 3.

Diagnosis of ovarian cancer

There is a tragic myth among many health care professionals and patients in too many countries about early stage ovarian cancer having no symptoms. A UK study, called The Target Ovarian Cancer Pathfinder study which surveyed 400 UK general practitioners and over 1,000 women, including 132 with ovarian cancer, found that 80% of GPs in the UK were wrongly of the view that women have no symptoms in the early stages of ovarian cancer. Studies in countries with top healthcare services have come up with similar findings.

The GP (general practitioner) will carry out a vaginal examination and check for any visible abnormalities in the uterus or ovaries. The doctor will also check the patient's medical history and family history. Further tests will be ordered - these are usually done by a gynecologist - a doctor who specializes in treating diseases of the female reproductive organs.

If the woman is diagnosed with ovarian cancer the doctor will want to identify its stage and grade. The stage of a cancer refers to the cancer's spread while the grade refers to how aggressively it is spreading. By identifying the stage and grade of the cancer the doctor will be able to decide on the best treatment. The stage and grade of ovarian cancer alone cannot predict how it is going to develop.

The following tests are used to diagnose ovarian cancer:

• Blood test
  There is a cancer marker called CA 125 (cancer antigen 125) which is made by certain cells in the body. A high blood level of CA 125 may indicate the presence of cancer, but could also be due to something else, such as infections of the lining of the abdomen and chest, menstruation, pregnancy, endometriosis, or liver disease. This blood test is just one test among others, designed to help the doctor make a diagnosis. Normal blood levels of CA125 alone do not definitely mean there is no cancer either. They are just indications.


• Ultrasound
  This is a device that uses high frequency sound waves which create an image on a monitor of the ovaries and their surroundings. A transvaginal ultrasound device may be inserted into the vagina, while an external device may be placed next to the stomach. Ultrasound scans help doctors see the size and texture of the ovaries, as well as any cysts.


• Laparoscopy and possibly Endoscopy
  A laparoscope - a thin viewing tube with a camera at the end - is inserted into the patient through a small incision in the lower abdomen. The doctor can examine the ovaries in detail, and can also take a biopsy (extract a small sample of tissue for examination). The patient will undergo a general anesthetic for this procedure. The doctor may carry out an endoscopy to determine whether the cancer has spread to the digestive system.


• Colonoscopy
  If the patient has had bleeding from the rectum, or constipation the doctor may order a colonoscopy to examine the large intestine (colon). The colonoscope - a thin tube with a camera at the end - will be inserted into the rectum.


• Laparoscopy and possibly Endoscopy
  If the patient's abdomen is swollen the doctor may decide to carry out this test. A build up of fluid in the abdomen might indicate that the ovarian cancer has spread. A thin needle goes through the skin into the abdomen and a sample of the liquid is extracted. Some of the liquid may be drained into a bag if there is a lot of it (abdominal tap). The fluid is checked in the laboratory for cancer cells.


• Chest X-ray
• This test will help the doctor see if the cancer has spread to the lungs, or to the pleural space surrounding the lungs.


• CT (computerized tomography) scan
  X-rays are used to create a 3-dimensional picture of the target area.


• MRI (magnetic resonance imaging) scan
  Magnets and radio waves produce 2-dimensional and 3-dimensional pictures of the target area.
  Combined positron emission tomography (PET) and computed tomography (CT) scanning of patients in the early stages of ovarian cancer can enable physicians to determine whether the cancer has spread to nearby lymph nodes without having to perform surgery, reported scientists at San Gerardo Hospital, Monza, Italy.

Three main types of ovarian cancers (tumors)

Epithelial ovarian cancer is by far the most common form of ovarian cancer. Germ cell and stromal ovarian cancers are much less common. Ovarian cancer can also result from a cancer somewhere else in the body that has spread:

• Epithelial ovarian cancer (epithelial ovarian tumors) - derived from cells on the surface of the ovary. It occurs mainly in adults.


• Germ cell ovarian cancer (germ cell ovarian tumors) - derived from the egg-producing cells within the body of the ovary. This rare type of cancer more commonly affects children and teenage girls.


• Stromal ovarian ovarian (sex cord stromal tumors) - develops within the cells that hold the ovaries together.


• Cancers from other organs in the body can spread to the ovaries - metastatic cancers - a metastatic cancer is one that spreads from where it first arose as a primary tumor to other locations in the body.

What Is Ovarian Cancer?

Ovarian cancer is any cancerous growth that may occur in different parts of the ovary. The majority of ovarian cancers arise from the epithelium (outer lining) of the ovary. According to the American Cancer Society it is the 8th most common cancer among women in the USA (excluding non-melanoma skin cancers). In the UK ovarian cancer is the fifth most common cancer among females, after breast cancer, bowel cancer, lung cancer and uterine cancer (cancer of the uterus).

Approximately 5,500 women in the UK and 21,000 women in the USA are diagnosed with ovarian cancer each year. Worldwide, around 140,000 women die of ovarian cancer every year.

Tragically, the overall five year survival rate is only 46 per cent in most developed countries (it is lower for more advanced stages). However, according to the National Cancer Institute, if diagnosis is made early, before the tumor has spread, the five year survival rate is nearer 93 per cent. In 2009 scientists in the US said that current tests for diagnosing ovarian cancer are not good enough .
Even modern screening tests for ovarian cancer, which include a blood test for the CA 125 marker, combined with ultrasound, often result in unnecessary surgery and "..are failing to catch early signs of the disease..", a study at the University of Alabama at Birmingham Comprehensive Cancer Center revealed.